How to Turn Your Healthcare Accounting Firm Into a Healthcare Advisory Practice

Healthcare accounting firms are already trying to move from compliance to advisory, but the work often remains too informal. A healthcare client may ask for guidance on growth, reporting, or an acquisition, and the firm answers because the relationship is already there. The problem is that this advice is rarely shaped into a service the client can clearly understand and pay for.

For healthcare specialist firms, the opportunity is to put structure around work that is already happening. That means defining the advisory offer, giving the team a repeatable way to deliver it, and making sure the firm captures the value it is already creating.

Why Is Canadian Healthcare Getting More Financially Complex?

The financial environment for Canadian healthcare practices has changed materially in the last three years. Single-entity practices are now fielding acquisition approaches, managing multi-location operations, and making capital decisions without compliance precedent in their accountant relationship.

• Private equity consolidation is arriving in Canadian healthcare. PE investment in the Canadian healthcare sector now spans medical practices, dental clinics, community health providers, and long-term care facilities.² In dental and veterinary services specifically, clinic aggregation activity continues to increase as Canadian and foreign private equity investors take advantage of acquisition opportunities.³ It’s reshaping the financial landscape, increasing efficiency and sparking concerns over market competition. 
• Healthcare spending is growing. Private sector health expenditure in Canada is projected to increase by 5.2% in 2025, following a 4.8% increase in 2024.⁴ Reimbursement structures will shift, and funding priorities will change. Clients need a finance partner who tracks the changes affecting their specific practice. Firms that merely file accurately at year-end are on the out.
• Growth ambitions are outpacing operational infrastructure. Intero Solutions carried out an analysis of Canadian health practices and found that owners’ expansion goals, adding locations, practitioners, and service lines, are rarely executable without operational infrastructure. Unfortunately, most practices don’t currently have operational infrastructure, creating an advisory opening or gap.

The question is whether accounting firms are positioned as strategic advisors or still as compliance providers.

Healthcare is so impacted by the political priorities of the time that these organizations have to be nimble and can address and assess what’s within their financial and clinical data. — Matt Lescault, CEO, TydeCo

What Does It Actually Mean to Advise a Healthcare Client?

Healthcare advisory is a strong service, not some vague offering. Healthcare specialist firms may already have a specific shape in mind, based on their experience and sector knowledge included in their offerings. 

• It means connecting financial data to operational performance. Integrating financial reporting with clinical and billing data builds KPIs around important metrics. For example, revenue per practitioner, service-line margins, and insurance reimbursement cycle times. This shifts focus from history to forward-looking guidance. 
• It means advising on multi-entity and M&A decisions. M&A transformations aren’t easy. Your accounting team must help with financial consolidation across entities, scenario modeling for acquisition structures, and compensation planning across multiple practitioners. Industry specialisation enables firms to deliver guidance reliably because consistent financial structures across healthcare clients make repeatable frameworks viable.
• It means providing fractional, affordable CFO-level guidance. Not all firms with PE in mind can afford a full-time CFO. However, sophisticated capital planning, burn-rate analysis, and financial modeling help establish scalable healthcare practices. Take a four-location physiotherapy group or a dental group in early consolidation; the accounting firm that provides this level of service becomes the finance function, not just the year-end filer.

The advisory work is often already happening. The issue is that it sits inside informal conversations and one-off client requests. The opportunity is to package it more clearly, so clients understand what they are paying for and firms can deliver it more consistently.

When we connect medical billing data into the financial side of the house, we can start creating key performance indicators around patient data, not private or PII, but generic patient data that allows us to do demographic financial key performance indicators. Accountants are then able to advise those healthcare organizations of where profits are shrinking, where profits are growing, and how to drive the organization forward. — Matt Lescault, CEO, TydeCo

Why Compliance Is the Structural Barrier and What to Do About It

Accounting firms had big ideas for advisory services in 2024. However, they spent less time on advisory than in 2023. Why?

Structural obstacles.

• Compliance workloads actively block advisory capacity. Data from Sage shows 92% of accountants feel overwhelmed by manual administrative tasks, and 85% want to pivot toward strategic work but remain on the compliance treadmill.⁷ Compliance-heavy operating models are time-consuming and use all the cognitive bandwidth strategic work requires. 
• New staff won’t solve the capacity problem. The problem has nothing to do with the staff on hand. Firms need to focus on their niche and codify expertise, turning the healthcare advisory methodology into firm-wide frameworks. This enables junior staff to participate by managing the foundational analysis, while senior advisors focus on strategy.
• Freeing compliance capacity is what creates advisory space. The Woodard Report’s analysis of 2025 found that firms must free capacity through automation before creating or expanding advisory capacity. Instead of recruitment, automate reconciliation, compliance tracking, and reporting cycles. Suddenly, senior staff have time for strategic client work. 

For healthcare firms, the advisory opportunity is not only about adding a new service. It depends on clearing enough compliance work out of the way, then turning sector knowledge into a method the whole firm can use.

They risk losing opportunity and their current client base to the next firm that’s willing to innovate and be different from what the status quo is. — Matt Lescault, CEO, TydeCo

How to Get the Ball Rolling to Formalize Your Financial Return.

The 2024 AICPA and CPA.com CAS Benchmark Survey gathered data from more than 200 accounting firms. It found that firms with more than half their revenue from defined industry niches report 38% higher median CAS revenue and 51% higher net revenue per client than firms without defined niches.⁹ 

It shows that healthcare-specialist firms have already found their niche. The only thing they’re not doing is formalizing advisory captures to ensure they get the revenue their niche should already be generating.

• Start by inventorying what’s being given away.  Reviewing the last 90 days of client interactions can be eye-opening. Focus on client interactions and identify conversations that weren’t directly tied to a compliance deliverable but generated value for clients. Consider packaged offerings tied to clear outcomes, via a repeatable workflow rather than a unique engagement each time. This turns conversations into services clients can buy, and the firm can scale.
• Price by outcome, not by hour. Hourly billing doesn’t fit advisory services because clients see the dollar signs flashing before their eyes whenever they ask a question or send an email. The solution is fixed monthly engagements tied to defined healthcare deliverables, quarterly benchmarking reports, reimbursement impact analysis, and multi-entity financial reporting. Relationships shift from transactional to ongoing partnerships. 
• Judicious testing with existing clients before taking it to market. Choose three or four long-term clients and ask if they would like to test your new system. The idea is to introduce a structured advisory offer where pricing is tested and the delivery framework is refined before it’s released to other clients and new business conversations.

The aim is not to create a brand-new service from scratch. It is to take the advisory value already being delivered, define it properly, test it with trusted clients, and turn it into revenue the firm can repeat.

They are CFO minded. They think about it from a data and from a results and from an advisory level. — Matt Lescault, CEO, TydeCo

The Sector Is Moving Forward. Is Your Firm Equipped to Keep Pace?

Canadian healthcare is creating financial complexity that compliance work alone cannot properly address. As PE consolidation, multi-entity growth, reimbursement pressure, and expansion decisions become more common, healthcare clients need accounting firms that can help them understand what those changes mean for their financial structure and future decisions.

For healthcare specialist accounting firms, the move into advisory is not as far away as it may seem. Much of the sector knowledge already exists inside the firm, and much of the advisory work is already happening in client conversations. The next step is to free the capacity, define the work more clearly, and package it as a service clients can understand and value.

Sources

1. Accounting Today, “Advisory services in accounting: Pruning for growth” (2026)
2. Canadian Doctors for Medicare, “Position Statement on Private Equity Investment in Canadian Health Care” (2025)
3. Osler, Hoskin & Harcourt LLP, “The latest in Canadian health clinic acquisitions” (2024)
4. Canadian Institute for Health Information, “National health expenditure trends” (2025)
5. Intero Solutions, “Why Canadian Health Practices Hit a Growth Plateau” (2025)
6. Firm of the Future, “Hot topics for accounting firms in 2025” (2025)
7. Sage,  “Sage Intacct Accountants Launches in Canada, Empowering Firms to Scale and Accelerate Growth” (2024)
8. Woodard Report, “Lessons from 2025: What Top Accounting Firms Are Doing Differently” (2026)
9. Journal of Accountancy, “Growth in client advisory services set to continue rapid increase” (2024)