Medical practices & clinics
Books and taxes for direct primary care practices.
Monthly memberships, annual prepays, meds you dispense at cost, and the occasional cash visit. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
September came in at $14,400. Three families paid their annual membership up front, so I kept that as prepaid revenue instead of dumping it all into one month.
- Hint Health payoutMonthly memberships
- Annual family plan, ReyesAnnual memberships
- McKessonDispensed medications
- Quest DiagnosticsLab send-out fees
- Suite rent, 4BRent
Why your books are different
A direct primary care practice's books go wrong in four specific places.
A generalist sees recurring deposits and assumes it is simple. A membership model has its own traps: money paid a year ahead, medications sold at cost, and a panel that grows slower than the bills do. Get those wrong and you cannot tell if the panel is actually paying for itself yet.
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1
A prepaid year lands in one month
A family that pays $2,400 for a year of membership up front hands you the whole year's revenue in one deposit. Booked as one month's income, that month looks great and the following eleven look thinner than they are.
What we doKeeps prepaid annual memberships visible as their own line, so one family's yearly payment does not make a slow month look fine or a good month look inflated. -
2
Meds dispensed at cost look like a markup
Many direct primary care doctors sell generic medications to members at wholesale cost, no markup. If that revenue and the wholesale bill both land in generic categories, it looks like margin that is not really there.
What we doKeeps what you collect for dispensed meds next to what you paid for them, so the wash shows up as a wash, not as profit. -
3
Enrollment fees get lost in monthly dues
A one-time enrollment or onboarding fee charged when a new member joins is a different kind of income than the recurring monthly due, and it tells you something different about growth.
What we doSplits enrollment fees from monthly membership dues so you can see new member growth apart from the recurring base. -
4
A slow-growing panel hides in a decent month
Membership practices can look fine on paper for a year while the panel barely grows, because a few annual prepays smooth out the number.
What we doTracks the recurring monthly membership total apart from one-time payments, so you can see whether the panel itself is actually growing.
Your categories
The categories Gus keeps for a direct primary care practice.
Set up once for how your panel pays and what the practice spends. You never pick a category. He does, and an accountant checks it.
Money in
- Monthly membershipsRecurring dues billed through Hint Health, Spruce Health, or a similar biller.
- Annual membershipsMembers who prepay a full year, kept apart from the monthly recurring base.
- Enrollment feesOne-time fees charged when a new member joins the panel.
- Dispensed medication feesWhat members pay for meds sold at or near wholesale cost.
- In-house lab feesDraws and point-of-care testing billed directly to the member.
Money out
- Dispensed medication costsWhat you paid McKesson or a similar wholesaler for the meds you sold at cost.
- Membership billing softwareHint Health, Spruce Health, or whatever runs your recurring billing.
- Lab send-out feesQuest, LabCorp, or another reference lab for anything not run in-house.
- Rent and utilitiesThe clinic suite, kept simple since most panels run lean on space.
- Staff wagesA front desk or medical assistant, if the panel supports one.
- Malpractice insuranceAnnual or quarterly premiums for the practicing physician.
- Marketing to grow the panelLocal ads, referral incentives, and the website that brings new members in.
What we watch for you
- Recurring membership total
The monthly dues alone, apart from prepays, so you can see if the panel is actually growing.
- Med dispensing wash
What you collect for dispensed meds against what you paid, to confirm it stays close to break-even as intended.
- Cost per member
What it costs to run the practice divided by panel size, tracked over time as the panel grows.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things direct primary care doctors ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
No, but I keep it labeled as prepaid membership, not regular monthly dues, so the following months do not look like they fell off a cliff.
You still report the sale and the cost, even if they roughly cancel out. I keep both lines so it nets out clean instead of looking like unexplained income.
That depends on whether she sets her own hours and bills you a flat rate, which usually points to a contractor, or works your schedule under your supervision. That call is above my pay grade, so I flagged it for the accountant.
The tax side
The tax side of a direct primary care practice.
Most of what matters here is timing prepaid revenue correctly and knowing where the pass-through deduction starts to phase out.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- The pass-through deduction phases outA medical practice can lose part or all of the 20 percent pass-through deduction once taxable income passes $201,750 single or $403,500 joint, since medical practices are a specified service trade.
- Exam room equipmentAn exam table, a portable ultrasound, or point-of-care lab equipment can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Covering physician payA doctor who covers your panel occasionally and bills you directly is often a contractor and gets a 1099-NEC if you pay them $2,000 or more in 2026, due January 31.
- S corp election timingIf you are weighing an S corp structure to separate salary from remaining profit, the election for the current calendar year is due March 15, with late relief available in some cases.
Deductions direct primary care practices miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Malpractice premiums
- Membership billing software
- Medications dispensed at cost
- Point-of-care lab supplies
- Small clinical instruments
- CME courses and travel
- License and DEA renewal fees
- Biohazard disposal
- Scrubs and clinical apparel
- Marketing to grow the panel
- Answering service
- Clinic suite rent
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A direct primary care year, kept every month.
Your panel pays the same way most months. Your taxes and your annual prepays do not. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, any 1099 for a covering physician is ready, and you get a monthly set-aside so April is already handled.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether panel growth this year changed the number.
- October
Before renewal season
Many members renew or reconsider membership around the new year. Gus looks at whether a prepay push makes sense and what to do before December.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for direct primary care practices. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions direct primary care doctors ask first.
Do you bill my members' insurance?
No. Gus does not handle insurance billing, medical coding, or claims of any kind, and most direct primary care practices are not billing insurance for the membership itself anyway. He works from what lands in your bank account.
How does Gus handle a family that prepays a full year?
He books it as prepaid membership revenue rather than one month's income, so your recurring monthly total still shows what the panel is really doing.
I sell some medications to members near wholesale cost. Does that complicate things?
Not really. Gus keeps what you collected for meds next to what you paid the wholesaler, so it nets out close to even instead of reading as unexplained profit.
My panel is still small. Is monthly bookkeeping worth it this early?
Most practices find it easier to grow with clean numbers from month one than to untangle a year of mixed dues, prepays, and med costs later.
Do I owe sales tax on membership dues?
Most states do not tax a medical membership fee the way they tax a retail sale, but rules vary by state and by exactly what the membership includes. Gus flags it and the accountant confirms your state's treatment.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever