Know what your practice actually earns, and what that number is worth.
SynqEdge runs the CFO function for membership-based physician practices. We build the financials, membership economics and forecasting behind the decisions in front of you now, and that hold up later when a lender, a partner or a buyer looks closely.
A short call first, then a written scope and fee.
For concierge, Direct Primary Care, membership, hybrid, and growing physician-owned practices.
Six decisions a standard P&L will not settle
These decisions get made either way, usually with real money attached and usually on a timeline. The only question is whether the economics are in front of you first, or whether they show up later in the financial statements as consequences.
- 01
Can we afford to hire another physician?
Compensation is the easy part. The harder question is ramp: how long before the new physician's panel covers salary, support staffing and overhead, and how deep the cash trough gets first. The number that matters is how many additional members are needed, and by when.
- 02
Should we open another location?
Capital required, build-out and occupancy, staffing ahead of volume, and the member growth needed to break even. A second site rarely fails because the model was wrong. It fails because the ramp took longer than the cash allowed.
- 03
Are we charging enough, and what are we actually collecting?
Posted rates and realized revenue per member are rarely the same figure. Grandfathered patients, family tiering and employer agreements each pull the average down, and the gap widens quietly over years. Any pricing decision starts with what you collect today, by cohort.
- 04
Where are we actually making money?
Consolidated profit tells you the practice is profitable. It does not tell you which provider is carrying which, or whether the second location has cleared its own overhead. Contribution after compensation, support staff and allocated overhead is usually the number that changes a decision.
- 05
How much can I take out of the practice without creating a problem?
Distributions get set by what is in the account. That balance holds prepaid membership revenue you have not yet earned, payroll that has not cleared and tax not yet due. Separating distributable cash from available cash is a monthly calculation.
- 06
If someone offered to buy this practice next year, what would they actually be paying for?
Buyers pay a multiple of what they can substantiate. Cash-basis books, undocumented owner expenses and thin retention data all reduce the number that survives diligence. That work takes two to three years and cannot be compressed into the ninety days after an offer arrives.
Each of these has an answer. Getting to it requires financial information built for a membership practice rather than adapted from a clinic, and someone whose job is to look at it every month.
One finance function, from the monthly close to the decisions that follow.
We take responsibility for the accounting and the advisory layer built on top of it. One engagement, not a menu.
- 01
The financial foundation
Monthly close on a fixed calendar. Balance sheet reconciled, not reviewed. Annual and prepaid memberships on a deferred revenue schedule, so revenue lands in the month it is earned. For hybrid practices, reimbursement, collections and payer mix carried in the same structure.
This is the floor. You should be able to rely on the numbers before deciding anything from them.
- 02
The management view
A monthly pack built around how the practice makes money:
- Revenue per active member by cohort, against posted rates
- Retention and attrition by tier
- Contribution by provider and location, after compensation, support staffing and overhead
- Cash position, distributable cash, and the near-term picture
- Performance against budget and forecast
Each pack carries written analysis on what moved and why. Not a variance column left for you to interpret.
- 03
The CFO conversation
A rolling forecast that updates with actuals, and a standing monthly review. Before you commit to a hire, a pricing change, a second location, a distribution or a capital investment, we model it first.
Between reviews we already hold the model and the context, so answers take days rather than weeks.
Working with the people you already have
Your CPA handles tax. Your practice manager runs operations. We fill the layer between them, and we keep the records current through the year so nothing accumulates until year end.
A short call first, then a written scope and fee.
Most physicians see one transaction. The people across the table see dozens.
Your attorney handles the language. Your banker is paid to close. We work the numbers, on your side, across all four stages. For clients on the ongoing engagement, the first one is already underway.
- 01
Before the offer
Two to three years out
Buyers pay a multiple of what they can substantiate, not of what the practice earns.
We document add-backs as they occur rather than reconstructing them later, convert the accounting, and build the membership retention data a buyer will ask for. Done early this is ordinary monthly work. Done after an offer arrives, it is a scramble the buyer will price.
- 02
When the offer arrives
LOI economics
The multiple is the least interesting number in the letter.
We model what you actually receive: the EBITDA the multiple applies to, how much of the price is cash against rollover, earnout and seller note, and how post-closing compensation offsets the headline figure. In a membership practice the working capital target matters as much as any of it, because it decides who funds the deferred revenue sitting on your balance sheet after closing.
- 03
During diligence
Quality of earnings response
The buyer's advisors will produce their own view of your earnings, and it will not match yours.
We reconcile cash to accrual across the lookback period, defend the add-backs that are legitimate, challenge the adjustments that are not, produce the cohort and retention analysis they ask for, and run the data room so answers arrive complete rather than in fragments.
- 04
Closing and after
The definition written into the agreement is rarely the one everyone assumed.
We handle funds flow and purchase price reconciliation, calculate the working capital true-up against the agreement rather than the assumption, and track the earnout from month one, while there is still time to influence the result.
We work the financial and commercial side and coordinate with your attorney, CPA and banker. No legal advice, no tax opinions, no attestation services.
A short call first, then a written scope and fee.
Practices that have grown more complex than their financial infrastructure.
Established concierge, direct primary care, membership and hybrid practices, physician-owned, where ownership is making consequential decisions about providers, pricing, staffing, cash, expansion and capital.
Not a revenue threshold or a location count. The common position is a practice where the decisions have outrun the reporting.
For a practice in its first year, or one that already has CFO-level capability in house, the ongoing engagement is usually not the right fit. Transaction and other specialized work often still is.
Built on the owner's side of the table.
SynqEdge is founded and led by Muhammad Kaleemullah, who works directly with physician owners on the financial decisions behind operating, growing, and ultimately transitioning a practice.
Kaleem has spent his career working in finance alongside the owners of physician-owned practices.
His experience includes supporting multi-location growth from a single practice location to a broader operating footprint. That work has included evaluating the economics of new locations, determining capital requirements, modeling provider and compensation decisions, building forecasts, and developing reporting that gives ownership a clearer view of performance as the organization grows.
He has also supported practice founders through transactions, working across valuation, deal economics, buyer financial diligence, and post-closing implementation. His role is to help ownership understand the financial implications of the decisions being made while coordinating with the attorneys, CPAs, tax advisors, and other professionals involved.
That combination of operating finance and transaction experience shapes how SynqEdge works with clients. The objective is not simply to report what happened, but to understand the economics of the practice well enough to support the decisions that come next.
Kaleem holds an MSc in Finance from the University of Strathclyde and is a Level III candidate in the CFA Program.
Outside of work, he enjoys cooking for family and friends and spending time outdoors.
Start with a review, not a proposal.
Before any ongoing engagement, we run a Practice Financial Review. It is a scoped piece of work with a written deliverable, and it exists so that both sides are deciding on evidence rather than on a sales call.
What it covers
Membership and patient economics, including what the practice actually collects against posted rates. Margin structure by provider and by location. Cash position and what is genuinely distributable. The condition of the current reporting, and what a lender, a partner or a buyer would find in it today.
What you receive
A written assessment, walked through with you, covering what the numbers show, what they cannot show in their current form, and what would need to change. If there is an obvious priority, it says so.
What it requires
Access to the accounting file and the membership or practice management data, and one conversation to scope it. You will have the scope and fee in writing before any work starts.
The point
The review stands on its own. If we work together afterwards it becomes the starting position. If we do not, the assessment is still yours and still useful.
A short call first. You will receive the scope and fee in writing before anything begins.
If a transaction is already underway, get in touch directly.