Brian Giesecke, CPA and Enrolled Agent

CPA, EA, and Practice Operator

I run finance and operations inside an independent healthcare practice. The frameworks, KPIs, and rhythms I share come from real monthly closes, not textbooks.

This means I understand the actual workflow: EHR exports, payroll timing, insurance reimbursement delays, and the operational reality of running a practice day to day.

I work with a small number of independent practices so the work stays operator-level. No junior staff. No generic advice. Direct access to someone who does this work inside a practice.

CPA New York
EA IRS Enrolled Agent
Operator Healthcare Practice

Why I Started Giesecke Advisory

I saw the same pattern over and over: practice owners who were great clinicians but felt overwhelmed by the financial side of their business. They had accountants who filed returns on time but never helped them understand their numbers or plan ahead.

The advice they got was generic. Their accountant had never dealt with insurance reimbursement cycles, EHR data exports, or the unique cash flow rhythm of a medical practice. Important decisions — hiring a new provider, buying equipment, restructuring compensation — were made without the financial context they deserved.

I built Giesecke Advisory because I knew I could offer something different. I'm not advising from the outside. I run finance and operations inside a dermatology practice every day. When I talk about monthly closes, KPI tracking, and cash flow systems, I'm talking about things I do — not things I read about.

My approach is simple: calm systems, clean numbers, confident decisions. I help practice owners build financial clarity so they can focus on what they do best — taking care of patients.

Not Your Typical Accounting Firm

Operator, not just advisor

I run day-to-day operations inside a healthcare practice. The frameworks I share come from doing the work, not reading about it. I understand the rhythm of a practice because I live it.

Proactive, not reactive

Most CPAs talk to you once a year at tax time. I build financial operating rhythms — monthly KPIs, quarterly projections, ongoing strategy conversations — so nothing surprises you.

Direct access, no layers

When you call, you get me. No junior staff, no account managers, no phone tree. I work with a small number of practices intentionally so I can stay deeply involved in each one.

Healthcare-specific understanding

Insurance reimbursements, provider compensation modeling, EHR exports, payroll timing — I understand how medical practices actually operate, not just how they look on a P&L.

Traditional CPA vs. Giesecke Advisory

Most accounting firms treat medical practices the same as any other small business. We don't.

Traditional CPA
Giesecke Advisory
Communication
Talk once a year at tax time
Monthly or quarterly rhythm with direct access
Tax Planning
Reactive — surprises at filing
Proactive — quarterly projections, strategies implemented throughout the year
Industry Knowledge
Generic small business advice
Operates inside a healthcare practice daily — understands EHR, reimbursements, provider comp
Who Does the Work
Junior staff with partner review
Direct access to a CPA/EA who does the work personally
Financial Visibility
Annual P&L at tax time
Monthly KPI pack — collections, payroll %, overhead %, cash flow, owner comp
Retirement Planning
"Max out your 401(k)" — generic advice
Plan structure analysis — Safe Harbor 401(k), Cash Balance Plans, $60K+ in annual savings
Approach
Compliance-focused — file and forget
Partnership — calm systems, clean numbers, confident decisions

Principles That Guide Every Engagement

Clarity Over Complexity

Simple dashboards that drive decisions. No 40-page reports. The goal is always: do you understand your numbers well enough to act on them?

Systems Over Heroics

Repeatable processes beat last-minute scrambles. Monthly closes, quarterly projections, documented workflows. Calm pace, consistent output.

Partnership Over Transactions

I'm looking for long-term relationships with practice owners who value clarity. Not one-off projects. Not "lowest price wins." Real partnership.

Let's See If It's a Fit

Schedule a 30-minute call. No pressure, no pitch. Just a conversation about your practice and whether working together makes sense.

Schedule a Call