A practice can feel busy and be fragile at the same time. Collections arrive, payroll clears, and the balance rises and falls without ever quite answering the only question that matters: is this practice building anything durable? A quarterly review built on four numbers answers it in under an hour. None of the four requires an accounting background. All four reward being watched over time.

1. Months of expenses in reserve

Divide the cash the practice could reach today by one month of operating expenses. The result is the number of months the practice runs if collections stopped. There is no universal correct figure, because a practice with stable insurance contracts and a practice dependent on a few large cases live in different worlds. There is a correct direction: the number should not quietly shrink quarter after quarter while the schedule stays full.

2. Receivables older than 90 days

Old receivables are work already done that has not become money. Tracked as a share of total receivables, this number tells you whether the problem is volume or follow-through. A rising share usually points to a process: a coding pattern, a payer behaving differently, a claim nobody owns. It is rarely a mystery once someone is assigned to look at it monthly.

3. Debt payments as a share of collections

Add every required debt payment the practice makes in a quarter, including equipment and practice acquisition loans, and divide by collections. The share matters more than the balance. Balances fall on schedule and tell you little. The share tells you how much of each month’s work is already spoken for before the practice makes a single discretionary decision.

4. What was actually set aside

Retirement contributions and tax reserves are where good intentions go to be postponed. The honest quarterly number is not the plan. It is the amount that actually moved, into the retirement plan and into a separate tax account, during the quarter just ended. Retirement plan types, contribution limits, and deadlines differ by entity structure and jurisdiction, and they change. The habit of funding on a schedule, reviewed against the current rules with your own CPA, matters more than any single year’s figure.

The review itself

Put the four numbers on one page, next to the same four numbers from the prior four quarters, and write two sentences about the largest change. That page, kept quarterly, is the difference between a practice that feels successful and one whose owner can show, in numbers, what it is building.