Group therapy practices
Fractional CFO for group therapy practices
You started as a clinician. Now you run a group: associates and licensed clinicians on different pay arrangements, several payers on different timelines, a waitlist, payroll every other Friday, and decisions that each carry real money. SmallBizCFO is the finance seat for that practice once it is somewhere between one and five million in revenue.
The work is advisory: a rolling cash forecast, a monthly KPI scorecard by clinician and payer, and regular decision sessions, led by Andrew Pizzello, CPA, for a flat fee starting at $2,495 a month. Here is what that means for the questions a group therapy practice actually has.
What each clinician actually contributes
A practice P&L tells you whether the group made money. It does not tell you where. We build contribution margin by clinician every month: collections from each clinician's sessions, less that clinician's pay and payroll taxes, before the shared costs of rent, front desk and billing. Then we read it with you, as a management tool rather than a ranking, because a clinician on a heavier insurance mix or a newer caseload will look different for reasons that have nothing to do with their work. The method is written up in profit per clinician.
Associate compensation, modeled before it is decided
A percentage split, a salary, or a salary with a bonus above a session threshold each move risk between the practice and the clinician in a different way. Before you offer one, or change one, we model it against cash and margin at a light, an expected and a full caseload, so you can see what the practice is agreeing to carry in a slow month. We do not decide whether a clinician is an employee or a contractor, and we do not run payroll; those belong to your CPA and your bookkeeper. The modeling approach is in associate therapist pay: split, salary, or hybrid.
Payer mix and the rate you are really paid
The scorecard shows collections by payer, the rate you actually collect per session from each, how many days each takes to pay, and how concentrated revenue is in any one of them. That turns panel decisions from a feeling into a comparison: whether to stay on a panel at its rate, whether to raise self-pay rates, and what happens to cash if one payer slows down. The one-time Pricing and Margin Review goes deeper on exactly this.
Capacity, utilization and the next hire
Held sessions against open slots, by clinician. New intakes against the openings that come as clients finish treatment. Those two lines tell you when the schedule is genuinely full and when it only feels full, and they show the point where another clinician pays for themselves, after credentialing and caseload ramp. The cash side of every hire runs through the test in can we afford this hire.
Cash flow with insurance payment lag
A session is revenue the day it happens and cash when the payer pays. Payroll does not wait. The rolling forecast is built week by week from claim timing by payer, expected denials and resubmissions, payroll dates, rent and debt service, with a cash floor the practice keeps and owner distributions planned from what sits above it. The weekly version is described in a 13-week cash forecast for an insurance-based practice.
Bigger moves: a second location, a partner, a sale
A second office, bringing in or buying out a partner, a line of credit, or the question of what would make the practice sellable someday. Each one becomes a scenario in the forecast before it becomes a commitment, and the lender package or exit readiness work is available as a flat-fee project on the pricing page.
What we leave to the sister firms
SmallBizCFO works from your books; it does not keep them. Our affiliate bookkeepz, LLC does bookkeeping for therapists and group practices, including how clinician pay and payer deposits are recorded, or your own bookkeeper does. SmallBizCFO, Inc. is not a CPA firm and does no tax work: tax returns, S corporation questions and clinician classification go to PizzelloCPA, PLLC, a CPA for therapists and counselors, or to your own CPA, under a separate engagement.
Not only therapy
Dental, veterinary, optometry and physical therapy groups share the same structure: several providers, a payer mix, a schedule that is the whole business, and an owner who still treats patients. The same engagement fits them, and who we serve describes the fit and the cases where we are not the right answer.
There is a fictional example of the one-page monthly scorecard on the homepage. The first call is free, and we will tell you plainly if the practice is not ready for this yet.
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