Keane Management Accountants LLC

"Should I buy or lease medical equipment?"

The answer is always the same. It depends.

Here's how we help clients decide.

Leasing makes sense when:

→ Your practice is new.
→ Cash is tight right now.
→ You want the latest version.

Buying makes sense when:

→ You're playing the long game.
→ You want stability and ownership.
→ Long-term savings matter more.

Ask yourself these three things first:

1. Can you pay cash today?
2. Is there an early payoff penalty?
3. What's the real interest cost?

Then the questions underneath all of it:

Does this item actually benefit you?

Time saved? Money saved? Aggravation gone?

Revenue goes up? Profit goes up?

If yes, the path is clear.

Reminder for practice owners:

Q2 estimated taxes are due June 15th.

Where to pay:

→ Federal — IRS Direct Pay: https://www.irs.gov/payments/direct-pay
→ Massachusetts — MassTaxConnect: www.mass.gov/masstaxconnect

A few minutes now beats a scramble later.

At Keane, everything we do is grounded in five core values - and they aren't just words on a wall.

Trust Is Everything - Client data stays confidential. We do what we say. We respond, we follow up, and we show up ready.

Quality & Accuracy - If we aren't sure, we ask. We check our work twice. Spelling matters. Good work is the standard, not the exception.

Embrace Innovation - We don't do things a certain way just because that's how they've always been done. We look for efficiency in everything, stay open to change, and never stop learning.

Care Deeply - We celebrate our clients' wins. We support each other. We lead by example - and we bring self-motivation to everything we do.

On Time & Consistent - Deadlines are non-negotiable. We plan ahead, communicate consistently, and show up the same way every time - because reliability is part of the service.

These values shape how we serve all our clients.

Q2 Estimates always sneak up on us.

We just closed 4/15.

And here we are — June 15th is already around the corner.

Here's the good news for our clients:

Proactive advisory means you're rarely caught off guard.

Regular financials mean your CPA can adjust mid-year.

And if it's a tough year? It's okay to pay less.

For first-timers, estimates feel strange.

You're used to taxes coming out of your paycheck.

When you run a business, it works differently.

You pay based on profit AND salary.

You pay quarterly, as you go.

A simple benchmark to start:

Set aside 30% of profit for taxes.

For Massachusetts business owners:

Don't forget your Entity Level Tax.

That's your 63D Tax. Also due June 15th.

We've got you. But the deadline won't wait.

I almost lost a client last year.

They pretty much ran out of cash. Taxes were due.

For years I was warning them to cut unnecessary overhead costs.

Expenses were out of control.

So finally, we got in a huddle together.

Line by line. Expense by expense.

We got rid of the non-essentials.

Invested life savings to turn things around.

Six months later?

They’re more than back. Super profitable. Thriving!

Looking back, one thing made the real difference.

We started holding real accountability meetings.

Every month or quarter.

→ Review budget vs. actuals
→ Revisit KPIs against the goals
→ Talk about what’s coming next

Management stopped reacting to problems.

They started calling before the problem.

Before the big hire.
Before the big purchase.
Before the big mistake.

That’s proactive. Not reactive.

And that’s the difference between an accountant
and an accountability buddy.

If your accountant only shows up at tax time.

You’re only getting a fraction of what you’re paying for.

Nobody wants an audit.

Until they do.

Most business owners avoid looking too closely at their books.

Not because they’re hiding something - because they’re busy.

Here’s the most common things we find after working with 200+ businesses:

→ 401k deposits not remitted correctly or on time (illegal!)
→ Vendor charges for services no longer used
→ Missing payments not applied to AR

None of these are disasters on day one.

All of them become disasters eventually.

Think of an audit like a physical for your finances.

Catch it early, fix it fast, and move on.

At Keane Management, we run these audit checklists regularly for our clients.

When we find material things, the clients are usually alarmed but always thankful

The ones who don’t? They find out the hard way sometimes - and it costs a lot more to fix.

Audits are good for you.

“You don't have a revenue problem.”

I had a call with a practice regarding their cash outlook.

I pulled a Q1 budget vs. actuals report from QuickBooks.

Income was 95% on target.

But expenses were WAY beyond budget

The culprits?

Medical supplies cost increase.

Payroll too high.

That's why a budget matters.

It's your early warning system.

We can now adjust the expenses accordingly.

We treat budgets more like forecasts.

This is what you want to happen.

And if it doesn’t track, then we move fast to change things.

Cash is oxygen in a business.

Here's my rule:

- Keep 2 months of expenses in cash.

Above that → do what you want.

Below that → you're treading water.

And you need a line of credit.

Three payroll cycles in one month can sneak up on you.

The best tool?

A 12-month cash flow forecast.

Look ahead. Not behind.

Good accounting isn't data entry.

It's catching problems before they're crises.

Are you chasing money?

1. Why it piles up unnoticed
Sometimes practices measure revenue at billing, not at collection
If you aren’t watching, A/R quietly grows

2. When AR becomes a red flag
90+ days outstanding → deserves attention
120+ days → timing out

3. What healthy looks like
Below 35 days in-A/R → great
Above 50 → warning
Above 65 → problem

Sometimes we spend years chasing the wrong thing.

Over April break I went for a challenging hike.

No emails. No meetings. Just family.

And that’s when it hit me.

Yes, thoughts that I may not make it down the mountain safely. LOL

But also that so many doctors are chasing the wrong metrics.

I spoke with a CPA this week.

He specializes in medical practices too.

We both agreed on the same thing.

Private practice requires a completely different mindset.

RVUs are not effective when you own the business.

Hospitals pay you to produce volume.

→ High RVUs ≠ money in the bank
→ You can work more and earn less

More production doesn’t mean more profit.

Pay providers on actual collections and profit.

Physicians are often the last to know how their practice is truly performing.

That’s the problem Keane Management Accountants was built to solve.

Founded in 2016, we serve private practice owners in the healthcare industry, providing financial clarity, structure, and strategy.

We handle:
→ Bookkeeping & Records Management
→ Financial Reporting & Analysis
→ Advisory & Strategic Partnership

If you own a private practice and want clarity over your numbers, you know where to find us.