Cash flow for a medical practice, planned 13 weeks ahead
Updated 16 October 2026
A practice can show a profit and still run short of cash. Insurers pay weeks after the visit, payroll runs on a fixed calendar, and tax payments and equipment bills arrive in lumps. The gap between those dates is a timing question, and a forecast answers it. This page sets out a 13-week cash forecast for a medical practice, the costs that drain cash without notice, and the rules for reserves, draws and a credit line. Some examples use clinic figures from franchise brands' Franchise Disclosure Documents (FDDs), the documents a franchisor must give a buyer before a sale.
What the forecast tracks, week by week
The forecast opens with the bank balance at the start of the week. It adds expected insurance payments, listed by payer and by week. It adds expected patient payments. It subtracts payroll, including provider pay and the dates bonuses fall due. It subtracts rent, supplies, vendors, taxes and loan payments. It subtracts owner draws and partner distributions. The last line is ending cash for each week, set against the minimum balance the owners have agreed the practice must hold.
AFC Urgent Care's 79 affiliate-run centers averaged $1,793,641 of revenue and $282,343 of 4-Wall profit in 2025. That leaves $1,511,298 of cost a year at the average AFC Urgent Care center, or $29,063 a week. Thirteen weeks of that cost is $377,825. AFC Urgent Care's Item 7 lists $200,000 to $500,000 of working capital for the first three months, and the 13-week cost of the average affiliate center sits inside that range.
Why thirteen weeks
Thirteen weeks is one quarter. That span reaches the next quarterly tax payment, the next large vendor bill and every payroll in between. It stays short enough that the practice can estimate collections from its current claims and aging report. The forecast is updated every week. Each update rolls one week off the front and adds one week at the end. The weekly rhythm lets the practice see a shortfall in week seven while it is still in week one.
The Joint Chiropractic's franchise agreement fixes a local advertising minimum of $3,000 a month and a technology fee of $599 a month. Together those come to $43,188 a year, or $831 a week, at any Joint Chiropractic clinic billing under $720,000, where the 5% advertising rate overtakes the minimum. The average facilities cost across 492 Joint Chiropractic clinics was $65,382, or $5,448 a month. A Joint Chiropractic owner can enter those three lines in every week of the forecast before estimating a single patient payment.
Four costs that drain cash without notice
Equipment and software leases renew while nobody checks how much the practice still uses the machine or the service. Supply orders repeat at par levels set years ago, and supplies, vaccines, injectables and reagents sit on shelves as cash. Staffing set for the busiest season stays in place through the slow months, so payroll absorbs the margin the practice should be saving. Owner draws taken from whatever the bank shows leave no reserve behind.
Medi-Weightloss requires $5,000 a month of local advertising from each clinic, or $60,000 a year. Medi-Weightloss's FDD shows that requirement equals 11.7% of sales at its bottom third of clinics and 3.3% at its top third. In a 13-week forecast that is $1,154 a week, or $15,000 for the quarter, for a Medi-Weightloss clinic at any sales level. A fixed outflow of that kind belongs on its own forecast line.
Reserves, draws and the credit line
The owners set a minimum operating balance and write it down. The tax reserve sits in a separate account, apart from operating cash. A line of credit covers timing gaps tied to growth or to a known event, such as a new provider's first months. A line drawn month after month signals a structural cash problem. The practice never pays debt down below its minimum operating balance. Whether to pay debt down or hold cash depends on the interest rate, the cash position and the next twelve months of plans.
Owner draws follow the forecast. The practice sets a draw amount the forecast supports and pays it on a set schedule. Vendors are paid on their terms, which keeps cash in the account until the due date.
MaxLiving charges a flat royalty of $1,850 a month, and with $400 of marketing the brand bill is $2,250 a month. MaxLiving's 77 reporting clinics averaged $54.80 a visit in 2024, so 41 visits cover the brand bill each month. That flat $27,000 a year is 9.14% of revenue at MaxLiving's bottom fifth of clinics and 1.36% at the top fifth. A MaxLiving owner who forecasts weekly visits can see the week each month when the brand bill is covered.
Tax payments and lumpy bills
Quarterly tax payments and annual bills cause most surprises in a practice's cash. Malpractice premiums, license renewals, equipment payments and year-end bonuses each arrive on known dates. The forecast places each one in its week as soon as the date is known. A CPA sets the amount of each estimated tax payment, and the forecast carries that amount and its due date.
The figures are an illustration. A practice holds $180,000 in its operating account and has set a minimum balance of $120,000. The forecast shows a $45,000 estimated tax payment in week five and a $38,000 annual malpractice premium in week six. Ending cash in week six falls to $97,000, which is $23,000 under the minimum. The owners move a planned $25,000 distribution from week four to week nine, and week six ends at $122,000.
What this means for a practice owner
A 13-week forecast lists cash in, cash out and ending cash for each week, against a minimum balance the owners have set. It is updated every week. Fixed brand and lease charges go in first because they do not move with sales. Tax payments, premiums and bonuses go in the week they fall due. Draws follow the forecast. The credit line covers timing gaps. At AFC Urgent Care's affiliate centers, thirteen weeks of average cost came to $377,825.
Getting the forecast built
Averan Advisors builds and updates 13-week cash forecasts for practices as part of its fractional CFO work, and the bookkeeping service keeps the bank and payer records current each week so the forecast starts from the right balance. The Medical Practice Numbers Check includes a cash section a practice can run on its own figures.
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