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Is ABA Cancelled? · ABA Business Leaders

• speaker-0: Is ABA getting cancelled? speaker-1: You guys are all a bunch of big fraudsters. Griff speaker-0: Is AVA a dumpster fire right now? speaker-1: The state would pay 40% of whatever you charged. Whoever wrote that bill was an idiot. Nobody wants anyone to steal $46 million. Do I think the industry is going to get canceled? Welcome to ABA Business Leaders, brought to you by 3Pie Squares, where we discuss topics on how to create and grow an ethical and sustainable ABA practice. speaker-0: Lady A in trouble? Should we be worried? Whether you're starting, scaling, or thinking about selling your business, we're here to share insights, stories, and strategies to help you on the journey. speaker-1: He owned a successful ABA practice for over ten years. speaker-0: And now we help other ABA business owners do the same without all the chaos. speaker-1: Stick around, you're in the right place. Welcome to ABA Business Leaders, brought to you by Three Pi Squared. I'm Steven. Bro. You guys are all a bunch of big fraudsters, grifters. speaker-0: And I'm April. Ste Steven's in a mood today. I don't know. I think that's last week we were planning a a topic that we wanted to discuss today and we were chatting about it, just the two of us, and and I was like, wow. I shared with him some screenshots of some social media posts. It's out there in our in our industry. Is ABA a dumpster fire right now? Is ABA getting canceled? Is is ABA in trouble? speaker-1: This topic really bothers me. speaker-0: ⁓ all all of us business owners in this ABA field should we be worried? And what should we do? How what what do we do? because we're already in a stressful being a business owner is stressful. We know that. I think I I mean if you if you didn't know it going in, you found out pretty quickly. being a business owner in our field and this quickly growing, changing evolution of ABA and how it's being funded and all the th or not being funded. ⁓ and all the things, right? yeah, I don't know. What ⁓ speaker-1: So I I mean, like first of all, h if you wanna learn how to build a business without losing your soul, there there's a great book that you can get on it. speaker-0: But you can get on it and the the the the link will be on the show notes, still ready. speaker-1: And and now it has a journal too, so you you may want ⁓ you may want to speaker-0: And a journal that will help guide you and walk you through the book. Navigating the book. speaker-1: Yeah, I mean we had ⁓ I can't remember his name. It's I I'm the Ethics Guy. What's his name? Yeah, we and and one of the things that he said was like sometimes you just gotta do good work and you gotta be okay without ⁓ it being acknowledged, right? And so for like that's kind of where ⁓ my perspective is on this. You just gotta do good work, right? And ⁓ speaker-0: Bailey? speaker-1: for most of the people that we work with, they understand. Maybe they haven't written it down and maybe that's why you need to get journal. but they they may have not written down what high quality ABA is, but I think that they can they they understand when they're watching it being done. This is what good ABA is, this is what not so good ABA is, right? speaker-0: Yeah. And and I think that that's we've been having this conversation a lot lately, which I'm super excited about. But like your personal everyone's individual responsibility as part of the team. Right. And at also the system that how like maybe and and I and you know, I am not a political person on purpose. I I tend to kind of I feel like I'm realistic. I I tend to be positive, but I also ⁓ ten the realism is there, I tend to be ⁓ easily swayed. ⁓ I used to say naive, but I think I've changed that. I think it's more like it's easily swayed. And so sometimes when people talk about politics and, you know, all of the like like systems and like systems are broken and we all need to take responsibility and all of that, right? Like sometimes I get like lightheaded because I'm like, ⁓ I don't know. Like I'm I'm like you know, recovering people pleaser and still sometimes I'm in that category of people pleaser and let's include everyone and make everyone happy and let's make sure that everyone gets equal, you know, their time and blah blah blah all the things, right? But so so so I am a little self conscious about digging into some of this that like, am I gonna use the right language? Am I gonna say this ⁓ in in the way that I'm intending to say it. So I'm gonna try to be intentional in in in how I say it. But I do wanna preface that that like We don't have to be well spoken or understand the ins and outs of this to be able to have a conversation and get curious about it. 'Cause I think that that is a lot, right? Like a lot it's easy to be like, ⁓ I'm just gonna Yeah, sure, I'll take responsibility for myself and I'll just be over here and I'll do my thing and I'll kind of just let all of that be over there. But I think part of being responsibility is to having some kind of knowledge and understanding or or Contributing to the conversations. I don't know. I don't know where if that any of that makes sense. speaker-1: I don't like that that's something that I've been searching for the last six months is where does my responsibility begin and end. And I I can't figure that out. So like that that's a that's a different cover. Everybody's gonna have to figure out what kind of load they can carry. And but like for ABA business owners, I I think that it starts it starts in your clinic, your therapy center, your in home agency, what whatever. That's where it starts, I I think and Taking responsibility for the quality of care that you're providing or lack thereof, right? And having the ⁓ self awareness and perspective that ⁓ you can look at it as objectively as you can and say, Hey, we we have some work that we need to do and not put your head in the sand and just say, it is what it is, right? so that that's something that I think we can all do. Right. And then as far as B C B A's like, you know, and dude, I don't do any of this, right? So like I can I can, you know, sit here yapping, right? Like I I mean I I'm not a B C B A. I I'm not I'm not a clinical director. I I like I've I've been there, I've I've I've watched it, but I have like, you know what I mean? Like so it's like easier said than done, Steven. Like, ⁓ and I get that, right? so I I just wanted to speaker-0: I you don't do any of the speaker-1: Share that, right? That I I can also acknowledge that this, you know, when you get in the weeds, it it's it can be very difficult. ⁓ and it's not always as easy as, well, I need to do better, so I'm gonna do better. Do you know what mean? ⁓ there's there's a lot of moving factors, there's resources, there's the financial stability of the company. I I can understand that, ⁓ but we can all take some small steps. And I it starts with awareness, right? It starts with, ⁓ okay, I can do this better. And And now I can at least take some little steps to get there. So like that. And then as far as B C B A's and RBTs, you gotta stop working for crappy companies, right? Like you just like there are there are many amazing companies out there. and ⁓ all of these companies that are doing not so great work, ⁓ like they can't do that work if you don't work for them, right? And if you're struggling to find a a high quality practice, I have resources for you, right? We we can get you in touch with Naskin, right? We can get you in touch with ⁓ other clinicians in the all around the country that we work with that are doing good work. ⁓ and so the amount of power that you have to shape this industry is is unlimited, right? And so that that's kind of you know where I'm at at this point. and then I, you know, I've I've read the articles around how ABA is just a bunch of fraudsters and you know, most of the training comes from on the job and they don't really know what they're doing, they don't need a certain degree to do the job. And not all of that is a lie. I mean the the some of that is true. And you know, again, that goes back to, you know, if you think as a ABA business owner that you can hire someone with no experience and and give them the forty hour RBT training, like and then just throw them into a full caseload. I mean, this you know, that's why we can't have nice things. That's why we can't have nice things. So so like you're part of the problem. No offense, right? Like ⁓ like that that is an issue. And so ⁓ yeah, I I I like that, yeah. ⁓ so speaker-0: Snowballs, right? Because like part of that is because why why do we not why do we throw staff in without adequate training and and assessment of their skills and all of the things is because we don't get paid for that. It's not billable. We don't no one's giving reimbursing us for those. So what does that mean? Take responsibility for what that cost is is going to be. speaker-1: You haven't budgeted. I'm sorry, like the you're a business owner. You you signed up for this. you know, the the other thing is like speaker-0: And I say this as like a like a big sis like I I you know, I I hope I come across as like your big sis or something, right? Like I don't know. You know, there again, there's my people pleasing. I'm like, ⁓ But I mean you can't be mad. You're you're allowed to feel however you want to feel, but like it's ⁓ I get it's hard like I I did I didn't budget for that when we started our company. Sure. Steven was like you you were even like, What do you mean? speaker-1: Yeah, I mean you can be mad. speaker-0: What do you mean they need more training? Didn't they do their forty hour thing? Like there was a point where that's where our conversations were and I'm like, yeah, but like this child is very different from this other, you know, or they've been on this other case for X amount of time. Like, can't they just hop on this other case? Well, no. Like this other case is very different. so but it but is that awareness and that understanding even going in? Like I say often, like you have no business starting a company if you can't like have the money available to train staff. That's kinda where speaker-1: Well, ⁓ And like we and we can we can talk about ten ninety nines, don't do that, right? Like we've had we've had many podcasts on the don't do that. ⁓ like ten ninety nine, don't just stop, right? The the not paying for drive time, stop, or not paying for required training, stop. and and so th there are things that are all too common in this field. And again, this is from well meaning. B C B A's trying to do the right thing. And, you know, when I'm talking to customers or on a free consult, and, you know, I've heard, well, you know, yeah, we're just doing these one or two things. Like, ⁓ and I I again I'm sorry, these are structural, like these are like, you know, this is the foundation of your company. ⁓ yeah, we only have We're only d only one or two of the corners of the basement are completely blowed up, right? Like the rest of the house is totally fine. ⁓ no, I I I don't think so, right? And maybe, but most of the time when we start down this path with ⁓ an agency where they are, you know, again, unintentionally doing some pretty I I don't like Actually quite yeah, that's a good word. speaker-0: intention speaker-1: Yeah, it's I I don't believe like again, most of the people that I talk, ⁓ I didn't know that, right? And so who wh how would I know that? I mean, I still to this day, like we started a billing company, right? It's an awful idea. And and like like so ⁓ we'll start with somebody in a new state and and they'll be telling me, ⁓ you gotta do this and that. And I'm how how do how would I know that? Right? Like, so like Like I get it. I understand. Like you didn't go to school for ABA business ownership, right? Which is probably why you should get the book. But no, but seriously. And so you get into this, you think, ⁓ I can do this. And there isn't that that understanding of all of these issues that could come up. There there isn't a foundation to the company. We haven't budgeted. And then we're in the weeds and we don't know how to get out. And and so like it it is what it is, right? So and I get it. But there are some questionable things that are happening in the industry. And then there's fraud. And that is also a hundred percent happening. Billing for break or billing for naps can't do that, right? ⁓ billing ⁓ one BCBA ⁓ under another BCBA because you just can't get them credentialed. You can't do that, right? And so there there is fraud. And then you have these extreme cases where, you know, ⁓ they the the latest article was like a They found a company in Minnesota that like billed forty-six million dollars fraudulently. Did they? I don't know, right? Like maybe. ⁓ I I I would like to see it go to court. You know, like I I would like to understand how that happens. you know, but ⁓ apparently they they got diagnoses that they shouldn't have got and they billed for hours that they didn't do. And they were paying off parents. That's awful. Those are terrible things and they shouldn't happen. And if they were actually true, ⁓ then those people should get punished for it, right? They they should they there should be justice. ⁓ they should have to pay that money back, right? But the you know, there there's been a lot of of fraud ⁓ going on in healthcare for a very long time. And ⁓ you know, I posted this on Facebook, I don't know, months ago now, and and like You you can call me a whataboutist. I don't I honestly don't care. ⁓ but like if you know, I ⁓ before we got on the air, ⁓ I said I made this go like so and I'll switch it around so I won't be sexist. ⁓ but you know, we're we're doing our home finances and ⁓ the Yeah, this is not true. And and so, you know, our our accountant comes on and says, Look, guys, you're spending way too much money a month. speaker-0: Just an example by the way. speaker-1: You can't afford to do this. Like you're gonna you're gonna lose your house. And so we're looking at the bills and and I see April got ⁓ an Amazon Prime account. ⁓ why did you get that? We we don't have the money for that. And then she looks at the bills and I I've spent ten thousand dollars on Lego this month. Like so both of those things are wrong, right? speaker-0: It is very possible that you could have spent ten thousand dollars on Lego. speaker-1: Hundred percent. So both of those things are wrong. One of them is way more wrong than the other, right? One of them is more impactful to our finances ⁓ and needs to be resolved first, right? And so like you can, you know, again, I get that ABA has its problems, but or and all healthcare has its problems. Like does anyone remember the opioid crisis? And like does any like like there was enough o ⁓ what like ⁓ I don't even remember the name of the drug anymore. but there was enough opioids at this one pharmacy that could they could prescribe, I don't know, like ten prescriptions to the entire state. Do you think that that was a good like do do you think that that was good, right? Like this one pharmacy, like how many millions of dollars ⁓ fraud was there, right? ⁓ as far as wasteful spending, the government spend the federal government spends two billion dollars a year, the entire premise of this fraudulent grifting ABA that they're talking about on unused subscriptions. Right? So like th maybe we tackle those things first. Maybe we stop spending money on bombs. That's a better use of our time, right? ⁓ I I don't know. But like Cutting ⁓ healthcare ⁓ from the most vulnerable population in the in the country, it seems like is so stupid. And and that is my opinion of what they're trying to do here. They're trying to justify the cuts to Medicaid, and they see this as an area that they can cut. And so we've got to villainize the clinicians doing the good work. So that people can say, ⁓ yeah, that they don't deserve the money. They're bad people. And so, you know, we we need it for the good people. And so that that's kind of where I'm at. You know, like again, is there fraud, waste, and abuse happening in ABA? Yes. But like respite care, right, is like notoriously worse than ABA. And so if the point was, hey, let's tackle fraud. We're gonna we're gonna do some real aggressive fraud prevention. There are many other things that could be tackled before cutting Medicaid for ABA therapy. So that that's kind of where I'm coming at from this, right? ⁓ you know, and and and another thing that ⁓ I've been saying this for several years at this point, ⁓ if you're running a clinic ⁓ with all of your cases are forty hours a week. Thirty five hours a week. ⁓ I you know, I said that like I said, I said this several years ago. I don't think that there is I don't think that that is where this field is going. I don't think that there is a ⁓ business case for that, potentially ⁓ for very long. And ⁓ so, you know, North Carolina I believe ⁓ has ⁓ drastically cut the amount of hours that they will allow. so I think it's down to sixteen hours a week. Is what they allow without a peer review. ⁓ I assume that they looked at the numbers and said the average kid gets sixteen hours a week when when they're diagnosed. And so we're we're just if if it goes above that, then we're we're gonna put ⁓ something in place. I don't necessarily think that's a bad thing. speaker-0: Well, I mean, ⁓ we've been having this conversation in our support group. if you haven't already heard about it, just a little plug here. ⁓ it's completely free, no strings attached. if you're a business an ABA business owner or a leader decision maker, ⁓ go to the show notes. There's a link there and we would love to have you. but I think I I I responded to to a message within it just this morning saying that, you know, you know Person was saying, wow, this is really hard. I'm thinking about maybe just going to like a BCBA direct model, right? Where we maybe provide coaching and parent support, maybe working within some districts and things like this because this RBT and you know, I and I don't know all the details ⁓ of the situation, but she was just basically saying, Wow, this is really hard. And I'm wondering if I should shift things. ⁓ And you know, my my comment was like I think that's where we are right now. I think we as a whole in general, we have to, especially as business owners, right? We have to get curious if we're not already curious, d dive in and get more curious and take a step back and look at the like different perspectives of of okay, it it's not okay, what are we basing? What are whether we're consciously aware of it? Maybe like let's get let's get curious because maybe we're not even aware of this, but what are we What are we hoping for and basing our budget on our income or our idea of what we're gonna make? Like are are we expecting that most of the kids that come across come come into our clinic to receive services have 20 plus hours a week? Is that what we're betting on? Is that I that's what I'm trying to say. Like are we are is that where we are, even if we're like, ⁓ but no, like it's medical necessity, it's what's important, what what the needs are for that individual, for that family, and all of that? Yes. But can it also be true that in the back of our minds we're kind of expecting these higher case higher treatment hours per week because that's just where what we're used to and what what we've done for years? And it isn't my it can help me out here. How do you know what I'm trying to say? Just that we're like we just have to start shifting our perspective of of what what that looks like, right? And not expecting that all kids are gonna be 30 hour, 20 hour case. speaker-1: And look, like s there are some clinics out there and they work with ⁓ high needs children and that's all they do. Right. And speaker-0: Truly need those I mean th some of those kids who you could argue need more than forty hours. speaker-1: But I think we can also agree, or maybe instead of but I'll say and we can also agree that not every child that's diagnosed needs forty hours of therapy a week. speaker-0: Because we get those families, right? You know, like that's what we we had this conversation before that, like, ⁓ well, you know, the the cancellation rate from the family is X percent, right? It keeps going up, or it just no matter how much we talk to them. Well, have we even had a conversation to see if this amount of hours is even like doable by the family? Maybe it's like medical necessity to the three year old, but like where how can we meet the family where they're at? Maybe they just cannot get their kid to us for that. Yeah. Like there's other three speaker-1: Yeah, I mean speaker-0: More things to think about. Like we have to take it as a big picture. We have to look at all the factors. It can't be just black and white. speaker-1: Yeah, maybe they wanna have a life outside of ABA therapy, right? You have two like assuming like ⁓ you have a two parent family and maybe they have two and a half kids, right? And they're both working forty hour a week jobs and then their child also has a forty hour a week job and you know, that's a lot. That's a lot the 'cause they the other one and a half children need to get soccer, they need to get to hockey, they need to get ⁓ you know, badminton or whatever sport right whatever whatever sport that they're into, right? We have grandparents that we need to take care of. We you know, ⁓ like like we just want to be able to like maybe we just go to the Yeah. And just like just chill and not have to be collecting data and not have to be performing and not have to be worrying about, ⁓ did we do the thing the right way? Like ⁓ speaker-0: Playground. speaker-1: So so there's that, right? And so some of these while the child may, you know, like you may believe that that child needs, you know, ⁓ twenty five hours, but you can only get ten. I I like this is this is I don't know. I I I can't answer this, right? Like I intentionally stayed away from the clinical side when we had our practice because I don't wanna have to be making those kinds of decisions. I I don't like that's not Yeah, maybe that's a cop out, but it like I don't feel that I should be making those decisions. I think that's a that's a bare that's a speaker-0: concerned that you are going to manipulate and and have our clinicians feel like they 'cause I think clinicians already like already is that pressure, right? That ⁓ they're expecting. Like you you get it. Whether you understand the ins and outs of business, I think B C B A's understand behavior analysts understand like the the dynamics and like they see the speaker-1: Yes, yeah. There is a pressure. speaker-0: even if they don't understand fully, they they get it that that okay, this this money helps pay for my salary and these tech salaries, right? And if we're counting on this kid being a full caseload, I then need to justify a full caseload or, you know, because if not, then I might get some pushback. And the pushback like from you, like in the beginning, it wasn't even pushback. You were just honestly I didn't understand that then, but I understand it now that you were just honestly asking questions. You're like You weren't like, Why can't this kid get more hours? I thought you said this kid was gonna be a twenty hour a week can whatever. It was more like, ⁓ that's interesting. You guys said that maybe this would be a a bigger case and it's not. Okay, but you were just trying to find out more information. But there is that like ⁓ like it maybe okay, well I'll bump it up like five hours just to stay you know, like it's a very it's a very ⁓ speaker-1: It's a big Like I don't yeah, this is a weird speaker-0: Not a there's not a formula. No, there isn't. There's not a formula. And there's so many variables that come into play. Yes. And skill set of the clinician can be a big part of that as well. Right. And looking at the values and what's important, right? And and you know, i i maybe the family saying we just want to be able to coexist as a family without our child taking off and running to the street. And and but and but we see speaker-1: I I a hundred percent agree. Right. speaker-0: it more. We see okay, there's even more potential. Which is a good thing. It can be a good thing, but like I it but there's that speaker-1: Or there could be that the the opposite thing where like we need to get our child in regular ed, like that is our goal. And so we've got, you know, he's he he's two and a half, we like he just got his diagnosis, we're going full and and you're like, ⁓ he like he needs to be able to have a nap, guys. Like like you know what I mean? And so that th No, there it's just a lot of nuance. Yes. And so there is no set speaker-0: So what we're saying here is it's not easy. speaker-1: You know, maybe AI next year will come up with a what you should what you should do. But right now, at this moment in time, like there there isn't a a great way. Now I think that Casp had just came out with something around ⁓ yeah, some something around treatment planning. Now I don't think that they go into like, okay, this therefore then means, you know, X amount of hours a week. ⁓ and you know, the the fact that again the the industry speaker-0: Yeah. speaker-1: This field is relatively new as far as clinicians. So like when we talked to ACQ last year, I think it was Eric, ⁓ he said it was like average ⁓ average clinician had three years experience. I'm going to say it's probably less than that now, right? Because of the amount of clinicians coming in to the field. Do I think the industry is going to get canceled? No, I I don't think so. ⁓ Do I think that there are people out there misbehaving? A hundred percent. Right. Like that that is happening. It's not good. And we should, you know, i if you can if you see it, you should you should say it, right? Like I I think that's what they say on our ⁓ my our son's playground, right? If if you see bullying, say something. ⁓ because then the if you don't say anything, if they scare you into not saying anything, then the bully wins, right? And so this would be A very similar situation. If you're working for a company that's doing something fraudulent, then you should report it. And ⁓ whistleblowers typically, if they if they get ⁓ if they report fraud, Medicaid fraud, you get a nice little paycheck for something like that. ⁓ yeah. Like I think it's 10% or whatever they find, right? So, you know, if if you can find forty six million dollars in fraud, that's a nice little paycheck that you got there, right? And so, like. That that goes back to my conspiracy. Was there really forty six million dollars of fraud there? Do you know what I mean? There's a lot of incentive to make it as high as possible, right? For a lot of people, right? ⁓ there are more clicks, the higher the amount is. ⁓ the government ⁓ can use that case to cut spending. You know, so because nobody wants nobody wants anyone to steal forty six million dollars. I think like everybody thinks that that's bad. Right. Like on I like I think everybody can agree, stealing forty six million dollars, not good. Right. ⁓ so what do people say? Stop that, right? ⁓ and so it's easy to say, well then fine, we're just gonna cut it. We're just gonna cut it. Right. And so I think that they're using that. You know, th though there I can't remember the state. I think it was Arizona, but I apologize, Arizona, if this is not true. but they had it where, you know, there was a br a big That was one of the first articles was this bad, bad ABA company was charging eight hundred dollars an hour for nine seven one five three. And ⁓ and and the reason why was because ⁓ the the state would pay forty percent of whatever you charged. Whoever wrote that bill was an idiot. They like, come on, right? Like you didn't think, ⁓ what happens if they charge us a million dollars an hour? We're just gonna pay it. And then everybody said, Yeah, totally. Like whoever, like, and ⁓ like I've said this probably twenty times since that article has come out. But when I put on my conspiracy hat, I think that was done on purpose. Like, what what can you do with that? Right. There are gonna be a couple of people that just find that out and then they're gonna bill eight hundred dollars an hour or a thousand or two thousand or three thousand, right? And then you can say, ⁓ look at all those bad people stealing from the government. So I don't know. That's just how I feel. And maybe no, I'm not even gonna say it. So so so there's that, right? ⁓ should they have charged eight hundred dollars an hour? Probably not, right? Should they charge two hundred? What about a hundred and seventy five? Well about two fifty, right? Like w you tell me what the right price is. I I don't I don't know what to tell ya. So ⁓ maybe their maybe their services were just that amazing. I don't know. I don't know these people, right? I don't know their outcomes. ⁓ so I I just think that yeah, maybe eight hundred dollars an hour is outrageous. Maybe it is. ⁓ they would have got forty percent of that. ⁓ so what is that? Like ⁓ three hundred bucks an hour? I don't i are are your services worth three hundred dollars an hour? How much do you charge when you consult with someone, right? I I don't that's a do you do you understand what I'm saying? speaker-0: Yeah, yeah, yeah. Yeah, it's it's all it's all fishy. I I but I yeah. Not nothing really nothing really I was gonna say, nothing really surprises me anymore, but I'm almost scared to say that because something's gonna pop out really, really, really crazy. speaker-1: So like i if if you got a a contract from ⁓ like l I'm not even gonna say an insurance company, I almost said it. If you got a funder, if you got a funder to agree to a hundred and twenty dollar an hour ⁓ rate for nine seven one five three, would you say, ⁓ I can't do that? That's not fair. Right? Like you would take that money and hopefully you would then reinvest that into your staff so that you could train your staff, right? And so like speaker-0: No, just speaker-1: That's all I'm saying. Do I think that $800 is the right price? No, I don't. But like I don't know what the cutoff is. And I don't think anybody can say they know what the cutoff is. Right. There are some doctors that just work at a network because they feel their services are so much better than everybody else's and they can't charge enough. So they're gonna do it the way that they wanna do it and they're gonna charge the amount that they want to charge. If you don't like that, go somewhere else, right? And and so like I I can't I can't answer that, right? Again, I don't think you should charge eight hundred dollars, but hey, I I don't know. I don't know the answer. So I don't know what the cutoff is. Is two hundred and fifty too much? 275 too much? Right. Like I don't know what the answer to that is. So ⁓ but I I I like, you know, kind of just rounding this out is I I think that, you know, we as a field are there's it's gonna be a little rough. ⁓ for a while. There's gonna be a lot of scrutiny around ABI. And it goes back to what I started ⁓ started with. Just do good work, right? speaker-0: Yeah, I mean, yeah, so so I don't know how grounding this podcast is. So but I do have my my my stone here that I picked up from the beach. Mm-hmm. And it's like the perfect little worry stone. I've been rubbing it the whole time. So maybe that gave gave some kind of grounding. But seriously though, like I think that what can be grounding is when we when we do have some control in the matter, right? 'Cause we're we we want to know, okay, what can we do? How can we What we have what's within our power? What's within our control? How how can we and so but I do I think that what I think that there is. It's taking care of yourself and showing up best that you can, right? Do good work. And if you need help doing if you're if you're like, gosh, you know, I I'm not sure where I stand, right? There we do have a isn't it one of our free little like a readiness quiz? I mean it I mean it speaker-1: I'm sorry. speaker-0: It could give you a good ⁓ not you're like, Well, I'm already I don't need a readiness quiz, I'm already in this, but I think it could kind of just help you just get start to get curious. Yes. And start to ask yourself some questions of like I mean I think that's what this is too. It's some some responsibility, but with that, like like is cure y like brings curiosity and and asking yourself questions and reaching out to others, you know, trusted people in the field and and and having these conversations and it's speaker-1: ⁓ It's a readiness to scale quiz. So I think that anybody that takes that, and if you get a low score, then you have systems that are not in place that need to be in place. Like like I can't say this with a hundred percent certainty, but I'm gonna say that there is a potential for ⁓ these things ⁓ for you to make it on the news. ⁓ if you get a low score on the readiness. Right. You know what I mean? And and then speaker-0: Give some concrete like way of checking in. So you're not like just spiraling out of control from a conversation like this, thinking, ⁓ gosh, it's all gonna blow up and speaker-1: Yeah, I d I don't I don't see it blowing up. I d I don't but I do see that more there's gonna be more hoops to jump through. There's gonna be more stipulations. ⁓ I I think like I said, I ⁓ with North Carolina, I don't I did not read everything that they were talking about in North Carolina, but limiting telehealth, ⁓ I don't know that I disagree with that so much. speaker-0: I that's the thing too, right? Is like I a lot of what I'm seeing, I'm like does that is that so bad? Does that sound so out loud? 'Cause you know, like like being more ⁓ curious probably isn't that accurate or being more like scrutinizing these hours more of like if if every treatment plan that that comes through or ⁓ auth or whatever that comes through for every kid has the same amount of hours in it. Like that's gonna I would think that would bring up some red flags. And you know, if you're if you're if if if a lot of your kids have the exact same goals, like I would think that should bring up some red flags. Like these things are starting to I think the companies are becoming more aware as too of like what to look for. Yeah, I think telehealth, yeah, telehealth speaker-1: I mean there are there are reasons why you would do telehealth, right? But I've had people reach out to me and say, My B C B A's are going to be ⁓ are going to be a hundred percent telehealth and we're gonna send the RBTs into ⁓ these areas and I was like duh I I I would like that was for me that's just kind of a deal breaker. ⁓ like the the issue wasn't even that they're in another state. The issue was, well, we wanna make sure our B C B A's are safe. And I'm like, wait, do you understand what you're saying? You know, we're gonna keep our BCBAs safe, so we're just gonna throw our RBT into this house. why don't you wanna keep all of your people safe? speaker-0: Yeah. But then we also hear from a lot of owners who are having a hard time finding HPs only do telehealth. Yes, yes. And they're or they're holding out for a job where they and I I I do question. I c I get it. Especially like if you if you're like, okay, if I go work from home and and save some money on childcare and blah blah blah blah blah for whatever your reasons are, hey, I get it. I I I have from health and and there's a lot of good to that. Yes. ⁓ but speaker-1: Yeah. I am a hundred percent tell out. speaker-0: As a BCBA, I think we have like ask yourself, okay, would I want to go work for a company that is a hundred percent telehealth? Like, does that what does that mean? What kind of clients am I gonna get? Am I gonna have two year olds on the other side of that screen that I can't fully support? Or you know, like it's it it it's telehealth isn't for every every speaker-1: So like we we've talked about a lot of the issues. You can go to our I hate my job series, why people are just not happy with the field. ⁓ this is just the icing on the cake. Okay. Like this is the r this is a natural response to an industry that is growing, and that maybe doesn't have enough guardrails in place. And so, you know, ⁓ I I again I've said this many times. If we don't put our own guardrails in, somebody else is gonna do it and you won't like them. And so this is what's going to happen. Like this is this is happening. We're seeing this right now, right? So ⁓ they're they're requiring accreditation in some states, they're limiting care in some states. And you know what? It is what it is. ⁓ again, I I get the appeal of telehealth, and in in some cases, that may be the only way the child receives care ⁓ because they're out, you know, a hundred miles from any any kind of area that A B C B A would be in a step. speaker-0: There's always these outlier cases. There are those cases that need more than forty hours a week. There are these cases who need multiple staff on them at one time. There are these cases where where telehealth i is is is the best that we can do or sometimes is the is the perfect solution. There are but what we're talking about is for the the the vast majority of the people because I mean that that just that's just how that's just how the systems work and the policy is for the majority. And then and then we can justify and try to figure out how to I I And maybe this is my naiveness and misunderstandings, but I do feel that if if we if we are truly giving our learners what they need or closer to what they need then those individuals, those learners who need more support more support would be available to them. I mean, is that I mean I is that is that too Pollyanna? I don't know. speaker-1: Yeah. I don't know. I I yeah. So like that that's again, that's where I'm at. Like ⁓ you know, I again I have many reasons why I think that ABA therapy should be the last thing that gets cut. ⁓ something needs to get cut. There's no money. There's no money at the end of the month and we're at like I don't know, two hundred and fifty billion dollars. We don't have it. Yeah, we we don't we're missing two hundred and fifty billion dollars every month. speaker-0: Can't even fathom what that speaker-1: Yeah, it doesn't it does it yeah, it doesn't mean anything. So something has to get cut, right? And so and and no one wants to get their thing cut. And so, you know, this is okay, well, we'll do something, let's make something the scapegoat. And so here it is, right? Like that that's what it's at ⁓ where we're at. ⁓ many states are cutting rates or limiting care in some way or putting up loopholes or barriers ⁓ to for access. and that's awful. ⁓ but it is what it is. And you know, again, I I just I'm repeating myself, ⁓ but it goes like in your treatment plan, can you read it and justify everything in it? Right? Do you do you can you back up the amount of hours that you're requesting for that child? ⁓ you know, th those like those are the things that matter. Can you can you read your ⁓ team's session notes and not like blush because you're like, my goodness, I can't believe we wrote this. Right? Like the it's it's as basic as that. It really is. Right? Like these these people that are getting caught are doing really bad things, right? Again, they're billing under a provider, everybody's hours under the same provider. They're falsifying session notes. The they're they're maybe they're using people that don't even have credentials. ⁓ to Bill. ⁓ speaker-0: I saw one thing it was they were they were saying something about scheduling around the round like s basing the schedules on the rounding rule. Yeah. and there was another one that was specifically like towards billing and I can't remember what it was. speaker-1: Like you can't like you can't use you can't have a policy that says we end the session seven minutes earlier every session so that we can cause that's all we need. We only have to work eight minutes. Like you can't use the roundup rule. And if you want to get into the roundup rule, we have a ⁓ a billing course that you can take. ⁓ but you can't use the roundup rule as like a systematic process. The roundup rule is a ⁓ man, something crazy happened. And I'm gonna use it once this month, right? Like that's what the Roundup rule is for. It's not, it's not something that is meant to be used on the regular. And so if you're using that, you're you're ⁓ if you're using that all the time, you're stealing seven minutes times however many times you're using the Roundup rule. Like that that you can't do that. I wish could, wish it was as easy, but you can't, because you're not doing it and you're saying you are. Like, are you embarrassed by your session notes? Can you read your treatment plans and justify what you're saying there? Does it match the human that you're going to work with? Or is it just a generic cookie cutter plan? Like the the this is these are the basic things. speaker-0: Yeah, those are the basic things. ⁓ speaker-1: You would you accept this for your own child, right? And and yeah, like would you allow this person to teach your own child? Right? Like this is ⁓ we were were working with a company in Colorado and he was like, Steven, what you're telling me to do is like just treat people kindly. Yeah, that's it. That's all I'm asking you to do, right? Is treat them the way that you would want to be treated. So pay them for the time that they worked and and give them the training so that they can be successful and and don't lie. And don't ⁓ not lying is hard. I I I i i it is hard. I understand that, but we have to strive for something that may be out of reach. So that that's that's it. Those are the three basic things. Treat people with kindness, ⁓ and and don't lie, right? ⁓ th those are the two basic things. So and that's it. Like do good work, right? Do good work. Do the work that you wanted to do when you started your degree, right? Like You got into this for a reason. What is the reason? What is the why? What is your vision? Right? ⁓ it goes back to ⁓ like what are the red lines? Right? What are those lines that you won't cross? The that you're just like, I will not do this again. I won't I won't just rush through a treatment plan. I won't ⁓ I won't just sit back and say, Yeah, this RBT, I don't even know their name, ⁓ is totally fine to do forty hours a week solo. Right. Like whatever those I will not do this again, you need a list of those things that you will not do again and then start living that, right? Like it yeah. So th that that's it. That's that's it. I don't know what else to tell ya. And and there is no rule or regulation or ethics guideline that can solve this. There's none. Because if there's a way to get around it, somebody will. So you just gotta yeah, you just gotta do good work. speaker-0: I have nothing else to add. I i really, truly. Take care of yourself. speaker-1: Yes. If if you yeah, if you're burnt out, if you're stressed out, if you're overwhelmed, like that impacts everybody in your company. It impacts your entire family, right? It it impacts all the clients that you work with. And and so like we have to get you you know, like the airplane rule, right? Like you put on your own mask before you put somebody else's on. speaker-0: And I'm gonna I mean totally feel like I've turned into like I've I've I've I've gone out s out of big sister and turned into your mom and that's not my intention here. But like if you like Okay, so when you are lying like it makes life harder. When you're not following the rule and you're you you're going rogue, you're doing all the things, like it causes so much more stress. And so I do wonder, I'm curious. I've said that word a lot today. ⁓ speaker-1: Mama said. speaker-0: It may so maybe this I mean, this is kind of how we parent. Out of curiosity, we try to at least. So maybe it's not gonna come across as too preachy, but like like I'm curious, like like really evaluate like where your own stress. And is some of your like burnout stress it is that because you're embarrassed of your session notes? It maybe is that because like you're you're nervous about ⁓ I don't I honestly if I really think about it, I don't think we're doing XYZ correctly. We need we need a ship. Maybe we are using the rounding rule even if we aren't really saying it. Maybe we are relying on that and I am concerned about that. I don't I don't know. It's ⁓ it's not even about like you're doing the wrong thing. Yeah. It's like, hey, like as ⁓ like you know better, you do better too. I I yeah, yeah. I I hear a lot of people in our field, I mean we're these conversations are happening more and more and so but I how can we support speaker-1: Yeah, yeah. If you feel like there may be some fraudulent issues going on, whether it be roundup rule, whether it be pay your your billing for naps or yeah ⁓ your your therapist is on lunch and you're still billing for for them while they're eating their sandwich, right? Like those those are ⁓ you know, whatever. and ta like maybe maybe maybe she won't like this, but talk to Kim Mac Rosenberg and and have a ⁓ ha have a conversation with her. ⁓ there's no one else more than I ⁓ than I trust ⁓ as like a leader in ABA billing, right? She's an amazing person. She's gonna give it to you straight, ⁓ and she can help you resolve this. ⁓ but self-reporting ⁓ is what you need to do, right? Or if you're if you're just coming to this conversation and you're like, whoa, whoa, whoa, whoa, whoa. I've got five B C B A's and I build them all under me. Like w what are you what are you saying now? ⁓ I can't do that. again, don't call me because I don't want to hear about it. ⁓ but talk to Kim and see what you can do. There may be things that can be done, but if you just put your head in the sand and say, Yeah, man, we're just gonna see we're gonna ride this, right? ⁓ we're gonna ride this out and see what happens. ⁓ no, don't do that. No don't do that, right? ⁓ yeah. I and and I mean this is all heavy. It is it like I don't know, yeah, like you said, if this is grounding or not, but good good lord, right? Like that it's a lot, it's a lot. And that again, you know, I'm joking around ⁓ about the book and but this is why we built this stuff that we built so that you have awareness of the pitfalls of starting an ABA practice and there is a lot of risk involved, right? But again, like the we're talking about the basic foundations of the company and they need to be in place before you start scaling. And so if you're a small ABA practice right now and you can't answer these very basic questions like we've already talked about, like can you read all of your BCBA's treatment plans and would you be satisfied with that? Then you have work to do, right? If you do a session note audit and you you you you're taken aback by the narrative in some of these sessions then you have some work to do, right? If you're using the rounding rule as a way to get people breaks and and ⁓ bathroom breaks or, you know, smoke break or I don't know, vape break ⁓ v a vape break, is that is that a thing? ⁓ then then you have some you have some work to do, right? And You're not paying people correctly or you have contra these are these are things that we can work on. and and but you can't just not you you can't just keep on doing it. I mean you can. You shouldn't. Yeah. So speaker-0: All right. You heard it here. Do good work. speaker-1: Yeah. I I think that's it. I I I really do believe that that's it. speaker-0: And you're not alone. No. You're not alone. So there's resources, so we're gonna we're going to speaker-1: Come to the free Discord group. Reach out, get a free console, try the readiness ⁓ quiz. All of these things are free. All all of them are free. They're I'm not gonna try and and be a sleazy salesman. I really don't like speaker-0: We block all of that stuff from the from our group. So yeah, like it's yeah, just yeah. If you need anything at all, reach out. ⁓ come, you know, sign up for this group. ⁓ that that's a great first step. Even if you just want to listen to what others say and you're not you're not you don't even want to communicate yet, just kind of get a feel of of the group and see how it is. It's a really supportive space. Anyways, we are gonna leave that ⁓ we're gonna say goodbye on that note for today and leave you to ponder. And we will ⁓ see you again next. speaker-1: ⁓ I I just have one more ask ⁓ before so if you are a BCBA thinking about building a company because maybe you're in a situation where you're like, I don't know about this. ⁓ this the the these guys are doing some crazy stuff. I saw a post on that last week. Yes, talk to them. Share this post, share the free console. Like, like don't just quit and say, maybe you do have to quit. I speaker-0: Quite a few of those. Yeah. speaker-1: But y give them the resources because I can almost guarantee that they're not doing this intentionally. Maybe they are, maybe they are, maybe, but I ⁓ most people that I've talked to, they just don't they're not aware of this and they're busy and it it's just the way life is. So, you know, share the podcast with a business owner that may be able to use it. It doesn't necessarily have to be this grounding podcast, but it could be another one. So that that's all. ⁓ have a wonderful week. speaker-0: Take care. Thanks for joining us on ABA Business Leaders. speaker-1: ⁓ bye bye. We provide mentorship, courses, handbooks, billing support, credentialing, HIPAA support, web design, and more. Everything you need to build an ethical and sustainable ABA practice. speaker-0: You can find all of our resources at three pie square dot com. speaker-1: Don't forget to subscribe and share this podcast with other ABA business owners. speaker-0: We'll see you next time, and remember, you don't have to build your practice alone.