The Pre-Launch Financial Playbook For Direct Primary Care Clinics with Dan Luna

Most people start a direct primary care practice because they want better medicine and more time with patients, but the part that quietly decides whether the clinic survives is the financial foundation. I sit down with Dan Luna, a bookkeeper who works inside the DPC world, to talk through the unglamorous basics that keep a membership-based clinic alive: planning for the income gap, building a simple cash-flow buffer, and understanding what your fixed costs really are when you finally open the doors.

We also zoom out to the business setup decisions that confuse almost every first-time owner. Dan explains how to think about an LLC versus an S-Corp election, why liability and tax treatment drive the choice, and when it’s smart to bring in a CPA so your accounting system is built correctly from day one. Then we get tactical about bookkeeping, what it is and what it isn’t, and the real-world signal that it’s time to stop doing it yourself. His “queen bee” analogy is a reset for overwhelmed clinic owners: your highest-value job is caring for patients and growing a sustainable panel, not reconciling transactions at night.

Finally, we talk tools and pricing. QuickBooks is still everywhere, but AI accounting software is changing the landscape, and the right support matters more than the logo on your ledger. We also tackle the fear behind undercharging in direct primary care, how pricing connects to burnout, and why charging enough to fund support and systems is part of delivering great care. Subscribe for the next part of the series, share this with a DPC owner who needs a financial reset, and leave a review with your biggest question about pricing or startup cash flow.

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Transcript

Season Kickoff And Guest Intro

0:06

Welcome to season three of the DPCMP Podcast. I'm your host, Amanda Price, nurse practitioner, clinic owner, and someone who believes there's a better way to care for patients. This season we're diving deeper into the real stories, challenges, and breakthroughs behind direct primary care. Whether you're just curious or ready to take that leap, you're in the right place. Let's get started. Hey everybody, and welcome to the DPC MP podcast. I am excited to bring to you a wonderful guest today. His name is Dan Luna. He is actually Monica McHitterick's bookkeeper. He came and spoke at the DPC Launchpad this year while we were out in the middle of the Caribbean Ocean, where I met him and decided he needed to clean up my books. So now he is my bookkeeper. So I wanted all of you out there to get a chance to know him and see how he could possibly help you get your DPC clinic started or to be able to scale and grow your clinic to the best of its ability. So, Dan, welcome to the show. Thanks. I am excited to be here for the second time since I didn't push record the first time. I I hope at some point you tell the audience about that. I think I'll leave that in. Yeah, because I want them to know that I am a flawed individual. Keep it authentic around here. Yeah. Absolutely absolutely. So now that we are recording, I would like them to have a brief synapse of who you are as a human being.

Dan’s Path Into DPC

1:40

Go for it, Dan. Sure. So super quick, about 25 years ago, I went to school, studied accounting, got out, realized I'm not a good employee, became entrepreneurial, did that for a while. Um when COVID hit, I became remote. And so I just did bookkeeping solely instead of this with other entrepreneurial pursuits. About four or five years back now, I ran into DPC just as a person looking for care. Uh wife and I were both uh non-W-2 employees. She had become a consultant at that point, and so I just ran into DPC and I stumbled across it and I loved it. I fell in love with the model. It became a huge values alignment because I think we all can agree the whole medical situation in this country is just not working. And I yeah, I fell in love with the business, I fell in love with the industry, and I think it's it's something that's important. So yeah, I've just been dedicating myself to that for the last few years. Awesome. And so you have a wife and your kids? Yeah, for sure. Yes, and don't forget to tell them the personal side. We like that too. Yeah, for sure. So my wife is an RN and she has been for she'll be it'll be 20 years at some point in the near future. Um, she worked at the uh local county hospital in Las Vegas, Nevada, and she became uh an epic consultant after a go live at that uh hospital system, and so she's lucky enough to homeschool our kids. So my 19-year-old daughter, she is going to school in Los Angeles. That's Christina. I have my 11-year-old son Max, who is super into dinosaurs and archery, and then I have Bella, who is six and is a princess everywhere she goes. Nice. Well, good. Well, let's get into

Bridging The Income Gap

3:15

it. You have written a book that we are calling DPC Bookkeeper, the pre-launch playbook, which, by the way, if y'all are on the um uh NP and PA in direct primary care Facebook page, he has graciously uploaded this to our Facebook page so that you guys can look at it. It's broken down beautifully in all these different phases to help someone be able to basically open their DPC and to make it successful. So I'm just gonna go through these phases, Dan, and ask a question out of each one of the phases. And if you'll just give us your two cents worth about that, I would appreciate it. Yeah, let's do it. Not just me, everybody will actually. Okay, so phase one is foundation. How do I bridge the income gap while my practice is ramping up? Yeah, so I think the number one thing is to plan for it. The gap is gonna be real. If you are a working clinician, obviously you're gonna go from six figures to to nothing, right? So planning for that is important. As far as timeline, I would I would set my internal clock to about 12 to 24-ish months to get back to where you currently are at. So running out of cash is gonna be the biggest challenge. So planning ahead is gonna be the biggest mitigating factor for that. A lot of people will do a simple business model. So finding out what your income is gonna be, finding out what your expenses are gonna be, and then being like, all right, I have roughly a five, I'm making up a number, five thousand dollars a month fixed costs that I have to spend every month once I start and open my doors. So I want to have a three-month buffer, five times three. So I'm gonna have a 15k savings before I launch. That's one of the ways to reduce uh the anxiety and to give yourself the best chance of survival. Because in the beginning, pre-launch, like as soon as you launch, the biggest threat to your business is not gonna be burnout, it's gonna be uh running out of money. So if you plan for that, you're good. Also, I mean, let's say you just go full bore, both feet in the water, and do DPC solely. There's also doing you can do some per diem work, some other things like that that can kind of help you bridge the gap. If you have a working spouse, obviously you're you're super blessed, and you can have that as a means of support as well. But the kind of the overarching sentiment is make sure that you have a plan for it and it's very manageable. Perfect.

LLC Vs S Corp And Taxes

5:38

Okay, phase two is the legal and business setup. So that may take a little bit more time to explain, but how do we know how to choose the right business entity? I know that I am an LLC, and then somewhere along the way this year, I'm now S-Corp. I don't really understand it, but I think it's gonna save me and some taxes. It will, yes. So the entity that you choose, you'll pick based for based on two criteria. One is the the liability, right? So you want to have a layer of veil between yourself and and any potential lawsuit. The other, and the more important, is the tax treatment. So the entity that you choose is going to determine how your practice is taxed, and it's also how your personal assets are protected, right? That's the liability and the tax portion. So those are the two ways. I could tell you that most, depending on the state, most DPCs will either be an LLC or a PLC, a professional LLC. I can also tell you that based on the entity, and obviously it's contextual, but based on where you're at, as soon as you hit 60 to 80k in income, take home pay, it's probably time to have a conversation about becoming and electing an SCORP. An S Corp isn't an entity, it's a it's a tax selection. As an LLC, you can either elect to be taxed as an S Corp or you can elect to be taxed as a sole proprietor. But yeah, that's definitely a conversation that you want to have with your CPA. Side note, you want to pick a CPA that you like and know and is going to help you make these kind of decisions. Timeline on when you want to pick a CPA would probably be about 90 days prior to your doors opening. You want to meet them one so that you have somebody that can file your taxes, and that's great. But more importantly, is you want to have somebody who can help you design the architecture of your accounting system, of your of your books. About 30 days prior to you opening, you want to look at a bookkeeper. And we can talk more about that, but that's roughly the timeline. About three months out, have a CPA in mind, about a month out, have a couple of bookkeepers in mind that you might want to do this. Yeah, so that's actually my segue into phase three, which is financial planning.

Bookkeeping Outsourcing And The Queen Bee

7:41

Should I hire a bookkeeper or should I try to do it myself? Yeah. So, you know, let's just let's define what bookkeeping is. I think that might be helpful. So in the envelope of accounting, the slice that is bookkeeping is the recording and the categorization and the reconciliation of your transactions. So basically, it means that all the money that has come in and out is properly labeled and accounted for, not accounted. So it's not tax strategy, that's a different animal. It's not tax filing, that's a different thing. It's simply the tracking and the correct treatment of transactions, money in and out. So that's a relatively simple prospect. Can you do it yourself? A hundred percent. If you are a PA, an NP, a DO, an MD, a whatever, you are for sure smart enough to be a bookkeeper. The thing is, and I'll give you an analogy. You, as a nurse practitioner, are more than capable of being a janitor, but is that a good use of resources? No, you're an incredibly expensive janitor. You are an incredibly expensive bookkeeper. So should you do it? Kinda, yeah. Like, especially before you launch, I would go through the prop thought process and do the thought work of figuring out all right, what are my possible income streams? Memberships, labs, annual memberships, employers, all these things. And then I would go through the thought process and be like, all right, well, what are my fixed costs, regardless of how many patients I have? Well, rent, business insurance, et cetera. And what are my uh variable costs? So, you know, they go up and down based on patient size, on panel size. So labs, some supplies, uh credit card payment fees, uh things like that. So I would definitely go through that thought process and figure that out so that you understand it. But as soon as you can afford it, I would have somebody who knows what they're doing doing it for you. Cleaning up a mess can be expensive. It's so much cheaper to just do it right the first time. But yeah, can you do it yourself? You sh, yeah, for sure. There's anybody who's listening to this for sure can do it themselves. It's is that the best use of company resources, aka your time and energy. Well, what is that number then where someone that is doing their bookkeeping themselves really needs to transition over? Is it a number of patients? Is it a number of is it a revenue number that's coming in at that point? Is it when it becomes overwhelming? Like what is it? Yeah, so is it overwhelming is a really good indicator. So if you dread opening up QuickBooks, it's probably time to hire somebody. If you are choosing to do admin work versus things that will help you either a get more patients or service them, then yeah, it's probably time to outsource that. The analogy that I like to use is the queen bee. So I don't I don't know how much you know about beehives, but but the yeah, I know very little. But the job of the queen bee is really, really simple. It's to make more bees, has no other job. So her job is protected by every other job in the beehive. So every other job in the beehive is really meant to support the queen bee. So as a clinician, as a provider, as a clinic owner, your queen bee role is to service patients, right? So anything that isn't that can and should be outsourced, some sooner, some later. But that's if you're choosing to do admin and not go to the networking meeting or not do some sort of client acquisition or not meet with an employer, that is a surefire sign that you need to offload that. Growing your panel to whatever your particular goal is and then servicing them well and doing medicine as it's supposed to be, that's the goal, right? Doing QuickBooks is not the goal. That's never been your goal. It shouldn't be your goal. As soon as it's overwhelming, or you're allocating resources to that where it could be better spent, that's definitely time to offload it. Okay, good. So asking the question, how do I build a financial model for my practice? Did you already, in a sense, answer that, or is that a different yeah? So I can kind of I I think I might have touched on it. It's basically like building a home budget. So mom, dad, kids, whoever the income sources are, I would notate that and Excel spreadsheet is great for this. And then on the other side, just like building a budget, these are the things that I'm going to spend every month, the mortgage payment, utilities, all these things are fixed whether we're in the home or not. And then the variable costs would be like uh entertainment, groceries, things that go up and down. And so I would have all of these and then doing the same exact thing for my business. The one thing that might be a little bit different is there are some expenses which shouldn't be looked at in the month that they're bought. So insurance is one of the things off the top of my head. So if I buy a $1,200 business insurance policy and it's for a year, I'm not spending $1,200 in January and zero dollars in February. What I'm doing really is spending $100 in January, $100 in February, because $1,200 divided by $12 is $100. So that would be the only thing that might be a little bit different. And it's probably only a small handful of things that are like that, but that would be the only difference between a home budget and say a business budget, a business model.

QuickBooks Vs New AI Accounting Tools

12:56

I was gonna ask you something about QuickBooks, but I noticed that in phase four, build the financial system. The question I had picked was how do I choose the right accounting software? Is that is that what QuickBooks is? And because you had mentioned to me when my business signed up with you that there were some other uh accounting software that may be better or just different, you know, that would service DPC clinics better. Yeah, yeah. Let's go through this door. So five, it's 2026 right now. So five years ago, there were really like two options. One was QuickBooks and its competitor Zero X ERO were like the only two games in town. There were only two that were good enough to handle a professional business. If you had dreams of having multiple locations, 15 providers, anything in that realm, you wanted something that was robust. And so that was QuickBooks or Zero. Now, last three years, the AI options have exploded. There are more options than ever before, and they're good, and they have bank level security and they're all solid. But let me take like one step back and say that they're just tools, right? So if you're going to use them and it's probably not a long-term prospect that you are, QuickBooks or whatever tool is not nearly as important as the person running those tools. So, should you get an F1 car or a NAS car? I mean, yeah, that kind of matters. What matters more is the guy behind the wheel or the gal behind the wheel. So, like me personally, I have a tech stack that I use, and there's some things that I won't use just because through experience and and other things, I've found out what works best. So if somebody uses uh Zoho Books, which is um not a great fit for a DPC, like that's not a like that's not a good fit for me. So that's not a client that I would probably engage with. That's not a uh DPC I would engage with. If somebody is of the opinion that, hey, it's just a system, use what's best, then that's probably a good fit. But yeah, QuickBooks is an option, but like picking the the general ledger, picking the books, picking the the QuickBooks uh tool, and then picking the bookkeeper is almost is almost the opposite of the choice, choice order. I would pick a solid bookkeeper if they don't have an opinion on general ledger, which QuickBooks Zero, these are all general ledgers. If they don't have an opinion on a general ledger, that might be a yellow flag. Somebody who doesn't know tools well enough to have an opinion might not have the experience that you want. I can tell you that QuickBooks is like 80% of the market. So QuickBooks is the most common, of which in there there are different multiple tiers. But yeah, more and more I'm seeing AI native options being one cheaper, two faster, three less uh less mistake prone because a lot of the manual stuff is getting taken off. You'll always have a layer of human for interpretation and review, or at least you should. So yeah, the tool doesn't really matter, it matters only if you're gonna be doing it yourself. And if you're gonna be doing it yourself, it's probably QuickBooks. I think you described QuickBooks to me as the legacy software program, which I really understood that so much. It it was the oh it was the original. It was like you said, it was the one that everybody just went to. Like if you didn't have QuickBooks, then what were you doing? But I appreciated the fact that you knew that there were other programs that would be a better fit. And as a nurse practitioner, like I don't care, I don't care what the program is. If it helps you do your job better, that makes my business better, then at the end of the day, that's what I want. I want it for you to do your job to the best of your ability. Yeah, and I think that's the mindset of somebody who's gonna have a successful business. Yay! Yeah, like it's I've just I've seen the patterns before, and I just I work with and talk to and I'm inside of a lot of TPCs. And what you're describing is as I interpret it, is it's just a system. So it's systems-based thinking. Use the system that matters most, don't be married to Intuit or QuickBooks, don't be married to a specific system, be married to success. Like what's gonna get us to our goal, I think is the thing. But yeah, you're right, QuickBooks is the legacy system, which has a benefit. Every company that makes anything, payroll companies, whatever, they have a connector for QuickBooks. So it's a legacy system. That's a positive. The negative is it's a legacy system. So all the modern technology that has come about and will come about, they're gonna be slow to implement. And also they raise their prices every five minutes, it seems like they are getting expensive by the day. I bet you since we've started, they've raised their prices, and other competitors don't have that same philosophy, and so that's a differentiator too. Yeah, I don't know why this analogy of thinking about blockbuster video and Netflix comes to mind, but I picture QuickBooks as like blockbuster video. They're going to age themselves out if they don't figure out how to keep up with all the newest things, and then all of a sudden, a Netflix is gonna come from behind and take over, and then they're gonna be out. I completely agree. And there's already a couple of QuickBooks killers out there off the top of my head. If somebody wanted to go Google this, digits is probably the most viable option right now for somebody if they wanted to try to do it themselves. The business model of DPC lends itself to something like that. But there's there's new competitors coming out every day. Side note, if you if you hire somebody to do your books and you're thinking about growing larger than a micro practice, like if you want to have 600, 1000 patient panel, a couple of providers, have somebody who stays up to date with what the tools are because like the tools matter, right? They're not the most important thing, but they matter. Yeah, good.

90 60 30 Day Pre-Launch Checklist

18:44

Okay, so how uh my next question under that same phase of building your financial system is how do I build a 30, 60, and 90-day pre-launch financial checklist? Yeah. That sounds like a chat GPT request to me. It it can, yeah. So so if you're 90 days out, you're looking at the foundation of your business. And so that's that's kind of a little bit of what we discussed with the spreadsheet and the the home budget analogy. And so that foundation is good. 60 days out is where I'm really starting to look at like the systems that I'm gonna use. 90 days out, it's a little bit more conceptual. 60 days out, I'm setting up the software. Like, I should have a software in mind, I should have a CPA already who's helped you make that decision. I should have a bookkeeper or two that I'm considering. I've already had those conversations. I've made decisions. Am I doing telehealth? Am I not? What labs are included, what labs aren't included. At 60 days out, I've probably or I should have had some conversations with other people in the community, started asking questions, getting clarity, maybe speaking to them directly. Yeah, at 30 days out, you're essentially gonna, it's short. Um, there's a short time between you open. So you're just doing some final checks. I'm making sure that all the all the systems are connected. If I'm doing payroll, let's say I'm starting off as a LLC and maybe electing to have payroll because I'm gonna have an MA out the gate. Maybe I'm gonna have those systems set up. I have all of my 30 days out, you should be ready with any kind of like business licensure, DEA stuff. Anything that you will need should already be there. 30 days out, you should for sure have a collaborating position or whoever. The last 30 days is just really kind of everything should really be set. And then now you have a buffer for things that will eventually for sure happen. Something will go sideways, something will fall through, the insurance that you wanted is no longer there. You find out that you need cyber insurance and you haven't gotten it yet, or whatever the case is. But 30 days prior, you should be pretty much locked in. In the book, it goes into more detail, but that's kind of the broad strokes of that. Is there anything else that you want to say about the financial planning side? Because it looks like we're gonna start getting into marketing and branding and

Pricing Fear Burnout And Charging More

20:55

things like that. Some things that some owners should probably decide sooner than later is uh lab costs. So labs and and medications are one of those things that it's it's um you could choose to pass it through, like pass through the cost or absorb it, but understand the implication and like what the ramifications are for either of those two things, whether you pass it along or you absorb the cost, neither one is right or wrong, but having an understanding of that will lead to having a more clear idea of how you should price. The number one thing that every every every if I could put a billboard and every soon-to-be DPC owner was to drive past this billboard, it would probably say something along the lines of charge more. Um, I don't know why it is. I mean, I have an inclination, I have a glue, but I don't know why it is. But every DPC owner wants to work for free, it seems like it's what that's like what the books would say. So I would tell you that the DPC offering is incredibly special, it's incredibly valuable. As soon as people feel it, like you, I'll never. Go back to a fee for service, like not if I can help it. I will choose to pay more than I'm currently paying for my own DPC that I go to. It's still gonna be cheaper and better than insurance. Like it's just it's better in every possible way, and it's still cheaper. If my rate doubled, because my whole family's on if my rate doubled, still cheaper than doing W-2 employer type insurance. So I would say charge more because you want to charge enough to provide good service, to provide quality care. If you're not able to charge enough, then you can't, you know, get all the supports that you need. Charge more. However much you think you should charge, add 25%. You'll be fine. I'm dying to know your theory on why we don't charge enough. I personally think it's because we don't think that we're valuable enough because we're just nurse practitioners and we have some sort of block in our brain that we're we don't deserve that much or something. Maybe, yeah. Maybe it's that. And I mean, you're a nurse practitioner, so you would definitely have more insight into how an NP thinks. I think it's along the lines of, and I could be wrong, but I think it's along the lines of as soon as we inject money into it, we're no longer caring. Like care and money seem to be oil and water for a lot of DPC owners. So if I'm injecting money into the conversation, it's no longer about me delivering care. And I think that's inaccurate because you gotta care about you. Like you have to care for you because you are not, you're no longer a clinician, you're now the most important part. You're most you're the most critical employee of a business. So you are that critical employee and comma space, you are also the owner of that business. So that critical employee has to be compensated well, or you're gonna invite burnout. If I had a business, which I do, but if I had a DPC and my most important employee came to me, said, Hey, I think I'm gonna get a little burnt out here, I'd be like, What do we do? Because as soon as you get out of the baby phase, as soon as you're six months out, as soon as you've gotten past break even, the most dangerous threat to the survival of your DPC is the clinician burnout. So I would mitigate that if at all, I'd get an MA before I let my clinician burn out if I owned a DPC. So yeah, for the first three to six months, survive, right? That's a money issue. Make sure you plan for that. But after that, it's like protect your clinician at all costs. I haven't raised my rates in three years. So my husband are gonna have a conversation about that. Well, I literally feel that people will cancel if I increase my rates even five dollars. Like I have this fear that people don't really value it the way I think that they are, and that I'm misunderstanding people's loyalty to me, and that if I raise my prices, that is all that it'll take to just make them go up the street to the other clinic that is taking their insurance. Yeah, super honest and super common, by the way. People are afraid that it's gonna drive people away. I can tell you two things. One, when I've seen people raise their prices, it hasn't been that dramatic for a couple of reasons. But two, and this is maybe more in my area, and it's specific and dependent on on a person's finances on on their on their panel and size and a couple other things, but you can rough numbers, you can raise prices by like 15%, and in some cases double your margins. So if I lose 10% of my panel, I'm still making more money and my quality of life is better. Like, do you want to sell Ferraris or Hondas? Nothing wrong with Hondas, but I'd rather sell Ferraris. It's a lot fewer customers, but I'm making more money. Or you can work at scale, which is great too. Have a 1600 patient panel across your four locations, that's great too. No worries. But it really kind of depends on what your goal is. If your goal is to go big and wide, yeah, you'll have a smaller price point. Uh, for those whose dream it is to have a 400 patient panel and that's it and no nothing else. Well, you know what? Maybe we increase the price up a little bit more than you're comfortable. If your financial thermostat is set at $65 a month, maybe you maybe you turn it up just a little, just go to $75 a month, right? Like, see, this is why I paid for the strategy part too, so that you can just tell me and my office manager, we're doing this, and you're going to be so happy that you did. And then I will thank you for it. Yeah, yeah. I think it's important that when you when anybody partners with somebody financial, and if they add anybody to their financial team, they have somebody, and it can be their CPA, it can be their bookkeeper if they have the ability, but they got to partner with somebody who's not just gonna be data entry, it's gonna be somebody who works with you at the strategic level.

Series Pause And Next Steps

26:55

Good. Well, actually, I think that this might be a great stopping point. We're going to make this a series. So I think the next time we talk, do you think this is a good stopping point where we can get into branding and digital presence, or do you want to talk about that? No, let's this is a this is a good place to put a pin in it. I think we've handled foundational financial systems, and of course, we can go into it more. But I think, yeah, I think we've got the the base layer. The money is the is the foundation of a business. So I think we've we've covered there, but we can obviously expound on it. But no, okay. It's a good place to stop. Yeah, because then we'll be getting into the actual physical clinic setup, we'll get into branding and digital presence, we'll get into clinical services and vendors and things like that, staffing, patient acquisition, and marketing. So we'll have a whole other conversation that we can do next time. Okay, well, thanks, Dan. What you've given us already has is bound to help so many people. Like I'm helping somebody right now who she's like, all right, so I have a provider and they have like 35% open schedule. So, like, how do we change the conversation? And that's like part of a larger conversation where we're like, how do we get you to be work optional? Like that's her goal. And that sounds like it's your goal. And we for sure can do that. We just have to make money's the the oxygen into the system, right? You run out of money and the business will pass out. So, how do we get enough money into the system so that you can afford all the systems that support you getting out? Yeah, yeah. Um, so yeah. Well, all right, Dan. Well, we will pick this back up on the next episode and continue to go on your pre-launch playbook and all the things that you can help everybody with. So I'm just so appreciative of your time and your willingness to be able to share all the little nuggets of information that you have. So thank you so much, Dan. I'm grateful that you have a podcast and that you're gonna help so many people. Thank you, Amanda. I'll talk to you later. Hey, I'm looking forward to it. Thank you so much for joining us today on the DPCMP. We hope you found our conversation insightful and informational. If you enjoyed today's episode, please consider subscribing to our podcast so that you do not miss an update. And don't forget to leave us a review. Your feedback means the world to us and it helps others discover our show. We love hearing from our listeners. Feel free to connect on our social media, share your thoughts, your suggestions, and even topic ideas for future episodes. As we wrap up today, we are so grateful that you chose to spend part of your life with us. Until next time, take care. This is Amanda Price, signing up for see you on the Mixed North.