Direct Care & Integrative Medicine
Most direct care and concierge doctors are running a business for the first time. We set up the books, track membership revenue, handle sales tax on retail products, and plan your taxes before they come due.
From Employee to Owner
For most of your career, someone else handled the business side. The hospital or group ran payroll, withheld your taxes, paid the malpractice premium, and dealt with vendors. You saw patients and got a paycheck. Opening a direct care or concierge practice changes all of that at once. You are now the one signing the lease, choosing the software, hiring the medical assistant, and deciding what to do with the money left over.
The membership model is simpler than insurance billing, and that is part of the appeal. But simple revenue does not mean simple books. Membership fees, visit fees, labs passed through at cost, dispensed medications, and supplement sales all land in the same bank account. Without a clear setup, it becomes hard to tell how the practice is really doing. Our Chief Information Officer, Marc Eastin, is a practicing neurosurgeon who also owns a business, so we understand both sides of that change.
Who This Covers
Who This Covers
Direct primary care, concierge medicine, functional and integrative medicine, hormone and weight-loss clinics, IV and longevity clinics, and naturopathic and acupuncture practices. Mostly solo physicians and small teams in their first few years of ownership, anywhere in the country.
Deposits That Don't Add Up
Deposits That Don't Add Up
Membership platforms and card processors pay you in batches, after fees, refunds, and failed payments are taken out. If only the net deposit gets recorded, revenue looks lower than it is and processing costs disappear from view. We match each payout to the member payments behind it so both numbers are visible.
Setting Up Before You Open
The decisions made in the months before opening tend to stick for years. Which entity to form, whether to elect S corporation status now or later, how to pay yourself, and which accounts to open all affect your tax bill and how easy the practice is to manage. Our New Practice Setup handles these pieces before the first patient walks in, so you are not untangling them during your first busy season.
We set up QuickBooks Online with categories that fit a membership practice, connect your bank and membership billing software, and set up payroll in Gusto for you and any staff. Startup costs get recorded correctly from the beginning, including the equipment, build-out, and supplies you paid for before opening. Many of those costs have their own tax treatment, and they are easy to lose track of when they were paid from a personal card months earlier.
Books Built for Memberships
Books Built for Memberships
Membership fees, visit fees, labs, medications, and retail products each get their own line. You can see what members bring in each month, how much of your lab and medication revenue is simply covering cost, and what the retail side actually adds.
Keeping Personal and Practice Apart
Keeping Personal and Practice Apart
Many new owners pay early expenses from personal accounts and keep doing it out of habit. We set up separate accounts and a clean way to reimburse yourself. This helps protect the liability protection your entity is meant to provide and keeps your deductions easy to support.
Where New Practices Get Caught
The first tax season is often the hardest. As an employee, taxes came out of every paycheck. As an owner, nothing is withheld unless you plan for it. Practices that turn a profit in year one often reach April with a large balance due and penalties for missed quarterly estimates. We track profit as the year goes and help set your estimates so the bill is expected and the cash is there to pay it.
Annual memberships create a different problem. When a member pays for the full year up front, the cash arrives today but the care is delivered over twelve months. Counting it all as income in the month it arrives makes one month look great and the rest of the year look thin. We spread that revenue across the months it covers, so your monthly numbers show how the practice is really performing. Your tax return follows its own rules, and we plan for those separately.
Sales Tax on Retail
Sales Tax on Retail
Supplements, skin care, and other retail products are taxable in many states, while medications and some health items often are not. Online orders shipped to other states can create filing obligations there as well. Our Sales Tax Filing service keeps track of what is taxable where and files on time.
Costs That Pass Through
Costs That Pass Through
Labs, medications, and IV supplies are often sold near cost as a member benefit. When those sales and purchases are mixed in with everything else, the practice looks bigger than it is and margins look thinner. We track them side by side so you can see whether they are breaking even or quietly costing you money.
What Changes
Each month the books are closed and you get a one-page summary. You can see what membership fees brought in, what the practice spent, and what was left for you. Questions like when you can afford a nurse or whether a second provider makes sense start to have real answers. If your books have already fallen behind, we bring them current first.
Tax planning becomes a yearly habit instead of a scramble. Our enrolled agents look at your structure, what you pay yourself, retirement contributions, and the timing of equipment purchases, then build a plan for the year ahead. Clients tell us they value that we look for savings before the year ends instead of only filing what already happened.
Knowing Your Break-Even
Knowing Your Break-Even
When you know your fixed monthly costs and your average membership fee, you know how many members it takes to cover the practice and pay yourself. That number guides decisions about pricing, panel size, and when to stop taking new patients.
Keeping More of What You Earn
Keeping More of What You Earn
Practice owners have choices that employees do not. An S corporation election, a reasonable salary, and a well-funded retirement plan can lower the tax bill by a meaningful amount. We work through those choices with you each year, based on your actual numbers.
A Family-Run Firm Since 1995
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