Investor reporting for growing primary care groups: what to have ready
What investors and lenders ask growing primary care groups for each month, and how finance can produce it consistently, by clinic and by legal entity.
Every month the same requests arrive: results by clinic, a consolidated view by legal entity, the current cash position, cost per clinic and the assumptions behind the growth plan. Your team knows what the answers should look like. The time goes on rebuilding them each time someone asks.
This post covers what investors and lenders usually ask growing primary care groups for, why the rebuild keeps getting longer as the group adds clinics, and the chart of accounts and dimension decisions that let finance produce the same package on a steady monthly cadence.
Key takeaways
- Agree a recurring monthly package with your investors and lenders. A useful start: profit and loss by clinic, results by legal entity, cash position, total operating cost by clinic and the rolling forecast with its assumptions.
- Decide the chart of accounts and dimensions (entity, clinic, department or service line, funding source) before the next clinic opens, so monthly results come out by clinic and by entity without re-mapping.
- The close determines when final monthly actuals are available, so label any preliminary figures clearly.
- Show each clinic’s direct operating costs and its allocated share of shared services separately, with a documented allocation basis.
- Ask how a finance system refreshes the rolling forecast against actuals without rebuilding the model.
What we’ll cover
Why the investor package takes longer every month
Private equity (PE)-backed primary care platforms, management services organizations (MSOs), employer-sponsored clinic operators and direct primary care (DPC) groups share the same pressure. As the number of clinics and entities grows, investors still expect monthly results on a predictable schedule.
The rebuild happens when the general ledger (GL) wasn’t set up to answer those questions. Finance pulls data from the GL, maps it into a spreadsheet template, reconciles intercompany balances by hand and rebuilds the clinic view, every month. Each new clinic adds to the next rebuild. If the close itself is the bottleneck, start with our post on a repeatable month-end close for primary care groups growing through acquisition.
The lasting fix is structural: a chart of accounts and dimension model designed to produce the investor package as a standard set of reports.
What the investor package usually contains
Before evaluating any system, agree the recurring package with your investors and lenders. A useful starting point includes these five views:
- Monthly profit and loss (P&L) by clinic. Which locations are performing, which are still ramping up, and where cost is running ahead of revenue.
- Results by legal entity. PE-backed platforms and MSO structures often hold clinics in several legal entities. Investors need the consolidated view and each entity on its own.
- Cash position. Cash across all entities, produced soon enough after month end to still be useful.
- Total operating cost by clinic. Each clinic’s direct operating costs and its allocated share of shared services, shown separately for the period, so each location’s economics are visible.
- Rolling forecast and growth assumptions. How cash and revenue are tracking against plan, and the assumptions behind the next clinic opening, updated every month.
The question for any finance system: can it produce all five as standard reports, on the same cadence, without a manual consolidation step between the GL and the report?
Dimension design comes first
The chart of accounts and dimension model decide whether the investor package is a set of saved reports or a monthly project. Settle them before the next clinic opens, and results come out by clinic and by entity. Leave them, and every new location adds another layer to the rebuild.
For a growing primary care group, the model usually needs at least these dimensions:
- Entity: each legal entity in the structure, so multi-entity reporting and consolidation come from the ledger.
- Clinic or location: a useful reporting unit, with direct clinic revenue and costs identified by location, and shared costs tracked centrally and allocated by documented rules.
- Department or service line: primary care, behavioral health, ancillary services, or whatever the group’s mix requires.
- Funding source or contract type: for groups with value-based care (VBC) contracts, employer contracts or Medicaid managed care alongside fee-for-service revenue.
CareATC, which provides primary care to employers through on-site and near-site clinics, describes using dimensions to analyze transactions by customer, clinic, territory and clinic type. As its chief financial officer (CFO), Spence Lloyd, put it: “We especially value Sage Intacct’s dimensions capability, which lets us easily tag transactions in order to group, compare, and analyze our data by customer, by clinic, by territory, or even by clinic type.” CareATC also halved its monthly close. Read the CareATC story.
The question to ask: can we add a new clinic or legal entity and see it in the standard investor reports without remapping the chart of accounts or rebuilding the consolidation template?
The close sets the pace
The close determines when final monthly actuals are available. Agree the delivery deadline with your investors and lenders, and label any preliminary results circulated during the close clearly.
In a multi-entity primary care group, three things tend to set the pace:
- Intercompany eliminations. Reconciling intercompany balances by hand can delay a multi-entity close. Ask how a system handles eliminations at consolidation.
- Approval workflow. Invoice approvals, expense reports and journal entry reviews that route in the system, so they don’t sit in email.
- Interim consolidated figures. A consolidated view during the close, so the CFO can see early whether the numbers reconcile.
Vera Whole Health, which runs work-site care centers for employers and insurers, implemented Sage Intacct across its three legal entities, revamped its chart of accounts and connected a planning system. Its story reports a 70% faster financial close. Read the Vera Whole Health story.
When you evaluate systems, ask to see the close workflow at your current entity count, and ask what the close looks like for organizations at the entity count you expect in two years.
Operating cost by clinic and clinic P&L
Total operating cost by clinic is one of the most useful views a primary care group can produce, and one of the harder ones to get from an older GL. Each clinic’s direct costs are useful on their own. Shared services (billing, human resources (HR), information technology (IT), compliance) sit at corporate level and are allocated to each clinic to show its full economics.
Show the direct costs and the allocated share separately for the period. Document the allocation basis for each shared cost pool, and reconcile the fully allocated clinic view to the consolidated results. When department and service line sit alongside clinic and entity in the dimension model, the allocation becomes a repeatable step in the close.
The question: can the system allocate shared service costs to clinics by documented rules, and show direct and allocated costs by clinic in the same report as the consolidated results?
Keeping the rolling forecast current
Investors in growing primary care groups expect the rolling forecast in the monthly conversation: how actuals are tracking against plan, what the next clinic opening assumes, and where cash is likely to land at quarter end.
Building the forecast model is a topic in its own right, covered for multi-site specialty groups in our post on orthopedic group budgeting, from annual plan to monthly reforecast. The question here is narrower: can the system refresh the forecast against actuals each month without rebuilding the model?
Questions to take into a vendor conversation
Before you talk to vendors, have answers to these questions for any system you are considering:
- Can we report monthly P&L by clinic and by legal entity without a manual consolidation step?
- Can we add a clinic or entity and see it in the standard investor reports without remapping the chart of accounts?
- How does the system handle intercompany eliminations at consolidation?
- Can we show direct and allocated operating cost by clinic, with a documented allocation basis, in the same report as revenue?
- Can we refresh the rolling forecast against actuals without rebuilding the model?
- What does the close look like for organizations at our current entity count, and at the count we expect in two years?
- How does the system connect with our electronic health record (EHR) and practice management system, and what does that connection take to maintain?
To see how Sage supports multi-entity primary care groups, explore our primary care accounting software.
If your team still rebuilds the investor package by hand each month, review your chart of accounts and close before the next clinic opens.
Frequently asked questions
What financial reports do investors usually ask a primary care group for each month?
Agree the package with them. A useful starting point is profit and loss by clinic, results by legal entity, the current cash position, total operating cost by clinic and a rolling forecast with its growth assumptions, on a predictable monthly cadence.
How should a primary care group structure its chart of accounts for multi-entity reporting?
Carry entity, clinic or location, department or service line, and funding source or contract type as separate dimensions. Deciding this before the next clinic opens lets monthly results come out by clinic and by entity without re-mapping.
Why does investor reporting take longer as a primary care group grows?
When the GL wasn’t designed to produce the investor package, finance rebuilds it in spreadsheets each month. Every new clinic and entity adds mapping and intercompany work, so the rebuild grows with the group.
What should a CFO ask when evaluating multi-entity accounting software for a primary care group?
Ask whether it reports profit and loss by clinic and by entity without a manual consolidation step, how it handles intercompany eliminations, whether it allocates shared service costs to clinics by documented rules, and how it refreshes a rolling forecast against actuals. Also ask what the close looks like at the entity count you expect in two years.
How does close speed affect investor reporting for a growing primary care group?
The close determines when final monthly actuals are available. Agree a delivery deadline with investors and lenders, and label any preliminary figures shared during the close clearly.
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