Healthcare practice owners we help
Healthcare practices have a payment structure that creates predictable cash flow friction, and MCA funders have moved aggressively into the space. The reasons are structural: insurance reimbursement cycles routinely take 30 to 90 days; patient responsibility (the post-insurance balance) is increasingly significant and slow to collect; equipment costs are high and financed long-term; and overhead — staff, rent, supplies, malpractice insurance — runs continuously regardless of whether reimbursements arrived this week.
The practices we see typically share some combination of:
- Stacked MCAs taken to bridge accounts-receivable gaps — particularly for practices with significant Medicaid, Medicare, or contracted-payer mix where reimbursement lag is structural.
- Equipment financing layered on top of MCA debt — dental chairs, imaging equipment, specialized medical devices, or build-out financing on five-to-seven year notes.
- Payer-mix shifts — a contract change, a payer dropping out of network, or shifting fee schedules that change the revenue picture mid-year.
- Personal-guarantee exposure — most small-practice debt carries a personal guarantee from the owner, which means business debt stress becomes personal credit and asset exposure.
- Specialty-specific pressure — dental, chiropractic, mental health, physical therapy, and aesthetics practices each have specific payer dynamics that shape what's realistic to negotiate.
Why practice owners work with us
Healthcare practices typically have valuable underlying businesses — established patient bases, clinical reputation, real equipment, and predictable (if delayed) cash flow. That value is what makes restructuring genuinely viable when the math supports it, and it's also what makes the wrong kind of debt resolution — aggressive settlement, contingency-fee firms, or premature bankruptcy — particularly costly.
We are not contingency-fee debt firms, not lenders, not factoring companies. We are independent business consultants paid a flat fee by you. We have no incentive to push you toward any particular outcome and no affiliation with any MCA funder, equipment financer, or refinancing source. Our role is to map your actual position — receivables aging, payer mix, overhead, debt service — and tell you what's realistic, including when the realistic answer is restructuring rather than settlement, or vice versa.
For some practices that's negotiating with current creditors while preserving the patient base and clinical operations. For others it's refinancing into SBA or bank financing if the financials and credit support it. For others it's settlement on specific positions, or in some cases a structured wind-down or sale. We give you the picture, with numbers.
How a healthcare practice consultation works
Step 1 — Position review. We map every open MCA, equipment note, line of credit, your accounts receivable aging by payer, your payer mix, fixed overhead, and any tax exposure. The receivables picture matters because A/R looks like an asset but doesn't pay daily MCA debits — the question is when it converts to cash.
Step 2 — Options modeling. We model the realistic paths — restructuring with current funders, refinancing into SBA or bank financing if your credit and financials support it, settlement on specific positions, or a structured wind-down or sale if the practice itself has value but the debt structure isn't sustainable. Each path includes cost, timeline, and risk.
Step 3 — Written decision framework. You leave with a written plan keyed to your priorities — preserving the clinical practice and patient base, protecting personal credit and licensure, minimizing tax exposure on forgiven debt, or executing a clean transition. You can execute it with us, with your attorney and CPA, or on your own.
What practice owners should know about MCA debt
A few realities specific to healthcare worth understanding before you negotiate or sign anything new.
Receivables as collateral. Most MCA contracts assert an interest in future receivables — and for healthcare practices, that includes insurance reimbursements. The interaction between an MCA's claim on receivables and any existing factoring or revenue-cycle-management agreement can create real conflicts. If you have both, the contracts need to be read carefully together. Our guide to evaluating an MCA stack covers the framework.
Compliance considerations in negotiation. Practices subject to HIPAA, Stark, anti-kickback, and state-specific regulatory frameworks need to be careful that debt resolution structures don't inadvertently create regulatory exposure. This is a real risk in some restructuring arrangements that involve revenue-share or referral-based structures. It's a reason healthcare debt situations particularly benefit from involving healthcare-experienced counsel. The U.S. Small Business Administration publishes general small business financing guidance that's a neutral starting point.
Tax treatment of forgiven debt. If a practice settles debt for less than the full balance, the IRS generally treats the forgiven portion as taxable income, reported on Form 1099-C. For a healthcare practice already pressured on cash, an unexpected tax bill in the year of settlement can compound the problem. We model this into the options review so it isn't a surprise.