Cash stuck in AR
Slow payer follow-up and denial write-offs quietly finance your operations. Every 5 days of AR on $5M in collections is ~$68k in trapped cash.
For independent physician practices · 3–50 providers
Your practice is excellent medicine. It should be excellent business, too.
A fractional CFO who speaks both languages — clinical operations and finance. Get the forecasting, compensation modeling, and cash-flow discipline of a full-time CFO, sized and priced for a private practice.
No full-time hireSenior finance leadership
without $250K+ salary + benefits
without $250K+ salary + benefits
Practice-specificRVUs, payer mix, buy-ins
& physician comp — not generic SMB advice
& physician comp — not generic SMB advice
Month-to-monthStart with a diagnostic.
No long-term lock-in.
No long-term lock-in.
This month in a typical practice13-week cash view
Payroll, distributions & tax estimates — known before they’re due.
Days in AR48 → 39
Illustrative improvement
Built for
Multi-specialty groups: Service-line P&Ls, shared overhead allocation that partners actually trust, and comp formulas that don’t pit specialties against each other.
Why practices call
The reports say you’re profitable. The bank account disagrees.
Most practices don’t have a revenue problem — they have a visibility problem. By the time the CPA’s monthly close arrives, the decisions that caused the cash crunch are already 45 days old.
Comp that creates conflict
A legacy equal-split or pure-production formula that no longer fits a mixed group — APPs, part-time partners, new service lines — and drives your best producers to look elsewhere.
Distributions by gut feel
Quarterly distributions, tax estimates, and bonus decisions made without a rolling forecast — until a lean month forces a capital call.
Growth without a pro forma
New location, ASC, ancillary, or a PE/MSO offer evaluated on enthusiasm instead of contribution margin, ramp, and downside cases.
What a fractional CFO actually does here
Not bookkeeping. Not tax prep. The finance function your practice never built.
Your CPA looks backward at tax time. Your office manager keeps the lights on. This role looks forward — and connects clinical volume to dollars, weeks before month-end.
01
Cash flow & 13-week forecasting
A rolling forecast your partners can read in 5 minutes — payroll, rent, malpractice, distributions, and tax payments sequenced so there are no surprises.
- Weekly cash huddle (30 min) + monthly partner finance review
- Line-of-credit sizing and bank relationship management
02
Physician compensation & partner economics
Redesign and model comp so it rewards production, citizenship, and quality — and holds up when a partner retires, a new physician ramps, or an APP team grows.
- wRVU / collections / hybrid models, buy-in & buy-out valuations
- Per-physician P&Ls that end the “who subsidizes whom” debate
03
Payer mix, RCM & margin by service line
Which payers, sites, and service lines actually make money after staffing and supplies — and which ones to renegotiate, reprice, or exit.
- Denial & AR diagnostics with your biller / RCM vendor held accountable
- Payer contract modeling before you sign the renewal
04
Budget, staffing & overhead discipline
Staffing is 45–55% of most practice budgets. Build a budget tied to visit/procedure volume, not last year + 3%, with variance explained monthly.
05
Growth, M&A & strategic decisions
New site, ASC, imaging or ancillary, hospital/PE partnership, or adding a partner — modeled with ramp, capital needs, and break-even before you commit.
06
Board & lender-ready reporting
A clean monthly package: P&L by location/provider, KPI dashboard, covenant compliance, and a short narrative — what happened, why, and what we’re doing next.
Try it — 30 seconds
How much cash is sitting in your receivables?
Drag the sliders to your practice. This is the same back-of-the-envelope we use in a first call — before we ever open your books.
Physicians + APPs who generate collections
Actual cash collected last 12 months, not charges
MGMA median for many specialties sits near 35–40 days
All operating costs before physician comp & benefits
Cash currently in ARCollections ÷ 365 × days in AR
$789,041Cash freed if AR → 38 days10 fewer days waiting on payers — a one-time cash release, then permanently faster collections
$164,384Value of 2 pts of overhead2% of collections — often one staffing-model or vendor fix, recurring every year
$120,000 / yrFull-time CFO, fully loadedSalary, bonus, benefits & payroll taxes for a healthcare CFO in most metros
~$310–420k / yrA fractional engagement typically pays for itself if it frees 3–4 days of AR — once.
Embedded CFO retainers below start well under 15% of a full-time hire. The diagnostic (below) tells you exactly where your fastest payback sits before you commit to anything ongoing.
Engagements
Start small. Stay only if it’s clearly paying for itself.
Every engagement starts with the diagnostic. Pricing is a flat retainer — no hourly billing, no surprise invoices. Final scope is quoted after the diagnostic, based on provider count and complexity.
Financial Diagnostic
Fixed fee · quoted up front · 2–3 weeks
Know exactly where you stand before you hire anyone. The right starting point if you’ve never had a CFO look at the practice.
- 3-year trend: collections, overhead, comp, AR & payer mix
- Per-physician & per-location profitability
- 13-week cash view + distribution safety check
- Prioritized 90-day action list with dollar impact
- 90-min review with partners — plain English, no jargon
Embedded Fractional CFO
Monthly retainer · month-to-month after 90 days
Your CFO, on a fractional schedule. In your partner meetings, on call for decisions, accountable for the forecast.
- Everything in the diagnostic, kept current monthly
- Monthly partner finance package + meeting
- Comp modeling, budgeting & hiring / growth pro formas
- Ongoing RCM & payer accountability
- Direct access between meetings for partner questions
Strategic Project
Project fee · scoped per project
One high-stakes decision, modeled properly. For practices that don’t need an ongoing CFO — yet.
- New location / ASC / ancillary pro forma
- Partner buy-in, buy-out, or retirement valuation
- Hospital, MSO, or PE offer evaluation
- Comp plan redesign (design through partner vote)
- Turnaround / cash-crisis stabilization plan
Not sure which fits? That’s what the discovery call is for — 30 minutes, no pitch deck. If a bookkeeper, a better CPA cadence, or a full-time hire is the right answer for your stage, you’ll hear that instead.
How it works
From first call to first partner-ready forecast in about a month.
Week 0 · Call
Discovery (30 min)
Your structure, specialties, pain points, and what “good” looks like for the partners. Honest fit check — both ways.
Weeks 1–3 · Diagnostic
We pull your numbers
Accounting, billing, and EHR exports — handled with your office manager so physicians aren’t chasing reports.
Week 3 · Review
Findings with partners
What’s working, what’s leaking, and the 90-day plan — with dollar impact ranked, not a 60-slide deck.
Ongoing · Rhythm
Monthly CFO cadence
Forecast, KPI package, and partner meeting every month. Decisions get modeled before they get made.
Who you’d be working with
Led by a healthcare CFO — not a generalist consultant.
Douglas Waldorf is a healthcare chief financial officer whose day job is running finance for a healthcare organization — budgets, payer pressure, staffing economics, and board reporting included. Bainford is his fractional practice for independent physician groups that need that same discipline without adding a full-time executive.
That matters because practice finance isn’t small-business finance with stethoscopes. Reimbursement timing, physician comp, Stark/anti-kickback-aware structuring, and partner governance change every model. You get advice from someone who lives inside those constraints — and who will tell you when not to spend, expand, or distribute.
Healthcare CFOFull-time finance leadership in healthcare — P&L, forecasting, and lender/board work
Atlanta-based, nationalOn-site for partner reviews in the Southeast; virtual cadence works anywhere
Independent onlyNo RCM, billing, or software commissions — advice isn’t tied to selling you a vendor
Partner-trusted formatShort, clear packages designed to be read and decided on in one meeting
Common questions
Before you book the call
Your CPA optimizes taxes and closes the books — backward-looking and essential. Your office manager runs daily operations. A CFO is forward-looking: forecasting cash, modeling decisions before you make them, and holding the whole economic picture (comp + overhead + payer mix + growth) in one place. This service doesn’t replace either role; it gives both of them direction.
Probably not — 3 providers is where comp, cash timing, and overhead decisions start compounding. Below that, the diagnostic alone often delivers most of the value. The discovery call will be honest about which tier, if any, fits your size.
Access (view-only where possible) to accounting, your last 2–3 years of financials/tax returns, billing/AR reports, and current physician comp agreements. Your office manager is the main point of contact — plan on about 2–3 hours of their time during the diagnostic, and 30 minutes per partner for the review.
That’s the design constraint. Every deliverable is built for a partner meeting: one-page dashboard, a short narrative, and a decision list. If a report doesn’t change a decision, it gets cut. The diagnostic review is the test — partners see the format before any ongoing commitment.
Yes — and we make them more accountable, not redundant. You’ll get clear AR, denial, and collection targets with monthly scorecards. If a vendor change is warranted, the data will make that case; there are no referral fees involved either way.
Yes. Engagements are covered by a mutual confidentiality agreement, data is handled only for your practice’s work, and nothing is shared across clients. No PHI is needed for financial work — we use de-identified, aggregate billing data.
Next step
Tell us where it hurts. Get a diagnostic plan back.
Complete the quick check below — it builds your inquiry email for you. No portal, no sales sequence. You’ll hear back within one business day. Prefer to write directly? Email Dougwaldorf@gmail.com.
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What happens next
- 30-min discovery call — fit, timing, and diagnostic scope
- Flat-fee diagnostic quote in writing before any work starts
- Findings review with partners within 2–3 weeks