A Look Back at 2024

As many of us do, I like to spend time thinking about the past year as I venture into the next; especially as it relates to the services we provide and how we can better support ABA agencies throughout the country and abroad.

When I think about ABA and 2024, there are a few things that immediately come to mind:

1. 1. Client acquisition is now something many ABA practices are struggling with. Historically, most everyone had 50 or more clients on their waitlist at any given time. In 2024, I was regularly coaching business owners on strategies to acquire patients. Saturation in most instances was the primary factor at play. In certain states and within certain geo areas in specific states, the “30-mile radius” I recommend people find and make their own is becoming harder and harder to do. And for some, they find themselves surrounded by 5 to 10 other similar providers, making it challenging to acquire not only clients, but the staff needed to service their clients.
   2. Another industry change is that it is getting harder and harder to maintain a profitable business only providing ABA services.  More and more companies are adding additional services to their offering such as Speech, OT, PT, pediatric therapies, and more. 

I think this is very beneficial, not just from a revenue standpoint, but also from a client acquisition and clinical excellence standpoint. Parents have long wanted all services provided by the same team where everyone is working together across disciplines to achieve “Johnny’s” goals. Likewise, payors have increasingly been talking about collaborative care as something they would like to see their providers do more of, and as a means of increasing provider reimbursement rates, once achieved.

1. Challenges recruiting and retaining staff seem to be at an all-time high. Although a significant number of BCBAs and RBTs are getting their credentials every year, it still is not enough to meet the demand. As a result, BCBAs salary and hourly requirements are higher than ever before. I’ve had many clients in 2024 pay more per hour to their BCBAs than they are reimbursed for the services they provide. That definitely adds to the struggle of sustaining a financially healthy business.
2. Rate challenges continue with many payors. Cigna/Evernorth for example is now paying $40 an hour for 97153 for those newly contracted. These nominal rates make it nearly impossible for an agency to hire skilled talent and/or implement best practice-based training that includes 40 hours of in person training. No matter having a budget for staff reinforcement and on going professional development, when rates are low, and these are non-reimbursable expenses.

On a positive note, some payors are increasing their rates as a means of drawing providers to establish practices in specific geo areas. As many of you know, Nebraska’s rates are great and we’re working with a number of practices establishing themselves there. But, remember the age-old adage “when something sounds too good to be true, it usually is.” These rates are fantastic, but they will not last. I recommend that you sock away every dollar above $65 that you are reimbursed for 97153 because within 12-24 months these incredibly high rates WILL be adjusted. Texas did a reduction a decade ago and IN Medicaid eliminated the pay 40 plan last year. Payors aren’t paying 2-3x the usual and customary rates because they understand and appreciate the value of the services you provide (unfortunately); they do it because they have to meet the need of their members. Once enough providers are in network to meet the demand, the rate reductions will inevitably happen as they have in the past.

As we move forward, remember that our industry’s challenges often spark the innovations that lead to better care delivery. Innovation transforms how ABA practices serve their clients, and I’m excited to see how our community continues to adapt and thrive in this evolving landscape. Your dedication to providing quality care while navigating these changes inspires us all, and we remain committed to supporting your success every step of the way.

Warm regards,
Kim Finger, Ph.D.
CEO