Scenarios Before and After Licensing in Ohio for PCTs

I have made some assumptions for these scenarios. One, we will not be reimbursed any more money by the State of Ohio for dialysis services after the new licensing scheme goes into effect. This assumption is important because cash flow is dependent on income as well as outgo. If the clinics get more money from Ohio or the Federal Government than one great objection to licensing is overcome; that of where the money is to be found to pay for the "better" PCT.

Two, I will assume that the management of most dialysis clinics when it comes to money will use a "zero sum" policy. "Zero sum" means, if I as a PCT get a raise because I test and pass than someone else in the unit must loose money. I don’t assume that management will use any tricks to save money besides keeping total labor costs stable for the group. I make this last assumption because if management could make save more money they’d probably be doing it right now.

Assumptions for all spreadsheets. I’ve created a dialysis clinic known as "Utopia Dialysis Ltd". I’ve given it twenty five patients, running on two shifts six days a week. The clinic has ten stations, with one or two backups. The salaried staff are one Nursing Supervisor (FMC equivalent is a DON), one Technical Supervisor (FMC equivalent is a CT) and part of an Administrator (they work around a few other clinics). I have not included salaried staff into these scenarios. I assume, and this is a big assumption, that if there is any shortfall in time for hourly people that the salaried staff will pick up the slack. Yeah, I said "assume".

You’ll note that the figures are all round. Yes, I too distrust round figures, but these are scenarios. In the "real world" round figures are rarely the result of anything but someone’s wishful thinking. I’ll leave it to your judgement what you think of my work.

Conventions

1. Total labor cost is hourly wage times one and a half. The extra half is to factor in the costs of the employer’s Social Security portion, the cost of Health Insurance and other taxes. That "half" could be higher or lesser, but since I am not doing your books I cannot say. All final figures are dollars per week.
2. Manpower efficiency is computed in dollars per manpower hour. This is a rough and ready estimate of the aggregate use of money per hour that your staff worked. Obviously this aggregate figure does not take into account responsibilities, such a patient care, or training, like the differences between a Reuse Tech and a Registered Nurse in Charge. Manpower efficiency does tell where to get the most savings, I used it to show that chopping the Reuse Tech does not get you anywhere near the savings you get by chopping the RNs or LPN.

Manpower efficiency gives a rough estimate between two groups of heterogenous employees, such as "Clinic A" and "Clinic B" about how well money is being spent by management. I use it here because it’s a lot like how the "Big Shots" look at you up in Corporate.

The Scenarios

My first assumption jibes with my personal experience in dialysis. I assume that each PCT will get a minimal raise, about a quarter an hour. In order to save money the Reuse Tech will be fired or forced to quit and be replaced by a cheaper, newer hire.

My second assumption is about as likely as the previous. I assume that management "churns" Patient Care Techs to keep as many trainees on the floor as possible. They "churn" the staff by abusing them, using such techniques as mild harassment, favoritism, denying some the opportunity to study or learn enough to pass the exam, and a whole bunch of other psychological tactics. In Ohio management has up to eighteen months before the PCT must be let go, plenty of time to milk them for cheap labor before tossing them over the side or sending them on to a unit which has lots of patients with private insurance - a unit which can afford licensed PCTs. In this scenario one PCT has achieved the license and a dollar an hour raise. This PCT may help supervise the two PCT trainees or cover for an RN who gets the job of doing it. (blchurning.htm)

The next scenario is to give the PCTs a quarter an hour raise plus dump the Equipment Tech and replace them with the Reuse Tech at a lower hourly wage than before. The Reuse Tech is replaced by a cheaper newer employee. (bldumpET.htm)

Another scenario, one which will greatly inconvenience the Clinical Supervisor, is to do one of two things. One, chop RN hours down to 37 hours a week (blRNchop.htm).

The other scenario involving cutting Floor Staff is to cut the LPN’s hours roughly over a third. (blLPNloose.htm). In either case the CS must take up the slack. I don’t consider this scenario likely, though it was be a good way to get rid of an annoying RN.

This scenario will be a favorite of stupid Administrators who like to trip over stacks of dollar notes to grab a penny. In this scenario the PCT trainee is hired for the wage they could get working as a trainee in a gas station or Grocery Store checkout line. I can only imagine the caliber of employee which can be had for such wages, excepting a few motivated employees (blPCTloose.htm)

In closing

Business each day uses such spreadsheets to figure out a "best" level of wages. I realize that a lot of you will have objections with my assumptions, staffing levels and so on. You’re welcome to rebut me at Dialysis.Org or in private. I suspect that within some limits I’m probably dead on with my figures.

Samuel Goins, BS, Senior Technician

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