I’ll start with the problem. This question as asked in the title, just doesn’t provide enough context.

The reality is, it depends on various factors.

👉 Client treatment dosages and treatment model: The number of clients you can reasonably manage will be directly and meaningfully impacted by service dosage of those clients.

👉 Job responsibilities: What other roles or expectations do you have beyond client time?

👉 Location: Are those services delivered in person or via telehealth? Are they center, home, school, or some combination. If it’s not all at one location, don’t forget to factor in drive time.

👉 Business mission/model: Different businesses may be set up to meet the different needs of their community and target population based on their available resources.

👉 Funder type (and funder expectations): School? Waiver? Insurance? Grants? Different funders may have different expectations or obligations.

👉 Total job time expectations by employer/employee: Whether expectations are for 20 hours, 40 hours, or more or less, will impact the total client caseload.

👉 “Intensity”, or effort relative to compensation: In the past, I’ve had employees who would rather work more hours, or have a more dense schedule, and get paid more. Others preferred a less stressful schedule, and would be fine with a lower but still fair base compensation. Obviously compensation structure comes into play here, but again, it’s an important factor in doing a fair comparison.

There definitely are some commonalities as you narrow down these factors. For example, one can make more informed assumptions looking at center based insurance funded comprehensive service models as compared to school based/funded IEP driven caseloads. Obviously these are two extremes but you get the point.

It’s nice to know others’ assumptions, but it’s just as important to do an apples to apples comparison, and ultimately base your decisions on your specific situation.

What factors do you feel I’ve left out?
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Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about. 

The post “What’s a regular caseload for a BCBA”? ➕ ➖ ➗ ✖ appeared first on Partners Behavioral Health.

When starting your practice, make sure you have a solid understanding of your financial obligations projected through revenue, and that you have considered how you’ll access cash to cover those obligations until the money you earn hits the bank.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health has industry knowledge and expertise in this area and can help with this. We can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post What is working capital and how does it affect ABA companies? appeared first on Partners Behavioral Health.

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Two actionable steps to drive improved clinical outcomes, patient experience, and stand out from the competition in recruiting and retaining clinicians appeared first on Partners Behavioral Health.

Top 5 actionable steps providers can take 

1. Diversification across and within funder types – commercial, Medicaid, Waiver, Schools, Tricare, private pay, etc in your service region(s) is certainly important, but I would argue this is not a long term or systemic approach or resolution since it does not directly address the issue identified in the title of this article.
2. Have it in your business plan to renegotiate with your funders on a regular basis. Perhaps even try to negotiate annual increases as part of the initial terms even if it comes at a small short term cost. I.e. maybe settling for slightly lower rates at the outset in exchange for annual increases. While renegotiating is an important part of the plan, the reality is funders often won’t make adequate or in some cases any changes. 
3. Build business models where you have it in your strategic plan to shift to alternate regions and or payers after X years in the absence of funder reimbursement increases. A difficult choice to make. 
4. Working with industry experts/ABA business consultants is also a good option as they work with various providers and payers across different regions and get to see broader industry trends. They also see what works and what doesn’t for other aspects of operating an ABA agency, and it positions them to generate more innovative ideas in supporting their clients.
5. Supporting national and state trade associations and professional organizations with a mission or history of demonstrated effort toward this end is also important.

What do you think?

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post 🛑📉 Actionable steps to address thinning margins faced by healthcare funded ABA providers appeared first on Partners Behavioral Health.

Key performance indicators (KPIs) are essential metrics to evaluate your ABA practice’s performance, guiding strategic planning and ensuring success. They are a measurement system that can exist in an objectives and key results (OKR) strategic framework. 

ABA practice KPIs typically fall into four categories: 

• Operations
• Clinical
• Financial
• Stakeholder satisfaction 

A well-rounded approach to KPIs ensures all aspects of your business are interconnected, supporting growth and progress.

For smaller ABA practices, starting with a few KPIs is sometimes a good idea. As your business scales up, your KPIs will expand too. Monitoring KPIs benefits different stakeholders, offering valuable insights for decision-making that ultimately lead to better outcomes for everyone. 

Related performance systems and measures should take into account who does what by when and how all those activities and how outcomes impact one another – i.e. do they compliment or conflict. Activities and outcomes are both important considerations. 

Below are some common ABA practice KPIs. This is not exhaustive, and there is no one “right” set of objectives. Different professionals may prioritize different objectives. 

Examples of clinical metrics:

1. Patient feedback surveys
2. Family feedback surveys
3. Are your patients making progress on their treatment goals?
4. Percentage of objectives with interobserver agreement (IOA)
5. Percent of students for which IOA data are collected
6. Percentage of objectives with procedural integrity
7. Percent of student objectives which are met or exceeded
8. Percentage of objectives showing experimental control in the assessment or treatment process
9. Rates of cancellation by client as well as by staff
10. Are your clients’ families or other caregivers engaged in the treatment process?
11. Do you have the right ratio of direct to supervision hours?
12. Decrease critical incidents
13. Client onboarding timeline
14. Client self audits (program and billing) with 100%
15. Clients self audits completed
16. BCBA checklists completed
17. BCBA checklists passed
18. BT checklists
19. Checklists for each position
20. Percent cases with interdisciplinary efforts

Examples of operational metrics:

1. Claims, Latency between claim submission and payment received (processing time)
2. How many accounts are 30, 60, or 90 days past due?
3. Intake timeline
4. Percent sessions scheduled from available
5. Percent performed from scheduled
6. Utilization – are you utilizing all authorized units or fulfilling all contracted hours (are you leaving money on the table)?
7. Rate of denial
8. Rate of appeal success
9. Is your documentation inclusive of all required indicators per payer guidelines (can you justify the medical necessity of your service if you bill insurance companies)?
10. Average caseload for behavior analysts
11. Training and professional development
12. Community partnerships
13. Are you conducting internal self-audits?
14. Recruitment and retention measures – how many technicians are your behavior analysts supervising?  What is your average caseload for behavior analysts?
15. Training compliance and professional development?
16. Do you have community partnerships?  If so, how engaging is that relationship? 

Examples of financial and growth metrics:

1. Revenue
2. Profit
3. Increase clients served
4. States served
5. Authorized hours per client
6. Increase in percent used of authorized – utilization. Service authorizations fulfilled.
7. Number of service hours
8. Increase in funding sources served
9. Increase in types of funding sources insurance,  state waiver, schools, federal programs, other?
10. Cash in bank

HR objectives: 

1. Payroll completed with 100 percent accuracy
2. Turnover/retention
3. Recruiting, Hiring and training timeline BTs and BCBAs 
4. Employee satisfaction survey 
5. Employee performance 
6. Productivity/efficiency
7. Cancellations (staff and clients)
8. Recruitment costs 
9. Interviews per month
10. Hires per month 
11. Recruiting 
12. Retention/turnover

Other ABA practice KPIs to consider:

1. Rev cycle management objectives 
2. Response time to new clients
3. Time to initiate services from initial request
4. Financials/books upkept monthly
5. Expand product/service lines
6. Expand to new markets

Do you think there are any crucial ABA practice KPIs missing from our list? Share your thoughts in the comments below ⬇️.

SCORE is another great resource to consider! 

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Mastering KPIs in Your ABA Practice: Drive Success & Growth 📈 appeared first on Partners Behavioral Health.

Doing these things will reduce overhead, minimize human error, and help to more efficiently replicate and scale.  

These things can yield meaningful return on investment (ROI), and result in increased resources available to reinvest in your staff (pro tip, buying them time can go a long way), clients, and general culture creation – all leading to better services and value. Everyone wins!

If leadership can get out of the “day-to-day” of operating the business, higher leverage activities can be completed more regularly. This allows valuable time to be spent on tasks that move the needle the most. More higher-level decisions ultimately lead to growth!

What are some areas you focus on? Share in the comments below:

Comprehensive business evaluation checklist: https://partnersaba.com/product-and-service-packages/comprehensive-business-evaluation-checklist-1

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post To scale an ethical and sustainable ABA practice, you must improve efficiencies – here’s how: appeared first on Partners Behavioral Health.

Approaching contract negotiations in an informed manner is integral in this process. It should be tackled at the outset and not retrospectively or as an afterthought. When contracts are signed with commercial payers it can be very difficult to renegotiate better rates. If you are not intimately familiar with this process, this may be one of the worst places to forgo professional expertise. Just do the math. Changing your blended rates by even a few dollars can have a meaningful impact on your financial position and therefore your ability to reinvest in quality and compliance. This impact magnifies as you scale.

Here are 5 misconceptions that some ABA providers have about the process.

MYTH #1: COMMERCIAL HEALTHCARE FUNDERS CAN’T OR WON’T NEGOTIATE. 

False.

Commercial healthcare funders can negotiate. Any internal policies discouraging this activity can be modified or waived at the funder’s discretion. It’s generally a matter of bargaining power more so than anything else, so network adequacy is an important factor.

MYTH #2: CONTRACTING WITH ALL FUNDERS IN A GIVEN REGION IS A SIGN OF SUCCESS OR BETTER BUSINESS ACUMEN. 

False.

The reimbursement schedule commercial funders offer as their initial rates are largely market dependent. Knowing and negotiating to your budget is key.

MYTH #3: ACCEPTING RATES BELOW MEDICAID IS A REASONABLE OR STANDARD PRACTICE IN HEALTHCARE.

False.

In healthcare in general commercial reimbursement is often well in excess of public funders – Medicaid or Medicare. These public funders have processes for determining their rates and although this is not the only factor by any means, this is a relevant indicator and relevant to provider budgets and projections. 

MYTH 4: A FUNDER PROMISED ME THEY WOULD RE-EVALUATE MY RATES AFTER A YEAR IN NETWORK; THAT SEEMS LEGIT.

Unless you have that in writing, I would definitely say false.

If they’re serious about that they’d be willing to put it in writing, whatever the specifics of the arrangement may be. 

MYTH 5: FUNDERS WILL PROACTIVELY INCREASE REIMBURSEMENT RATES PROPORTIONAL TO INCREASES IN PROVIDER OPERATING COSTS

False.

SOME FINAL THOUGHTS: 

If any of your payer rates on their own can sink you, you might want to give that thought, since it’s possible your “better” payer lowers their rate. It’s not a regular thing, but it has happened multiple times across several markets. 

The “I’ll figure it out later approach” is not only unlikely to pan out, but it’s entirely irresponsible. You have people whose jobs depend on you, and clients who probably don’t want to get back on a waitlist at another provider.

ABA is an emerging market and whether it’s lack of knowledge on the part of providers, or market share, the reality is funders won’t make it a practice to pay more than they need. If providers keep taking the rates they’re offering, then why would it make sense to pay more, right? Providers operate independently and as part of a competitive market, and it’s up to the provider to determine whether the rates allow for sustainable operations that meet pertinent standards.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Five myths about contracting with commercial healthcare payers appeared first on Partners Behavioral Health.

Organizational ethics lives at the intersection of management, practices, policy, and organizational systems within which clinical practices are an output. This requires coordinated activity among skilled professionals, and comes with a price tag.

These costs should be looked at like an investment – in your company, your clients, and the professional field. They should be built into your financial model to ensure viability and sustainability of ethical operations.

When properly implemented, you can strengthen company culture, improve outcomes, and reduce liabilities. This can lead to big return on investment for your different stakeholders, including clients, and can increase overall value of your practice.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post Organizational ethics in ABA. They ain’t free, but they are key. appeared first on Partners Behavioral Health.

✔ Step 1: Identify and objectively define quality outcome measures and metrics. INCLUDE RELEVANT STAKEHOLDERS IN THIS PROCESS; i.e. clinicians and even clients. Starting small is better than not starting at all – maybe one clinical and one stakeholder satisfaction.

✔ Step 2: Aggregate the data and report out on those measures. Maybe even post some of those measures on your website (this may be more appropriate for some measures than others).

👍 And, there we have it… Who knows, the impact may be bigger than you intend.

For patients who are unable to self-advocate, this may be more difficult. You can look to the research and consider other creative things you might do, even if just as a starting point. I’ll plan to post on this at some point.

Brandon Herscovitch, Ph.D., LABA, BCBA-D

Partners Behavioral Health can help with your clinical and business standards, compliance, and outcomes. We can help you scale an ethical ABA practice you’re proud about.

The post 2 actionable steps to drive improved clinical outcomes, patient experience, and stand out from the competition in recruiting and retaining clinicians appeared first on Partners Behavioral Health.

As a friendly reminder, multiple provisions in the Behavior Analyst Certification Board Ethics Code for Behavior Analysts obligate ABA practitioners to use and recommend services that are based on scientific evidence, and to educate consumers about that evidence so they can make informed decisions. For young children diagnosed with autism, the best available scientific evidence indicates that comprehensive ABA intervention for at least 30 hours per week produces substantially larger improvements in key domains than less intensive (i.e., lower “dosage”) ABA intervention, eclectic mixtures of interventions, and other early intervention services (e.g., see this “Clarifications” document published by the BACB and APBA). Some studies that are touted as showing that low-intensity ABA treatment is highly effective for young autistic children have serious methodological weaknesses. Some may have been influenced, funded, or conducted by entities that are financially incentivized to favor lower-intensity services.   

It’s important to note that the young autistic participants in most of the sound studies of comprehensive, intensive ABA intervention published to date represented all levels of severity. That is, the evidence does not support recommending intensive intervention only for those who are deemed to have moderate, severe, or profound autism. That’s consistent with our profession’s standards of care, which call for services to be individualized to the needs and preferences of each client regardless of their diagnosis, chronological age, or functioning level. 

In addition to the studies of early intensive ABA intervention for autism, many scores of peer-reviewed studies document the efficacy of focused ABA interventions for building useful skills and reducing dangerous behaviors in individuals with a variety of diagnoses. Some of those clients may require relatively intensive ABA intervention to help them acquire skills and reduce challenging behaviors in order to enhance their health, safety, and independent functioning. The point here is that dosages and other characteristics of ABA interventions should not be predicated on diagnoses or severity levels alone (see the Model Coverage Policy published by the ABA Coding Coalition). 

Some argue that high-intensity interventions are too much for autistic children to handle, that high-intensity ABA consists mostly of discrete-trial drills, and that it’s wrong to teach young children to follow instructions, attend to tasks, and sit at tables. Those assertions are not borne out by the research on early intensive ABA intervention. Indeed, they contradict the evidence from that research as well as the facts that high-quality ABA intervention for autistic children has long comprised many procedures – structured as well as “naturalistic,” both learner- and practitioner-led  — and emphasized making learning fun. There has also been an emphasis on building skills that will ultimately help learners succeed in home, community, educational, and work settings. 

In sum, although we are not fans of arbitrary “red flags” for ABA service providers, we can’t help but wonder why those who are, advocate in favor of practices that are not supported by the best available scientific evidence, given the BACB Ethics Code.

Additionally, we suggest that instead of asserting or implying that all providers who recommend high-intensity ABA services for autistic individuals are unethical or “predatory,” it would be good to review the best available scientific research on the efficacy of various treatment models. No single study can produce definitive evidence, so it’s necessary to look to good systematic reviews or meta-analyses that synthesize and analyze results from multiple studies. Two examples in the realm of intensive, comprehensive ABA intervention for young children with autism are these meta-analyses of data on hundreds of individual participants in 16 studies: 

Eldevik, S., Hastings, R. P., Hughes, J. C., Jahr, E., Eikeseth, S., & Cross, S. (2010). Using participant data to extend the evidence base for intensive behavioral intervention for children with autism. American Journal on Intellectual and Developmental Disabilities, 115, 381-405. doi:10.1352/1944-7558-115.5.381

Klintwall, L., Eldevik, S., & Eikeseth, S. (2015). Narrowing the gap: Effects of intervention on developmental trajectories in autism. Autism, 19, 53-63. doi:10.1177/1362361313510067.

There are also many reviews and meta-analyses of research on the efficacy of focused ABA interventions for several client populations. For some examples, see the bibliography in the ABA Coding Coalition’s Model Coverage Policy, cited earlier. 

We support the notion that different service models are needed to meet the varied needs of autistic people, other client populations, and their families. Of course, further research is needed to refine existing models, and we hope entrepreneurs will work with researchers to develop and evaluate new ones.

Co-authors

Brandon Herscovitch and Gina Green

Partners Behavioral Health

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Partners Behavioral Health helps ABA clinic owners and operators structure a program based on best practice, and that meets the needs of their stakeholders and all applicable compliance standards.

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