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MSO Service

Tax strategy and planning for healthcare practices

Year-round planning, entity structure, reasonable compensation, and state-level elections — decided before December, not reported after it.

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CPA-led · Nationwide & fully remote · Flat monthly fees

The Problem

A tax return is a receipt. Planning is what changes the number.

By the time the return is prepared, almost every decision that mattered has already been made. Practices that pay less tax are not more aggressive, they are earlier.

The entity was never revisited

The structure that fit a solo practitioner rarely fits a three-provider group. We rerun the S-corp math annually rather than assuming the original answer still holds.

Reasonable compensation guessed at

Set it too low and you invite an audit. Too high and you overpay payroll tax. It deserves a documented study, not a round number.

State elections missed

California PTET and similar state workarounds have hard deadlines and real money attached. Missing the prepayment window costs the whole benefit for that year.

What You Get

Everything your practice needs behind the front desk

One integrated, CPA-led team handles the entire business side, so your energy stays on care.

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✓ Annual entity structure review and S-corp analysis
✓ Documented reasonable-compensation study
✓ Quarterly estimates and projections
✓ California PTET and multi-state election planning
✓ Retirement plan design and contribution strategy
✓ Depreciation, Section 179, and equipment timing
✓ Business and owner return preparation
✓ Audit representation if a return is examined

What You Get

What tax strategy includes

Planning that runs on your calendar year, with the decisions surfaced while you can still act on them.

Assess

A free deep-dive into your books, entity, comp, and pain points.

Build

We clean up the books, set your chart of accounts, and stand up the compliance calendar.

Run

Monthly financials, payroll, and tax filings delivered like clockwork.

Grow

Quarterly strategy, benchmarking, and proactive tax planning.

A worked example

What a year of planning is actually worth

Not a list of strategies. One practice, one year, and the decisions that moved the number.

S-corp election and reasonable compensationIllustrative

Net practice profit before owner compensation$318,000

Self-employment tax with no election, capped at the wage base$31,200

Owner salary set at a defensible level$135,000

Payroll tax on that salary, both halves at 15.3%$20,655

Payroll tax saved by making the election$10,545

Cost of the study and the added payroll filings($4,200)

Solo 401(k), employee plus employer$46,000

Tax deferred on the contribution at a combined marginal rate$18,400

Net benefit for the year$24,745

What this tells you

Why the salary number mattersSet it too low and the election invites an audit adjustment plus penalties. Too high and you have paid payroll tax you did not owe. It is a defensible-range question, documented in a study.
Why this is a January decisionSalary has to run through payroll during the year. Discovered in March, most of this is gone.
What we do with itThe election, the study, the payroll setup, the plan document, and the quarterly check that the numbers still hold.

Illustrative single-owner example using round numbers and current-year rates to show the mechanics. The payroll-tax saving is smaller than the headline 15.3% because the Social Security portion stops at the wage base, and the retirement figure is a deferral rather than a permanent saving. Your result depends on entity, state, payroll and plan design. Not a projection or a guarantee.

Questions

How year-round planning works

No, and anyone who tells you otherwise is selling. Below a certain profit level the payroll and compliance cost exceeds the self-employment tax saved. We run the actual math on your numbers each year.

The pass-through entity tax lets the business pay state income tax and deduct it federally, working around the SALT cap. In California it requires a prepayment by a specific date. If you have California income and have not elected, that is worth a conversation.

Yes, and that matters. When the same team plans and files, nothing gets lost between the strategy and the filing, which is where most planning quietly fails.

The Difference

No equity. No percentage of your growth.

Most management services organizations charge for your back office by taking ownership or a share of every dollar you collect. One costs you control. The other costs you more each year you succeed.

Equity MSOs take ownership

A DSO or private-equity group provides the back office in exchange for a stake. You get infrastructure. You also get a board, a budget you no longer set, and an exit on their timeline.

Percentage MSOs tax your growth

A fee set as a share of collections does not stay flat. Running your back office is not twice the work when revenue doubles, but the fee is. Every good year costs you more.

We take neither

A flat monthly fee for a defined scope. No equity, no share of collections, no right of first refusal if you sell. Grow the practice and the upside stays with you.

Why our model is different →