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Are Missouri Therapists Underpaid by MO Healthnet?
This past fall and winter, we asked MO Therapy Network members to complete a survey on-line that queried the financial realities of their therapy practice. We have used these numbers to calculate the estimated costs of serving clients, including the time it costs outside of the treatment hour to serve clients and the costs of maintaining a therapy practice.

MO Therapy Network members told us that they spent on average about 21 hours a week providing therapy services to clients. But they also told us that they spent on average another 20.5 hours a week in service to their clients in unreimbursed time, doing things like treatment planning, talking on the phone, documenting and billing. This varied widely, from only a few minutes per case per week for some therapists to several hours per case per week for others. The median number was .93 hours of unreimbursed professional time per client per week. A $46 reimbursement per therapy hour by Missouri Healthnet therefore translates to about $24 per hour of professional service. This does not count cancelled or no-show appointments, which members told us averaged 3.32 in number per week.

But that’s not all. We asked those who had a private practice to detail for us the costs of maintaining that practice, for things like rent, phone, and malpractice insurance. The median of those costs totaled about $1120 per month, or about $12 per client seen per week. A full-time private practitioner serving all Medicaid clients in Missouri might schedule 24 appointments a week. Of those, 21 might show and be billable. At an office rate of $46 an hour for a social worker or licensed professional counselor, this would be $966 per week of billable income. This therapist would work an additional 20 hours serving those clients in non-billable ways and expend roughly $260 per week in expenses maintaining the practice.

Taking all numbers into account, the total per hour “profit” for a private practitioner drops to roughly $12 for a clinical hour reimbursed through Missouri Healthnet. Several assumptions were used in calculating these numbers that may not apply to each therapist.

We also asked network members to tell us what they thought they should be reimbursed for a treatment hour. On average they thought they should get paid $73 per clinical hour for office visits and $85 per clinical hour for an in-home visit. So most members think they are underpaid by Missouri Healthnet by about $20 per hour.

What should the MO Therapy Network do with these numbers? Who should we share them with? E-mail us your thoughts at

By: Dr. Curtis McMillen