Shorkey Strong - 80 Years
To say the last several months have been a struggle is an understatement. It is daunting for me to list all our woes and I do not want fear to disrupt the excellent work we are committed to provide. I will be very candid. I believe we have the most incredible, brilliant staff and we need your voice to push the changes for children with special needs. Our issues are bigger than SETX.
What We Do
We serve over 325 kids a week in clinic and schools serving 34 different zip codes. We carry waitlists in all disciplines.
Medical Therapy Services
Physical, Occupational, and Speech Therapy. We provide the only year-round pediatric aquatic therapy in SETX.
Applied Behavior Analysis (ABA Therapy) for children with autism. Children receive therapy for 30-40 hours a week. We are one of four facilities in SETX. The Board Certified Behavior Analyst can treat maybe 8 kids, this means only about 40 kids in all of SETX are receiving services. Yet, the CDC states that 1 in 35 kids has ASD. We carry a waitlist of over 40 kids.
Kids in ABA therapy have a 1:1 therapist. This requires a registered behavior technician (RBT) certificate. We provide in-house training to prepare for Board testing.
Stand up paddle boarding, kayaking, Miracles Dance Team, parent support group, camps.
Children in SETX are referred to Texas Children’s Hospital in Houston, it is a 2-year waitlist for testing. We can provide the testing but there is no billing code thus it is Grant funded. Last year, we tested 45 kids, we are currently out of funding and our waitlist is growing. United Way of Orange County has grant funded testing for children from Orange County.
Through Grant funding we provided 2 free screening clinics and all but 1 child was referred for therapy evaluation.
Our inclusive preschool provides a safe space, incredible compassion, and understanding for children with high needs. Most of the children have been dismissed from other programs due to high needs and/or behaviors. State recommends 15:1 ratio for 3-year-olds, we provide 3:1 or 4:1 ratio.
Why are we in this position?
Why are we
in this position?
- When I arrived three and a half years ago we served just under 100 kids and the yearly deficit beyond our United Way support was about $50,000 easily covered through fundraising. As we serve more kids the yearly deficit grows and that fundraising gap is difficult!
- Insurance does not cover the cost of operating! It is not due to mismanagement of funds.
- Staff are not overpaid, and our administrative costs are less than 13% of our overall budget (good business under 20%).
- Contractual adjustment: the difference between what we bill and what the insurance company pays us. The month of November alone was $118,433.
- We have outstanding payments from the insurance companies July – December of $264,000 based on the payment schedule we would expect $88,000 (1/3 of billed rate).
- We bill weekly but it often takes up to 3 months to receive payments from insurance.
- Insurance companies look for ways to not pay and the rate of denials is unfathomable.
- If you have ever called your insurance, you’ll understand. On the phone, we may hold for 45 minutes, be transferred, get a provider that cannot answer our questions, calls dropped, “we’ll call you back” (hahaha) etc., all to get an $80 payment. That $80 must cover the session of therapy, unbilled time to write notes, billing time for service, and the hour Clarissa worked the denial…it does not cover the cost of the service.
- Families on Medicaid have been auto enrolled since the pandemic. This ceased in September 2023. Families either did not re-enroll, no longer qualified, or dropped. We lost a large number of families. One family had 3 kids with multiple services multiple times a week, they no longer qualify for Medicaid and no longer receive any services. Private insurance co-pays are too high.
- ABA is a behavioral health copay these kids attend M-F but PT, OT, ST is a medical copay (2 co-pays in one day). Families often get behind.
- Medicaid rates were last reviewed in 2019 prior to the pandemic. Inflation in 2023 alone rose 8%.
- Medicaid is set by the state, but the insurance company can determine what percentage of the allowed rate they’d like to pay. Our biggest payor, TX Children’s Health Plan, pays at 75% of the
already low allowed rate. We are trying to renegotiate contracts and change those rates. Medicaid companies pay less than private insurance who pay 40% less for PT Assistants and OT Assistants. BCBS has announced a reduction in rates for speech therapy.
- We have had a series of very large challenges with insurance billing with client authorizations, billing secondary insurance, IT glitches in their updated systems, and the list goes on and on.
- We have been hit hard by kids, parents, and staff coming down ill. Strep, Covid, RSV, and flu have resulted in the quarantine of individuals for 5 days.
- Our aging building creates challenges, too. Very apparent are the plumbing challenges, leaking roof, air handling system, etc. The costs continue to rise to conduct business. All vendor fees have greatly increased since the pandemic.
- Preschool kids with state funding, we receive $35 less per kid per week than the tuition we charge. Our kids with special needs do not meet the 4 criteria to receive the additional funding set by Texas Workforce.
The easiest thing you can do is be attentive to attendance. Help with student attendance reminders and ensuring scheduled make ups. Be mindful of your own attendance and avoiding client cancelations.
We have the most amazing staff with servant hearts who provide exceptional services. More important than us are the families we serve, the developmental progress made, and the experiences we provide for our families.
We need to share the message as this impacts OUR community!
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