3 min read
2026-02-19
Most derm practices run two businesses, medical and aesthetic, out of one bank account. That hides what is actually working. Two virtual accounts under one root let the cash split cleanly without splitting the entity.
A typical derm practice runs two businesses at once. The medical side bills CareCredit, insurance, and HSAs. The aesthetic side takes cash, cards, and patient deposits for Botox, fillers, lasers, and treatment packages. Both sides land in the same operating account. That makes everything from cash flow planning to provider bonus math harder than it needs to be.
Why mixing aesthetic and medical cash hurts you
When the two revenue streams co-mingle, you cannot see what is actually working. Aesthetic margins are different from medical margins. Aesthetic cash is immediate. Medical AR can sit for 60 to 90 days. If you are trying to figure out whether your med spa is pulling its weight, you need to net out medical receivables, payroll splits, product costs, and shared overhead. Most practices try to back into this with monthly reporting that is always two weeks behind reality.
You also lose the ability to fund the aesthetic side with its own dollars. Product reorders, laser maintenance, and provider bonuses should come out of aesthetic revenue, not from medical receivables that have not arrived yet.
One practice, two virtual accounts
The cleaner pattern is two virtual accounts under one root operating account:
Aesthetic virtual account: cash-pay procedures, deposits, retail product sales, gift cards.
Medical virtual account: insurance ERAs, HSA payments, copays for medical visits, patient balances.
Both share the same routing number and the same entity, so payroll, taxes, and your CPA do not have to learn a new structure. But every dollar lands in the right bucket from the moment it hits the bank, which means your aesthetic P&L stops being a reconstruction project. If you run more than one location, the same pattern repeats: per-location virtual accounts, with aesthetic and medical splits underneath.
When this is worth it
If your practice is 95% medical and you do a few units of Botox a month, the lift is not worth it. If aesthetic is 20% or more of revenue, or if you run a med spa attached to your derm practice, splitting the cash usually pays for itself in the first quarter.
Setup takes minutes inside Lemma. ACH transfers between the virtual accounts cost $0, so true-ups at month-end do not introduce a fee line. Operating cash earns 1.75% APY while it sits, with FDIC coverage up to $10M per entity through the IntraFi sweep network.
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