It maybe a less obvious issue, but in addition to the substantial cost in absolute fees, loss of “billable time” and wages for the very specific training which will be required for both professional and paraprofessional staff, the significant reduction is hours of service per person per week from the current accepted level means an equally significant increase in travel time.  Not only is this time for which staff wages are paid, but it also disproportionately increases the ratio of non-billable to billable time.   Add to this the increase in the number of notes to be written (more clients, fewer hours per client per week) and the required weekly team meeting, and you have tipped the ratio of non-billable to billable time to be unsustainable.