Today marks the official start of fall, and it's a natural checkpoint for shifting focus to Q4. A lot of practice owners treat the fourth quarter as something that starts in October, but the decisions that actually shape how Q4 goes need to happen now, while there's still runway to act on them.

The first thing worth fixing is any gap between where your books currently stand and where they need to be for accurate year-end tax planning. If you've been behind on categorizing transactions or reconciling accounts, catching up now means your CPA is working with real numbers in December instead of scrambling through a backlog in January.

Next, look honestly at your year-to-date profit and compare it against what you expected when you set goals back in January. If you're ahead of plan, Q4 is the window to think about tax strategies that make sense with strong profit, whether that's a retirement contribution increase or equipment that makes operational sense and also helps with depreciation. If you're behind plan, Q4 is the time to understand why, while there's still a full quarter to try to close the gap or at least understand it clearly before the year closes.

This is also the point to start thinking about 1099 preparation if you use independent contractors for anything, whether that's a fill-in provider, a cleaning service, or marketing help, since anyone paid $600 or more during the year needs a 1099 issued by the end of January. Gathering W-9 information now is far easier than chasing it down in a panic in early January.

If you're considering any equipment purchases before year-end for depreciation purposes, this is also the time to run those numbers, because a purchase made in December still needs to make operational sense for the practice, not just tax sense. Buying equipment purely to reduce a tax bill without a real clinical or business need for it rarely works out as well as it sounds on paper.

Fall isn't just a change in weather. For your practice, it's the start of the stretch that determines how the whole year actually closes out.

Jeremy Brewer is the founder of 911 Bookkeepers LLC in Baton Rouge, Louisiana. 911 Bookkeepers partners with MBJA Accounting Service to give chiropractic and MDVIP practices clean, current financials. He is a Xero Certified Advisor.