Medical practices & clinics
Books and taxes for wound care clinics.
Skin substitute products that cost thousands per application, a hyperbaric chamber running sessions daily, and patients coming back weekly for months. 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
February came in at $45,300. A skin substitute graft applied to two patients cost more than most of the month's other supplies combined, so I kept that cost tied directly to those cases.
- Availity batch deposit, graft applicationsAdvanced wound product reimbursements
- Skin substitute graft orderAdvanced wound product costs
- Hyperbaric session reimbursementsHyperbaric therapy revenue
- Chamber maintenance and certificationHyperbaric equipment costs
- Clinical staff payrollClinical wages
Why your books are different
A wound care clinic's books go wrong around a few very expensive line items.
Most of your patients come back weekly for months, but the real swings in your books come from advanced products and equipment that cost far more than a typical office visit. A generalist averages it all together and loses sight of what's actually driving a strong or a thin month.
-
1
Skin substitute and graft costs dwarf other supplies
An advanced wound care product applied during a single visit can cost thousands of dollars, reimbursed separately from the visit itself, and if that cost gets lumped into general supplies it swamps every other number in the category.
What we doKeeps advanced wound product costs and their reimbursements in their own lines, tied to the cases they belong to, so one expensive application doesn't distort the whole supply picture. -
2
Hyperbaric therapy runs like its own business inside the clinic
A hyperbaric chamber generates per-session revenue but also carries its own maintenance, certification, and staffing costs, closer to running a separate piece of equipment-heavy infrastructure than a normal treatment room.
What we doKeeps hyperbaric revenue and its equipment costs in their own lines, so you can see whether the chamber itself is paying for its upkeep. -
3
Weekly recurring visits hide how long a patient stays on the books
A patient with a chronic wound might come in weekly for three to six months, and without tracking that arc, a full patient panel can look the same whether it's mostly new short-term cases or long-running ones.
What we doTracks recurring visit revenue by patient where the bank data allows it, so a shift toward longer-running cases becomes visible over time. -
4
Wound vac rentals get treated as a one-time sale
Negative pressure wound therapy devices are typically rented for the length of treatment and returned, not sold outright, and booked as a single sale, the ongoing rental nature of the revenue disappears.
What we doKeeps wound vac rental revenue in its own line, tracked as ongoing rather than a one-time transaction.
Your categories
The categories Gus keeps for a wound care clinic.
Set up once for how visits, advanced products, and hyperbaric therapy all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Office visit reimbursementsDeposits from payers for standard wound check and debridement visits.
- Advanced wound product reimbursementsSkin substitute and graft applications, kept apart from standard visits.
- Hyperbaric therapy revenuePer-session hyperbaric oxygen therapy reimbursements.
- Wound vac rental revenueOngoing rental fees for negative pressure wound therapy devices.
Money out
- Advanced wound product costsSkin substitutes and grafts, tied to the specific cases they were used for.
- Hyperbaric equipment costsChamber maintenance, certification, and safety inspections.
- Wound vac equipment and suppliesDevices and dressing kits used for negative pressure therapy.
- Clinical wagesWound care nurses and hyperbaric technicians, kept apart from provider compensation.
- Malpractice insuranceAnnual or quarterly premiums for the practicing physicians.
- Rent and utilitiesTreatment rooms and the space housing the hyperbaric chamber.
- Practice management softwareScheduling, charting, and billing tools.
What we watch for you
- Graft cost per case
What advanced wound products cost against what those cases reimburse.
- Hyperbaric margin
What hyperbaric sessions bring in against the chamber's maintenance and staffing costs.
- Long-running patient share
How much of the patient panel is long-term recurring cases versus newer, shorter ones.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things wound care clinic owners 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.
Probably not, a skin substitute graft for two patients likely drove it. I keep advanced product costs tied to the cases they belong to, so a spike like that reads as expected, not alarming.
I keep session revenue against maintenance and staffing costs in their own lines, so you can see that math directly instead of guessing.
Where the bank data allows it, I track recurring visits by patient over time, so a shift toward longer-running cases becomes visible instead of blending into the total.
The tax side
The tax side of a wound care clinic.
Most of what matters here is tracking advanced product costs 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 wound care clinic 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.
- Advanced wound product costsSkin substitutes and grafts are generally deductible as the cost of the specific case they were used for, separate from your other operating expenses.
- Hyperbaric chamber purchasesA hyperbaric chamber can usually be written off the year you buy it, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Contract or covering physiciansA physician covering your clinic occasionally who 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.
Deductions wound care clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Advanced wound product costs
- Hyperbaric chamber maintenance
- Wound vac equipment and supplies
- Malpractice premiums
- CME courses and travel
- Board certification renewal
- Practice management software
- Biohazard disposal
- Scrubs and clinical apparel
- Dressing and debridement supplies
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 wound care clinic year, kept every month.
Advanced products, hyperbaric sessions, and long-running patients each move on their own rhythm. Your taxes come on a fixed schedule. 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, and you get a monthly set-aside so April is already handled, even with expensive graft cases in the mix.
- 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 advanced product volume or hyperbaric sessions changed the number.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, while chronic wound cases often continue steadily through winter.
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 wound care clinics. 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 wound care clinic owners ask first.
Do you bill insurance for graft applications or hyperbaric sessions?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
How do you keep expensive graft costs from distorting our supply numbers?
Gus keeps advanced wound product costs in their own line, tied to the specific cases they belong to, so one costly application doesn't swamp your general supply category.
Can Gus tell me if the hyperbaric chamber is worth what we're spending to run it?
He can show you session revenue against maintenance and staffing costs directly. Whether that math works for your clinic is a call for you and your accountant.
Do wound vac rentals get booked differently than a normal sale?
Yes, they stay in their own line as ongoing rental revenue rather than being treated like a one-time sale, since the device is usually returned once treatment ends.
Some patients have been coming weekly for six months. Does that matter for the books?
Where the bank data allows it, Gus tracks recurring visits by patient over time, so a shift toward longer-running cases is visible instead of disappearing into the total.
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