In multi-site ABA organizations, a five-point swing in utilization can separate a clinic that’s stable from one that’s quietly slipping. But when it’s time to confirm that number, you often can’t. Operations says utilization is fine. Payroll says overtime is climbing. Finance says cash is lagging. You can’t tell if the clinic has a delivery problem, a staffing problem, or a billing problem—so you default to guesswork.
This dynamic becomes common once organizations move beyond a single location. Most ABA providers have already tightened the basics: scheduling discipline, supervision standards, intake controls, and conversion expectations. Those processes exist.
The challenge at scale is consistency.
Once you have multiple clinics (often added at different times, with different teams and habits), “the same process” starts to mean different things in practice. One location assigns clients by where they’re seen, another by where they’re staffed. One team tracks utilization against scheduled hours, another against authorized hours. Those variations don’t feel dramatic day to day, but they change the math.
Two clinics can run nearly identical operations and still report different utilization, productivity, and cost per hour simply because definitions diverge between systems.
Part of the issue is that the data you need to answer basic operating questions live in different places: CentralReach for authorizations and session delivery, Paycom for payroll and labor costs, and your accounting/billing system for claims, adjustments, and cash. Each system has its own identifiers and timing, so the same KPI can shift depending on whether you’re using service dates, pay periods, or posting dates.
To bridge the gap, teams often export data into spreadsheets. Over time, reporting becomes a manual reconciliation exercise. By the time inconsistencies are identified, the operational impact has already occurred—authorizations nearing expiration, claims aging, labor costs exceeding delivered hours.
The organization spends more time debating the number than managing it.
What Needs to Change
At scale, performance depends on aligning systems around a single operating model.
That means defining hierarchies that match how leadership runs the business:
- Enterprise → Region → Clinic
- BCBA → Therapist → Client
- Payor → Service Line → Authorization
It also means defining key metrics once and applying them consistently.
For example, if utilization is defined as converted hours divided by authorized hours, the model must explicitly address:
- Partial weeks
- Overlapping authorizations
- Inactive clients
- Retroactive adjustments
Without documented rules, utilization becomes situational.
Integration has to happen before reporting. Service delivery, payroll costs, and billing data must connect at the data level so dashboards are not dependent on manual stitching.
Exception handling should be built into the reporting model itself, including sessions delivered outside authorization dates, duplicate or overlapping authorizations, delivered hours that exceed remaining authorized balances, supervision gaps, and missing pay rates or clinic assignments.
These start as edge cases, but in multi-site environments, they become routine.
What Integrated Reporting Enables
When systems are aligned, leadership can see the full operating chain:
Authorization → Scheduled → Delivered → Billed → Collected → Labor Cost
Business intelligence tools like Power BI can then present a single set of KPIs across clinics, provider roles, payors, and time periods—without redefining metrics in separate spreadsheets.
The impact is practical:
- Earlier detection of underutilization
- Visibility into authorization risk before expirations
- Identification of unbilled or underbilled services
- Accurate cost per delivered hour—including PTO, training, travel, overtime, and supervision overhead
- Clean comparisons across clinics without manual adjustments
Most importantly, leadership discussions shift from “Which number is correct?” to “What are we going to do about it?”
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In early-stage growth, expansion drives results. In multi-site organizations, operating control drives results.
The competitive advantage is not simply adding another location. It is being able to answer, at any moment, how authorized hours are converting, what it truly costs to deliver them, and where breakdowns are forming before they reach the P&L.
That level of clarity does not happen by accident. It requires deliberate alignment of practice management, payroll, and finance—shared definitions, connected data, and reporting that reflects how the business is actually managed.
Organizations that invest in that connective layer shorten decision cycles, reduce margin drift, and give leadership a reliable operating view across clinics. Those that do not remain dependent on reconciliation and post-hoc analysis.
At scale, the difference is not the dashboard. It is the control behind it.
This material has been prepared for informational purposes only, and is not intended to provide or be relied upon for legal or tax advice. If you have any specific legal or tax questions regarding this content or related issues, please consult with your professional legal or tax advisor.
