RN told she will now get LPN wages

[Blackcat99]

I am an LPN and I take care of a child in his home. The other nurse who works with this child is an RN. Mom said that the agency told the RN that if she wanted to continue with this child that she would now only get LPN wages. It's a shame to lose this good nurse. She is not going to accept LPN wages so is going to get a new case. Does this kind of thing happen very often in home care? I feel sorry for the nurse because I am sure she is very attached to this child like I am.

[caliotter3]

No, it does not happen often, but it does happen, especially lately. RNs who are desperate for work might accept the situation, but most look for employers who respect them.

[Blackcat99]

Thanks caliotter3. I'm glad to hear that it does not happen often. I bet they were thinking that she was indeed attached to the child and would accept LPN wages. I think they are going to end up regretting their decision. He is not "an easy case" and they might have trouble finding a replacement. So it sounds like this situation is just "an agency decision" and it is not a "medicaid decision." I love this child but if they ever tell me they are going to just give me "CNA wages" I will leave too.

[caliotter3]

Medicaid establishes their reimbursement rate. It is up to the agency to decide wages for their employees. The medicaid people do not care (one exception, that I am aware of, but that was an individual) what the agency pays their employees. A good example of this is overtime. Required by labor laws, but medicaid pays a set rate, they do not pay overtime rates. It is up to the agency to avoid paying nurses overtime. They can pay more, less, or equal to what the reimbursement rate would justify. Their call, and the call of the employed nurse to decide whether s/he is being paid enough.

[Kyasi]

Below I've copied and pasted a post I made on Medicaid reimbursement a while back. While no company can afford to pay the entire reimbursement they get because there of office overhead, state mandated supervisory and reassessment visits, Start of Cares etc., you can see that there is still plenty to cover that without cutting the employee wages. My agency would never ask a RN to accept LPN wages or a LPN to accept HHA wages. I'd find another agency to work for! Sometimes these things are a sign that it's time for a change. Don't short change yourself!

Kyasi

I would say the biggest money maker for a Medicaid agency is Prior Authorizations where the per hour reimbursement is $18.34/hr for a HHA, $25.01/hr for a LPN, and $37.36/hr for a RN. I'm sure this varies from state to state. The biggest reimbursement is the 'overhead' where they pay $34.30/day of service. So if the agency is paying roughly $9.50 - $10.00/hr for a HHA, $17.00 - $18.00/hr for a LPN, and $22.00 - $23.00/hr for a RN, you can see the profit.

So an example would be: let's say we provide a HHA 10h/day, 7 days per week. Reimbursement will be is $1,283.80 + overhead $240.10 = $1,523.90/week. If the average HHA pay is 9.75/hr, the pay out is $614.50/week. Toss in there minimal benefits and a very small travel reimbursement and you can see in a years time that there is a big profit. But then you do have to take into account the nursing staff who does the paperwork to obtain this funding and who do the needed start of care and follow-up visits with the clients. That's what the overhead pays for. But obviously, there is profit or the company would fold.

[Blackcat99]

Thanks all so much. I talked to the RN and this is the story the agency told her. The agency told her that it had to do with the payor source. They feel if an LPN can do the job then there is no need for an RN. :confused:

[Kyasi]

This still sounds strange to me. Any of our field staff Skilled Nurse positions can be filled with either a RN or LPN but if this is Medicaid you are talking about, the reimbursement is commensurate to both. I just don't see how it matters unless you are talking about Medicare reimbursement, which I understand is very different.

I know a while back, Medicaid cut reimbursement to LPN's and a large HHAgency in town cut their LPN's wages by 3.00/hr. It turned out to be a huge mistake. They lost some really good, experienced nurses and they came to me. (Their loss, my gain!) Our company decided that they would ride out the cuts and that we would not ever cut our staff's wages. So pulling this kind of thing only hurts the agency in the end.

Kyasi

[Blackcat99]

Thanks again. This is a medicaid client and I think the agency is lying to this nurse. I know the paperwork in the chart for this client specifically says "RN or LPN to care for the child". I am wondering if they were having problems in finding an RN for another client so maybe decided to make up this story? Or perhaps they were hoping she was so attached to this child already that she would accept LPN wages.

[Kyasi]

Bingo! It could be all of the above. The reason isn't because they don't get enough reimbursement for the RN.

Kyasi

[caliotter3]

Just yesterday I made the observation to someone that it does not make sense that one agency can pay X amount to their employees for a medicaid patient, including covering necessary overtime by following the law, while the next agency can not. It is all a matter of how the agency chooses to allocate their income and how much they respect their nurses as the basis for them being able to stay in business.

[smartnurse1982]

With the reimbursement rates from medicaid above it seems most of the profit is from the rn. Maybe I should have posted on this forum when it happened to me!

[Blackcat99]

With the reimbursement rates from medicaid above it seems most of the profit is from the rn. Maybe I should have posted on this forum when it happened to me!

Smartnurse1982. So this has happened to you too!!!! Please tell us exactly what happened to you. I am very curious as to what lies your agency told you. Thanks.