Twenty minutes, once a month

You look at your schedule every morning and your bank balance every few days. The numbers that show whether the practice is getting stronger sit one layer deeper, and until recently they lived in three different systems.

On our monthly CFO calls at Goodman CPA, I walk Direct Care owners through six numbers. Most of the inputs now live in Hint, and each one points to a decision you can make this month. Put twenty minutes on your calendar for the first Tuesday of the month, open Hint, and read them in this order.

1. Active members per provider

Start with active members and count each person. For example, a family of four on one family plan is one membership with four active members. The difference matters in every calculation that follows: pediatric and family-heavy practices can be off by half if they count memberships instead of people.

Then split that count by provider in Hint's Memberships report. Filter by Status and Provider, and set it to show patients rather than membership owners so each person counts once. Plan and Month filters give you a narrower cut when you need one.

This number does two jobs: it tells you how full each provider is, and it is the member count behind the revenue-per-member and cost-per-member math later in this list. Set your own target panel for each provider when they start, based on your model and their schedule. A home-visit practice and a clinic-based practice will set very different targets, so skip the industry averages and measure each provider against the number you agreed on.

What to look for: a provider closing in on their target means it is time to plan the next hire or close that panel. A provider well under target with flat enrollment points to a marketing or scheduling problem, not a staffing one. Also check for active members with no assigned provider. If that number is above zero, fix the assignments before you read anything else, because those members won’t show up in any provider’s panel count.

2. What one member is worth

Add up your monthly membership revenue, converting annual plans to a monthly figure, and include employer contracts. Divide by active members. The result is revenue per member, and it feeds into almost every growth decision you will make.

There is no right number here. A $200 home-visit membership and a $75 clinic membership can both be priced correctly. What matters is the trend line against your own price sheet.

Hint bills employer sponsors separately from individual patients, and those invoices show up in the Company Invoices report. If you have employer contracts, make sure you include both streams in the total.

What to look for: revenue per member drifting down while membership grows. The practice is getting busier and earning less per hour of work. You'll want to investigate why. The most common causes are legacy rates nobody moved, family-plan discounts, and coupons that never expired. If revenue per member falls two months in a row, pull your plan list and count how many members sit on a rate you no longer offer.

3. Enrollments minus cancellations

Revenue tells you what already happened. Enrollment tells you what revenue will do in three months. Hint's Dashboard does the counting for you: pick the month as your reporting period, and it shows active members at the start, enrollments, terminations, active members at the end, and net growth. The chart on that page tracks active members, growth rate, and attrition rate. Attrition is your monthly churn: cancellations divided by the members you had on the first of the month.

You can cut the same view by provider, employer sponsor, plan, or lead source, and lead source shows which channels are actually filling panels. On the cancellation side, the decision lives in the reason, so if you don't already record one, ask every member who leaves and note it. A churn spike traced to members moving out of state calls for nothing. A spike traced to price, three months after a rate change, calls for a conversation about how the increase was communicated.

What to look for: net growth below zero, or an attrition rate above your own trailing twelve-month average. Compare against your own history rather than a published benchmark; don’t rely on published benchmarks whose circumstances may not be comparable to your own. When a month runs above your average, pull the cancellation reasons for that month and sort them into four piles: moved, price, coverage change, and experience.

4. Read your margin in Hint Bookkeeping

Net margin is net income divided by total revenue: of every dollar that came in, how many cents you kept. With Hint Bookkeeping, a bookkeeper categorizes your transactions inside your Hint account, and the Overview tab shows your profit and loss: a twelve-month view of revenue, expenses, and net profit, compared against the previous month, with a breakdown of where revenue came from and where expenses went. That puts your profit next to your membership numbers instead of in a separate login or spreadsheet.

As you look at the Bookkeeping Overview, split revenue into membership and everything else: labs, medications, supplements. Membership revenue keeps coming while you are on vacation; ancillary revenue needs inventory and your time.

We start most Direct Care owners with a 30% net margin target and adjust it once we know the practice. Two things keep the number honest. First, pick a bookkeeping method and stay with it. Cash basis records revenue when the money arrives and expenses when you pay them; accrual basis records revenue when you earn it and expenses when you incur them. A prepaid annual membership lands in a single month under cash and spreads across twelve under accrual. Cash is simpler and is what most small practices use for taxes; accrual gives a truer month-to-month picture if you sell a lot of annual plans. Either works, as long as you don't switch back and forth. Second, keep your own pay consistent: an S-Corp owner who shifts money between salary and distributions will move the margin without anything real changing.

What to look for: a margin below 30%, or a drop from last month. If you aren't at 30%, look hard at both sides: are you earning plenty of membership revenue but also spending on high rent? If margin dropped, figure out whether lower revenue or higher expenses caused it. Open the expense categories for that month, find the line that moved, and mark it as recurring or one-time before you react.

5. Where the card spend is creeping

Now that you know where your biggest expenses are, use Hint Spend Management to see who is making those purchases and set card and category limits to control spending. The first hire changes your expenses more than your payroll line shows. Your MA orders supplies, your front desk renews software, and your own card statement stops telling the whole story.

Hint Spend Management issues a card to each person who buys for the practice, and the receipts flow into Hint Bookkeeping or QuickBooks. Its Spend Insights view shows spending by person and by category, so you can see how spending is tracking across the month and how it compares to last month. It also calls out your largest transactions from the month for a quick spot check.

That turns one monthly question into a two-minute check: did any category grow faster than your member count? Divide total operating expenses by active members each month and track that figure next to revenue per member, so the gap between the two shows you what each member contributes.

What to look for: a category growing faster than membership. Supplies rising 10% in a month when members rose 10% is a practice growing. Supplies rising 10% while members held flat is worth a conversation with whoever holds that card. Watch the gap between revenue per member and cost per member too; when it narrows, each new member is adding less profit.

6. Months of runway and a dedicated tax account

Take the cash in your operating accounts and divide it by your average monthly operating expenses over the last three months. Leave out owner distributions. Also leave out any line of credit, since borrowed cash is not a reserve, and the Tax account described below, since that money is already spoken for. The result is how many months the practice runs if revenue pauses.

Membership revenue is steady enough that you don’t need a year in the bank. Our recommended minimum: keep cash equal to at least 10% of your last twelve months of revenue, then convert that floor into months of expenses so you can compare it with your runway.

A practice with $600,000 in trailing revenue holds at least $60,000. At $35,000 a month in operating expenses, that floor equals about 1.7 months of expenses, so if revenue stopped entirely, you could cover about seven weeks.

Then open a second savings account and name it “Tax”. Each time membership revenue lands, move a set share of profit into it. A 30% set-aside of net income is a reasonable starting estimate for federal, state, and self-employment tax for an S-Corp owner. Your actual figure depends on your state and your plan, so treat 30% as a placeholder until a tax plan replaces it.

A tax plan is where that placeholder turns into savings. We identified $27,436 in tax savings for a Maine Direct Care owner in 2025, and $3.16M across the 70 tax plans our firm has completed. Check the Tax balance against your year-to-date set-aside on the same Tuesday you read everything else.

What to look for: runway sliding toward your floor two months in a row. That is the signal to slow spending or push back a hire before cash decides for you. If the Tax balance trails what you should have set aside year to date, catch up now rather than in April.

Putting the six numbers to work

Read one at a time, the six numbers tell you how the practice is doing. Read together, they answer the bigger decisions. The one we hear most from growing practices is whether they can afford the next hire, and it makes a good worked example, with arithmetic you can do on the back of a Hint printout.

Can you afford the next provider?

Here is an illustrative example with round numbers, not a client's. A new provider costs $150,000 a year fully loaded, counting salary, payroll taxes, benefits, and malpractice. That is $12,500 a month. At $100 revenue per member, the provider covers their own cost at 125 members, because $150,000 divided by $1,200 a year per member is 125.

Now use your enrollment number. If the practice nets 10 new members a month for the new provider, it takes about thirteen months to reach 125. Across those months, the shortfall between the provider's cost and the revenue their panel brings in adds up to roughly $72,000. That is the cash the practice has to float before the hire pays for itself.

Set that $72,000 next to your months of runway. If paying it would take you below your floor, you have three levers: start the provider part-time, pre-sell their panel with an employer contract, or wait two quarters and build cash first. Run the math with your own revenue per member and your own enrollment pace before you post the job.

About the author

Nate Goodman founded Goodman CPA in 2019. The firm works with Direct Care practice owners across the country on tax planning, bookkeeping oversight, and CFO advisory, and Nate hosts the monthly Finance Q&A in the Hint Community.

Want help reading your numbers? Reach out to Goodman CPA on Hint Marketplace and bring your last three months from Hint.

This article is general information, not tax, legal, or financial advice. The 30% target margin, 10% cash floor, and 30% tax set-aside are starting points, not recommendations for your specific practice. Talk with your own CPA or advisor before acting on them.