The real value isn’t the one-time look. It’s staying there.
Ongoing fractional CFO and virtual CFO services for independent dental practices.
Certified Management Accountant (CMA) · Member, Institute of Management Accountants (IMA)
Who it’s for
Independent dental practice owners who’ve completed the Financial Pulse Assessment and want a financial partner beyond a one-time review.
What’s included
A 12-month cash forecast, a monthly insurance AR review, plain-language monthly numbers, dental benchmarks, and someone watching your numbers between meetings.
What you get out of it
Decisions made with current information. Fewer surprises. A roadmap that changes as your practice does.
How it’s delivered
Two scheduled calls each month plus unlimited email. Onboarding happens in person, and the rest works remotely anywhere in the US.
Running a growing practice without a CFO
The decisions are getting bigger: another provider, new equipment, a second location, a partner who wants in or out. Each one has real money attached, and most get made with last year’s numbers and a gut feeling.
Meanwhile you’re still seeing patients. Your office manager is holding more than their job description. Your CPA checks in at tax time.
What happens without ongoing oversight: Small problems grow quietly. A payer slows down. Overhead creeps up a point at a time. A great month hides a bad trend. By the time it shows up, it’s a bigger fix than it needed to be.
Why most practices don’t get the CFO support they need
A full-time CFO doesn’t fit most independent practices.
The cost and the workload rarely match what a practice needs week to week.
Once-a-year check-ins look backward.
Your CPA’s year-end work matters, but it tells you what happened, not what’s coming.
Doing it yourself happens at 9 p.m.
After clinic, after charting, when you’re the least interested in a spreadsheet you’ll ever be.
One-time consultants leave.
You get a report, maybe a good one, and then nobody’s there when the numbers change next quarter.
Senior financial oversight, scaled to your practice, from someone who stays.
What a fractional CFO does for your practice
Think of it like a GPS. You’re in the driver's seat. It’s your practice, your call, your direction. I’m the one watching the map, telling you what’s coming up, and recalculating when the road changes.
We start with what the Financial Pulse Assessment found. That becomes your roadmap. From there, we settle into a rhythm: regular reviews, a forward-looking cash outlook, and me flagging things before you have to ask.
The roadmap isn’t a document you get once and forget. It evolves as your practice does.
What’s included in fractional CFO advisory
Every advisory relationship includes the same core. Partner goes deeper on every piece and adds planning for your next big move.
A 12-month cash forecast.
Big bills and slow months stop catching you off guard.
A monthly insurance AR review.
I work alongside your office manager to shrink the 90+ day bucket.
A one-page monthly picture.
Your numbers, explained in plain language.
Benchmarks built for dentistry.
See how your overhead compares, including specialty benchmarks where published data exists.
Growth without longer hours.
One or two ways to grow that don’t mean more patients or longer days.
Help with one-time decisions.
Equipment: buy, lease, or finance, and what each choice does to cash flow.
Annual goals, checked quarterly.
A goal-setting session and a one-page plan we revisit every quarter.
Two scheduled calls each month.
A strategy call and a mid-month check-in, with email replies by the next business day.
Partner adds
A full plan for your next milestone, with the numbers behind every decision
“What if” models before you add an associate, open a location, or get exit-ready
A close look at your insurance contracts and write-offs, so you know what your PPOs really cost you
Which providers, days, and locations actually make you money
An annual budget built with you
A quarterly planning session with you and your office manager
Up to two major projects a year, one at a time
I join your CPA, attorney, or broker meetings so everyone works from the same numbers
How it works day to day
Every client gets a 60-minute strategy call and a 30-minute mid-month check-in, plus unlimited email. Foundation keeps a steady practice on track. Partner is for practices making a big move in the next year or two.
Between meetings, if something needs your attention, I reach out. If something urgent comes up between calls, we’ll get on the phone.
What this asks of you
A little time, and honesty. Regular check-ins, full attention, and no distractions. Books kept current, and a willingness to act when something needs to change.
What this doesn’t include
I don’t prepare taxes, keep books, run payroll, or handle billing. Your CPA, bookkeeper, payroll provider, and billing team keep doing what they do. My job is making sure everyone’s working from the same clear picture.
Two ways to work together
Advisory is priced monthly, and the tier depends on what’s ahead for your practice, not its size.
After your Financial Pulse Assessment, I put together a proposal built around what we found. You review it before anything starts, and 25% of your assessment fee is credited toward the work.
Foundation
For steady practices with no major milestone in the next year. You know where your money goes, your AR gets real attention, and one-time decisions like equipment get a clear answer.
Partner
For practices making a big move: adding an associate, expanding, or getting ready to sell. Practices running more than one location often land here too. You get a partner who plans each move with you and stays through it.
Need help with one big move but otherwise steady? Foundation clients can add a fixed-fee milestone project instead of switching tiers.
The value case: a full-time CFO is out of reach for most independent practices. Fractional advisory gives you the same level of financial thinking, sized to what you actually need.
Your first 90 days with a fractional CFO
Why choose Keystone as your fractional CFO
Two things shape how I look at every decision you bring me.
I’ve worked chairside.
I started as a certified dental assistant. I know what a no-show, a morning that runs long, or a short-staffed day actually does to a practice, because I was there for it. Most finance people only ever see it as a dip on a report.
I’ve worked on the payer side.
Ten years in healthcare finance, including health insurance and workers’ compensation. I know why claims get denied, what payers look for, and where reimbursement quietly slips away.
Put those together and you get a different view.
Most CFOs look at your practice from the books outward. I look at it from the chair, the claim, and the books, and how each one affects the others.
And the rest of what you’d expect.
A Certified Management Accountant (CMA) built on forecasting and decision analysis. You work with me directly, with no hand-offs to associates. I keep a small client list on purpose, and I’ll tell you if I’m not the right fit.
Fractional CFO FAQ
What is a fractional CFO?
What’s the difference between a fractional CFO and a virtual CFO?
Do I need the Financial Pulse Assessment first?
Will you replace my CPA or bookkeeper, or do my taxes?
How often do we meet?
What’s the difference between Foundation and Partner?
Can I switch tiers?
Is my practice big enough for a fractional CFO?
Can you help with a practice sale, partner buy-in, or DSO offer?
Do you work with practices outside Oregon?
Meet your fractional CFO
Before I was a fractional CFO and business advisor, I was a dental assistant. I know what it costs a doctor to carry patient care, staff, and business pressure all at once, and later, in insurance, I saw the same squeeze from the payer’s side.
I’m Melissa Leavitt, a Certified Management Accountant (CMA), and I keep my client list small on purpose. You want to provide a standard of care for your patients. Your team needs you focused. Your work-life balance deserves to be better. That’s what real clarity makes possible.
How fractional CFO advisory works
1
Schedule a conversation.
We talk through what’s happening in your practice.
2
Complete the Financial Pulse Assessment.
This is a paid engagement, and 25% of the fee is credited toward any work that follows.
3
Review your proposal.
Foundation or Partner, built around what the assessment found.
4
Get set up.
Access to your books, an introduction to your CPA and bookkeeper, and your roadmap.
5
Settle into the rhythm.
Regular reviews, a forward-looking outlook, and flags between meetings when something needs your attention.
Ready for a fractional CFO who stays?
Start with a conversation. If ongoing advisory makes sense, the assessment is next. If it doesn’t, you’ll know that too.