Helping children with autism reach their full potential

CEO to CEO: Is a BCBA qualified to open an ABA Practice without assistance from specialists in other fields?

Yes, to a point, assuming the BCBA has sufficient clinical experience, a decent degree of business acumen, and appropriate state licensing. 

But like every other business, organization, and organism, specialization is critical to growth and development.  Each plant and animal begins as a single cell; likewise, every business begins with one person who has a vision/idea/determined purpose.

An ABA practice with a couple of BCBAs and eight or ten technicians may get by without much outside help.  Many healthcare professionals have learned how to incorporate, contract with insurers, obtain credentialing, and manage billing and collections, while at the same time hiring, training, and supervising a group of support personnel.

Then again, many of those enterprising do-it-all-myself superstars have also exhausted themselves by burning the candle at both ends and they learned the lesson that entrepreneurs face in every field—that nobody is an expert at everything.  

A wide familiarity with every aspect of one’s business is an enormous advantage to every owner or senior manager.  At the same time, the further one progresses toward expertise in any field, the rarer their ability becomes in the market.  Rare abilities command better pay and, if sharply prioritized within an organization, produce significantly better profitability.  You probably won’t find many $1,000/hour surgeons spending much time on clerical work which they can get done by someone faster and better for $60/hour.  Nobody is an expert at everything.

Advantages and Disadvantages in Growth

As a practice grows, both advantages and disadvantages occur.  

Advantages may include greater general profitability, economies of scale, accumulated capital, seasoned teams of personnel, proprietary systems developed over time, accumulated knowledge of the market and industry, networks of relationships throughout the community, fully-trained back-up personnel ready to step up when surprise circumstances demand, and a finely-tuned equilibrium developed throughout the organization between how resources are apportioned between dangers, obligations, and opportunities.

Disadvantages include all the well-known troubles associated with bureaucratic systems: multiple levels of management; increased time and expense related to changes in policy or procedure; decreased familiarity with clients, client families, and personnel; and broader potential exposure to lawsuits and complaints to authorities for multiple reasons.  A bigger company is typically perceived to have deeper pockets, which means greater responsibility toward clients, employees, and the public generally.  The larger enterprise is therefore often more willing to settle a claim or dispute, even when it is not in the wrong, simply because it has more to lose by dragging it out.  

As a practice grows, the larger a target it becomes, and the more likely it is that some error or happenstance—large or small, foreseeable or not—will occur which produces a substantial legal crisis.  While not every disaster is avoidable, the great majority never occur where appropriate precautions are employed.  As the size and scope of dangers and precautions increase, so do the size and scope of the expertise necessary to recognize those dangers and implement preemptive action.   

CEO to CEO: Interviewing BCBAs


Business Planning Acumen

Experts in business planning apply certain principles and best practices in their roles throughout the economy—whether on behalf of small start-ups or Fortune 100 corporations.  Those best practices include accessing input from a range of professionals both inside and outside the field of any prospective endeavor.  Those practices include market analyses, long-range planning, budgets, profit projections, and entrepreneurs should particularly emphasize the importance of ongoing input from those with previous success in comparable enterprises.

Almost every book on the subject of starting any business will insist that the would-be entrepreneur begins with a business plan.  A business plan includes several basic components, including clearly-defined goals and the budgets and supporting requirements necessary to meet those goals.  

The process of writing a business plan requires that one look down the road—past the simple immediate steps necessary as a start-up—so that steps required early to achieve goals much later might get identified and find their proper place in the plan.  

The inexperienced in business are likely the most vulnerable to underestimating the importance of gaining perspective from professionals outside their familiar field.  They don’t know what they don’t know, and they haven’t experienced the disasters which occur when “fools rush in where angels fear to tread.”  Much better to ask too many questions than too few.

Increased Value in SpecializationIS A BCBA QUALIFIED TO OPEN AN ABA PRACTICE

As an ABA practice grows, it may glean extraordinarily valuable advice and guidance from a range of other professional disciplines.  Relevant legal specializations alone are multiple.  Contract law, insurance law, corporate law, tort law, employment law, for-profit tax law, non-profit tax law, and Medicaid law can each impact the typical ABA practice—even a small one.  And while each legal specialist may be a licensed attorney, she will typically decline to answer most legal questions outside her certain knowledge.  Even within a given area of expertise, such as employment law or tax law, one lawyer may help with letters, applications, or negotiations, but refer you to someone else entirely if the matter moves to the litigation stage. Is a BCBA qualified to open an ABA Practice

Thought for perspective’s sake: If experienced, licensed attorneys won’t pretend to know the answers to common legal issues which arise outside the scope of their expertise, why should the BCBA assume the legal competency to make a determination on a question which could have unknown ramifications?  Again, nobody does everything well.

Specialization is key to both capturing advantages and limiting disadvantages in a growing practice.  Just as the training and education of BCBAs prepare them to make complex clinical decisions, the training and education of MBAs, CPAs, lawyers, and business managers of multiple types, prepare them to make complex business decisions which those without that knowledge and experience could not imagine.

Prioritizing Goals and SpecializationIS A BCBA QUALIFIED TO OPEN AN ABA PRACTICE

An ABA practice involves two essentially different aspects—the clinical and the administrative.  To the extent that a BCBA is interested in developing as a clinician, much attention paid to administrative matters will necessarily subtract from both clinical expertise and organizational results.  The better that a BCBA can define and understand what constitutes the administrative functions of the practice, and procure trustworthy personnel (whether inside or outside of the practice) to competently and efficiently accomplish those administrative tasks, the more attention she can devote toward the clinical business of training and developing top-flight clinicians under her supervision.

So yes, a BCBA is potentially qualified to open a practice without assistance from specialists in other fields; but the wise entrepreneur clearly defines her career goals and priority of specialization, cultivating relationships with other individuals and organizations to provide necessary supporting roles with reliable excellence.

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