Your P&L swings $100K month to month. That is not normal. That is bad OB accounting.
Global OB packages, malpractice costs, Medicaid mix. OB-GYN accounting has complexity that most firms just average out. We break it down.
A 4-minute test your accountant hopes you skip.
At a glance
Is This Right for You?
This service is for OB-GYN practice owners who recognize these problems:
Need strategic financial leadership? Our Fractional CFO service for OB-GYN practices may be a better fit.
What's Included
How We Work With OB-GYN Practices
OB-GYN-specific accounting that goes beyond reconciliation.
OB Global Package Accounting
- •Global OB fee revenue recognition methodology
- •Antepartum visit tracking and unbundled billing identification
- •Delivery revenue and cost analysis (vaginal vs C-section)
- •Postpartum visit reconciliation
OB vs GYN Service Line Separation
- •Separate P&Ls for obstetric and gynecologic services
- •Malpractice cost allocation between OB and GYN
- •Provider time allocation analysis
- •Revenue per provider per service line
Malpractice & Risk Cost Tracking
- •Per-provider malpractice cost analysis
- •Malpractice cost as percentage of OB revenue
- •Risk reserve planning and tail coverage costs
In-Office Procedure Economics
- •Per-procedure margin analysis (colposcopy, IUD, LEEP, biopsy)
- •Supply cost tracking for in-office procedures
- •Procedure volume and revenue trending
Results
What OB-GYN Practices Experience
| Metric | Typical Outcome |
|---|---|
| Revenue recognition fix | Stable monthly P&Ls enabling $295K in previously deferred investment decisions |
| In-office procedure capture | $72,000 annual revenue recovered from charge capture corrections |
| Payer strategy | Medicaid volume capped and commercial patient recruitment increased, improving average revenue per visit by 8% |
Case Study
See The System In Action
4-physician OB-GYN practice, two locations, delivering 600 babies per year. Revenue was $3.8M but profit had dropped from 22% to 13% over four years. The physicians blamed declining reimbursements and rising malpractice costs, but the root causes were more varied.
What we found:
- •Global OB revenue recognition was causing monthly P&L swings of $80K to $120K. The accounting methodology had never been updated for the practice's volume, making financial reporting unreliable for management decisions
- •Malpractice costs were $520K annually ($130K per physician) but OB services contributed only 38% of revenue. The GYN side was effectively subsidizing OB's liability costs without any visibility
- •In-office GYN procedures (IUD insertions, colposcopies, biopsies) were performed 1,400 times per year but charges were missed on 18% of procedures. That is $72K in lost annual revenue
- •Medicaid patients (27% of volume) were generating a negative margin after fully loaded costs. The practice was losing $14 per Medicaid visit but had never calculated this
The results
Stable monthly P&Ls enabling $295K in previously deferred investment decisions
Revenue recognition fix
$72,000 annual revenue recovered from charge capture corrections
In-office procedure capture
Medicaid volume capped and commercial patient recruitment increased, improving average revenue per visit by 8%
Payer strategy
“We had no idea our Medicaid patients were costing us money. Not breaking even — actually losing money on every visit. That changed how we think about our schedule.”
— Managing Partner, Southeast
Common Questions About Accounting for OB-GYN Practices
Don't pay for reports. Pay for progress.
Take the 4-minute financial assessment—and find out if your books are helping or hurting your OB-GYN practice.
The test your accountant hopes you skip.