Maximizing utilization is important for ensuring your clients achieve their full potential as well as securing your company’s financial health. If the client’s authorization is written for a six-month period and amounts to, for example, 25 hours a week of services, then it is critical to all parties that every effort is made to provide 25 hours a week of service and utilize the max units authorized. The reality is that clients and staff get sick, families go on vacation and other circumstances arise that result in session cancellations. My highest fulfilling client hits 97% on average and some on the lower end, less than 50%. If we believe as I think most all of us do, that these hours are medically necessary, then that means a 50% potential loss in skill acquisition and 50% revenue left on the table which is neither good for you or your clients. Below are some strategies that you can implement today to bolster those numbers:
Review and revise your Client Services Agreement.
Set policies around cancellations and makeups with accountability measures that everyone understands and agrees to at the onset. Couch all of these policies around medical necessity and the impact on their child’s progress as that is the goal – to provide the necessary services so your client/their child can reach their maximum potential.
I recommend that families be willing and able to schedule a minimum of 90% of the authorized hours. Depending on the number of hours per week, you may want to set the floor at 100% but clients with intensive services of 30 to 40 hours a week may realistically not be able to schedule 100%.
Overschedule!
Most authorizations are written in 6 month increments with a total number of units to be provided during that period of time. Ideally, that breaks down into for example, 20 hours per week of services but, the reality is that is that cancellations occur. By overscheduling by 10-20%, what is the worst-case scenario? You temper down hours the last week of the authorization period. Guess what? In 20 years, I have NEVER seen this happen. The reality is you are just less likely to be at 50% and more likely to achieve 70% utilization or maybe higher.
Cancellations will occur and you need to have strategies in play for how to recover those hours lost.
Alternates and/or floaters – ensure your Client Services Agreement spells out clearly that if their regularly scheduled therapist is unavailable, they will, if possible, be scheduled with an alternate therapist. Explain that clinically it is critical that generalization occur and by having alternates, the skills are generalized and not just successful when implemented by their regularly scheduled provider. If cancellations occur a lot, you may want to hire a seasoned RBT to serve as a floater. This person typically is paid for a guaranteed number of hours per week and is very skilled so they can be deployed to any client should a staff cancellation occur. Be sure to look at 90 days in review and confirm that the floater would be deployed as you don’t want to pay for hours that they have no work to do.
Once sessions resume, extend the sessions by 10-15 min each day until the cancelled hours are made up. It is challenging for parents to find 2 or more-hour blocks to add into their week but it is not terribly hard to extend a few sessions by 15 min. to capture last weeks missed sessions. And yes, I know for many of you, the challenge is that the therapist is scheduled back-to-back and this means the next session will start late but if families understand that your goal is to ensure that all clients receive their full amount of authorized services including their own child, most parents will understand and be willing to start their sessions a few minutes later to ensure everyone receives their medically necessary services and reach their maximum potential.
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