Finance & FP&A

How to forecast runway and months of cash as Independent Clinic Owner-Operators

Finance & FP&AFor Independent Clinic Owner-Operators2 apps12 steps~24 min to set up

You close the books once a month, if your billing person has time. Your actual cash position lives in a checking account you eyeball every few days and a QuickBooks file your accountant touches quarterly. You know roughly what payroll costs, but insurance reimbursements land on unpredictable schedules — a Blue Cross batch hits one week, a Medicare adjustment hits three weeks later — so 'how many months of runway do I have?' requires a 45-minute spreadsheet session you never quite trust. When a piece of equipment dies or a provider gives notice, you're doing that math in your head at the worst possible moment.

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Finance & FP&AFor Independent Clinic Owner-Operators2 apps12 steps~24 min to set up

Outcome

What you'll set up

A live burn rate dashboard that pulls your actual bank transactions via Plaid and any Stripe payments on a daily sync — so runway is a number you look at on Monday morning, not something you reconstruct at the end of the quarter.

A scenario model showing what happens to your cash position if you add a fourth provider, buy that CBCT machine on a payment plan, or absorb two more months of slow insurance reimbursements before collections catch up.

An automated weekly summary pushed to your inbox so you don't have to remember to open a dashboard — it comes to you.

The Starch recipe

Apps, data, and prompts

The combination of Starch apps, the data sources they pull from, and the prompts you use to drive them.

Apps used

Runway Analysis Scenario Analysis

Data sources & config

Starch syncs your Plaid bank transactions and balances on a daily schedule — this is what powers the real-time burn calculation and category breakdowns. If you take any patient payments through Stripe, Starch syncs that too. QuickBooks entity data (invoices, bills, vendor payments) can also be connected via Starch's scheduled sync so your expense picture includes accruals your bookkeeper has entered, not just cash out the door. The Monday morning summary automation runs on a schedule and posts to Slack via Starch's integration catalog.

Prompts to copy

Connect my Plaid bank feed and show me net burn by month for the last six months, broken out by payroll, rent, supplies, and insurance/billing fees. Then project forward 18 months at current burn.

Build me three scenarios side by side: one where I add a fourth provider in July at $9,500/month fully loaded, one where I buy the CBCT unit on a $2,200/month payment plan starting August, and one baseline where nothing changes. Show me runway and break-even month for each.

Every Monday at 7am, send me a Slack message with my current cash balance, this month's burn rate so far, and the projected runway number from the Runway Analysis app.

Run these in Starch → or paste them into your favorite agent

Walkthrough

Step-by-step

1 Connect your business checking account through Plaid in the Starch connections panel — takes about two minutes, and Starch begins syncing categorized transactions and daily balances immediately.

2 If your front-desk software or billing service processes payments through Stripe, connect Stripe as well so revenue from patient payments, memberships, or direct-pay services flows into the same model.

3 Optionally connect QuickBooks if your bookkeeper uses it — Starch syncs invoices, bills, and vendor payments so your expense view includes what's been entered, not just what has cleared the bank.

4 Open the Runway Analysis app from the Starch App Store. Out of the box it shows net burn, cash balance, and months of runway. Tell it: 'Break my expenses into payroll, rent, clinical supplies, billing/clearinghouse fees, and other' so the category view matches how you actually think about your cost structure.

5 Review the six-month trend. If one month looks like an outlier — say, you pre-paid malpractice insurance or bought a sterilization unit — flag it and tell Starch to exclude it from the burn average so the forward projection isn't distorted.

6 Open the Scenario Analysis app. Set your baseline from the Runway Analysis numbers — Starch pulls the same Plaid and Stripe data so you're not re-entering anything.

7 Build your first scenario: 'Add a fourth provider starting July 1 at $9,500/month all-in including salary, benefits, and credentialing costs. Assume their patient panel generates $7,000/month in net collections by month three.' Starch models the cash drag during ramp and shows you when that hire is cash-flow positive.

8 Build a second scenario around a major equipment purchase or a known slow-collections period — for example, 'Assume net collections drop 15% in August and September because of a payer contract transition, then recover.' See exactly how much buffer you need to keep in the account.

9 Screenshot or export the scenario comparison before your next conversation with your accountant or banker — it's a one-page view of the three futures you're actually choosing between.

10 Set up the weekly summary automation: tell Starch 'Every Monday at 7am, pull the current runway number and this month's burn from Runway Analysis and send me a Slack message with both figures and a one-line flag if runway has dropped below six months.'

11 Revisit the scenario model when something material changes — a provider departure, a new insurance contract, a rent renewal. Updating assumptions takes a few typed sentences; you're not rebuilding a spreadsheet.

12 Once a quarter, ask Starch to compare your projected burn from three months ago against actuals, so you can see whether your collections assumptions are accurate and tighten the model going forward.

See this running on Starch

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Worked example

March 2026 runway review — three-provider family practice

Sample numbers from a real run

Checking account balance (Plaid)	187,400
Payroll — 3 providers + 3 support staff (monthly)	-52,000
Rent + utilities	-8,200
Clinical supplies and lab	-4,100
EHR + billing clearinghouse fees	-1,900
Malpractice insurance (monthly equivalent)	-1,400
Other (continuing ed, software, misc)	-1,600
Net collections — insurance + direct pay (Plaid inflows)	61,500
Net burn (collections minus expenses)	-7,700

In March, the clinic is running about $7,700/month net burn — collections of $61,500 against $69,200 in total expenses. At the current checking balance of $187,400, the Runway Analysis app shows 24.3 months of runway, which feels comfortable until you build the scenario where you add a fourth provider in July. That scenario shows cash dropping to a $94,000 floor in month four of the hire (the ramp period), with runway compressing to 9.1 months before the new provider's panel is generating enough to cover the drag. The baseline scenario also flags that two back-to-back months of claims denials — modeled as a 20% drop in net collections — would push runway below eight months by September. None of this was visible from the QuickBooks file alone, because the bookkeeper hadn't yet closed February when the owner-operator needed to make the hiring decision. With Plaid syncing daily, the March number was current as of that morning.

Measurement

How you'll know it's working

Months of cash runway at current net burn (updated daily from Plaid)

Net collections per provider per month — the number that tells you whether your panel and payer mix are actually sustainable

Days in accounts receivable — how long insurance reimbursements are sitting before they land in your account

Payroll as a percentage of net collections (healthy family practice target: under 55%)

Runway delta month-over-month — are you gaining or losing buffer, and by how much

Comparison

What this replaces

The other ways teams handle this today, and how the Starch version compares.

QuickBooks + manual spreadsheet

QuickBooks holds the historical record, but your accountant closes it monthly at best — you're always looking at last month's picture, not today's, and the scenario modeling lives in a spreadsheet no one else can read.

Jane or SimplePractice built-in reporting

Your EHR shows appointment revenue and billing status well but has no view of operating expenses, bank balances, or forward cash projection — it's half the picture.

Kareo / Dentrix financial reports

Good for understanding collections by payer or provider, but not designed to answer 'how many months of cash do I have?' or model the impact of adding a provider.

Hiring a fractional CFO

A fractional CFO brings judgment a tool cannot, but at $2,000–$5,000/month for a three-provider clinic, you're paying for monthly check-ins when what you actually need is a number that's current every day.

Float or Dryrun (dedicated cash flow tools)

Purpose-built for cash forecasting and solid products, but they don't let you build the admin automations alongside the financial view — you'd still need separate tools for the front-desk and scheduling workflows that affect your revenue line.

On Starch RECOMMENDED

One platform — runway analysis, scenario planning all running on connected data. Setup in plain English; numbers stay current via scheduled syncs and live agent queries.

Try it on Starch →

FAQ

Frequently asked questions

My revenue doesn't come through Stripe — I collect through my EHR's billing module and it lands in the bank. Can Starch still track it?

Yes. Starch syncs your Plaid bank transactions on a daily schedule, so any deposit that hits your checking account — whether it came from a clearinghouse, a direct-pay patient, or an ERA batch — shows up in the burn calculation. You don't need to run payments through Stripe for Runway Analysis to work. Stripe is additive if you have it; Plaid alone is enough.

Will Starch connect directly to Jane, SimplePractice, or Kareo?

Starch connects to 3,000+ apps through its integration catalog, and can automate any web-based tool through browser automation — so the web-facing side of most EHRs is reachable. For the financial runway workflow specifically, the data that matters (cash balance, expenses, collections as deposits) all flows through your bank account, which Plaid syncs daily. You don't need a native EHR integration for this use case.

How current is the data? My bookkeeper closes the books monthly.

Plaid syncs your bank transactions on a daily schedule, so your cash balance and recent deposits are always current — you're not waiting for month-end close. QuickBooks entity data (bills, invoices, vendor payments your bookkeeper has entered) also syncs on a schedule if you connect it, which adds the accrual layer on top of the bank feed. The two together give you a more complete picture than either alone.

I'm not SOC 2 certified — should I be worried about connecting my bank account?

Starch is not SOC 2 Type II certified yet — that's an honest limit worth knowing. Plaid is the connection layer for bank data, and Plaid itself is SOC 2 Type II certified and used by thousands of financial applications. Whether that's acceptable for your practice's risk tolerance is your call, and it's fair to ask.

My QuickBooks P&L report is what I usually look at. Can Starch pull that?

QuickBooks report views — including the P&L — are temporarily unavailable in Starch while an upstream connector issue is being fixed. Entity-level data syncs normally: bills, invoices, vendor payments, journal entries. For the burn rate calculation, entity-level expense data is actually more useful than the formatted P&L report, so this limit is less of a problem in practice than it sounds.

Can the Monday morning summary go to email instead of Slack?

Yes. Starch connects to Gmail and Outlook via scheduled sync and can send messages through either. When you set up the automation, just tell Starch to email it rather than Slack it — or both, if you want a record in your inbox and a quick-glance in your team channel.

I'm a solo owner-operator, not a VC-backed startup. Is runway analysis even relevant to me?

The framing changes slightly — you're not thinking about 'when do I raise' but 'do I have enough cushion to hire, buy equipment, or weather a slow quarter without touching my personal finances.' The math is identical. A clinic running $7,000/month net burn with $84,000 in the account has 12 months of runway. Knowing that number — updated daily, not reconstructed quarterly — is what lets you make the July hiring decision in April instead of in July when it's urgent.