ACA Blog

Robbin Miller
Jul 29, 2010

The Assembly Line Transformation

Imagine a cartoon of three slides: The first slide is a line of clients in an outpatient office waiting to be seen by a clinician on a Friday. The second slide is the clinician trying to focus but is showing signs of fatigue by yawning and looking at the clock. The last slide is the client leaving the office and the clinician swimming in gold bag of green dollars bills. Read on...

A new trend of how to make money in outpatient counseling services is upon us. Despite new laws to reform mental health services for children in Massachusetts, some agencies and entities are still facing financial losses serving clients on Mass Health. In order to stay afloat, some of these for-profit and non-profit entities are using "carrots" with clinicians to keep their doors open. The new gimmick is to offer financial rewards, for example, $ 500.00 for those clinicians who see a certain number of clients a week, 30-40 for a certain period of time. Honestly, this new incentive is enticing and rewarding, but it is really so?

In my professional opinion, I believe that the quality of offering compassionate and caring services can be difficult to establish on this "new assembly line" business model. I remember the old days when clincians earn decent salaries for seeing 16-20 clients a week which was not so long ago. This caseload is much more manageable for clinicans to have time to do their paperwork properly, take care of their own mental health needs during the day, and most of all, establish healthy workable relationships with their clients.

I ponder the following questions on this new business model:
1) How can clinicians establish quality relationship with their clients if a bag of gold awaits them in the new future?
2)How do you prevent burnout? The answer that scheduling 35 clients a week is not an acceptable answer though it is a cold reality on how to accomplish seeing 30 clients a week.
3) How do you prevent possible unethical behaviors such as fraudlent billing? For example, seeing clients for a half hour and then billing an hour for services?

Isn't time for a healthy dialogue to be established with national associations for social workers and counselors to see this new business model is feasible?
How about clinicians learning how to lobby their legislators to change the way counseling agencies are reimbursed by Medicaid? Please note that agencies don't get paid for no-shows for medicaid clients.

What do you think?

Robbin Miller is a counselor who specializes in mindfulness meditation; Positive Psychology; and Cognitive-Behavioral Therapies. She is also a volunteer cable access producer and co-host of her show, "Miller Chat" in Massachusetts.

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1 Comment

  1. 1 laura lopez 19 Jan
    I completely agree with this article. I worked as an administrative assistant at a chemical dependency counseling center.  Some counselors were given loads of 80 cases.  they didn't even eat lunch.  Some bought voice recognition programs to write their notes faster.  Still they were told they needed to keep up.  Of course then people started charging full sessions for only some minutes of chatting when the client was in a hurry or weren't interested in counseling some days.  How can this not happen? the demand for production is irrational.  I would like to ask if there is any research done in this area.  Is there a law that sets a standard of the caseload size for counselors? What do you do when things get this bad? is anyone advocating for counselors anywhere? I know your time is priceless but please let me know where I can find more information.


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