Healthcare Staffing Agencies and Affordable Care Act: A Taxing Issue

Posted by Tim Teague on Wed, Oct 29, 2014 @ 11:30 AM

Many healthcare staffing agencies that have over 50 FTEs are looking at the cost (or Tax) associated with NOT complying with the Affordable Care Act.  In 2015, employers with more than 100 FTEs will need to cover 70% of their full-time employees and by 2016 employers with more than 50 FTEs will have to cover substantially all employees, (95% with margin of error of 5%). 

tax_calculatorThe annual fee for non-compliance is $2,000 on an annual basis, but it is actually calculated on a month-to-month basis for employers. The fee could rise to $3,000 if at least one employee receives a premium tax credit because employer coverage is not affordable or employer coverage does not cover at least 60% of total healthcare costs.

There is only one possibility that there will be no penalty (tax) for any company with over 50 FTEs that does NOT offer any health insurance; no employee receives a premium tax credit or cost-sharing subsidy in an Exchange. When considering all the possibilities for 50 + employees, the likelihood is very small that not one employee would receive a tax credit, or cost sharing subsidy.

Here are the balance of the possible combinations and their impact:

Employer of over 50 FTES does not offer health coverage and at least one (1) employee receives a premium tax credit or cost-sharing subsides


Penalty of $2,000 per year times the number of FTEs over 30. (i.e. 60 FTEs would result in a penalty of $2,000 for employees # 31 to 60, or $60,000.

Employer of over 50 FTEs offers health coverage


If the insurance does not cover at least 60% of the covered healthcare expenses of a typical population, then the penalty will be $3,000 per employee that receives a tax credit as a result of the disqualified employer insurance. (this penalty cannot exceed $2,000 times the number of FTEs over 30.) i.e. total FTEs =75, then limit would be $2,000 for FTEs 31 to 75, or $90,000. Since $90,000 is the cap, the $3,000 penalty could only apply to the first 30 FTEs that received a tax credit. 

If the insurance DOES provide coverage for at least 60% of covered healthcare expenses but it requires a payment of more than 9.5% of the family income for the employer coverage, then the penalty will be $3,000 per employee that receives a tax credit as a result of the disqualified employer insurance. (this penalty cannot exceed $2,000 times the number of FTEs over 30.) i.e. total FTEs =75, then limit would be $2,000 for FTEs 31 to 75, or $90,000. Since $90,000 is the cap, the $3,000 penalty could only apply to the first 30 FTEs that received a tax credit.

If the employer-offered coverage provides at least 60% coverage as in (a) above, and does not cost more than 9.5% of annual FTE income, then there is no penalty for the employer.

Despite this relative straightforward explanation, there are sure to be grey areas in defining 60% coverage in specific markets, as well as some further explanation on the 9.5% of total family income.

5 Halloween Costumes for Healthcare Staffing

Posted by Julie Moore on Mon, Oct 27, 2014 @ 12:25 PM

Now, you probably have your work Halloween party coming up this week and want to make sure you have something appropriate but different, right?  Well the BlueSky team brainstormed and came up with a great list of costumes specifically for healthcare staffing. Check them out!  

1.  Travel Nurse

This is probably the easiset thing to do as a recruiter.  All you need to do is grab some scrubs, a stethoscope, a globe and then make a Google Pin hat out of some cardboard. 

2.  BlueSky Man

For those of you who were at the Healthcare Staffing Summit 2012 in Las Vegas you got to see Rick Ault, our implementation specialist dressed up as BlueSky man.  Its a pretty simple costume with a blue spandex suit, blue mask, blue cape, and of course have BlueSky running on your iPad. 


3.  BLS Card

For those medical staffing credentialers that want to do something simple yet funny to all of their coworkers then dress up as a BLS card.  You can make the card body sign by printing out a large American Heart Association BLS Card, pasting it to cardboard and then hanging it from your body.  


4.  Prophecy Healthcare’s Anita Nurse

We love Prophecy Healthcare and Anita Nurse.  She is the fun loving teddy bear that they have been giving out at shows for the past several years.  You may even have an Anita Nurse sitting on your desk.  For this costume you need a bear outfit, a stethoscope, a surgical mask and a nurses hat.  


5.  Jason Lander from Staffing Robot

Finally we save the best for last and if you know Jason Lander from Staffing Robot then you know he has a certain recognizable style. Since he works with so many healthcare staffing agencies I thought this was very appropriate.  All you need is a fedora, jeans, vest and of course some cool shoes.  This is quintessential Jason.


We would love to see you and what you decide to dress up as for your office halloween party.  Please tweet pictures of your costume to @blueskymss #healthcarestaffinghalloween.  We look forward to hearing from you!

Tags: halloween, Healthcare Staffing

Affordable Care Act and VMS/MSP Representations

Posted by Tim Teague on Fri, Oct 24, 2014 @ 09:34 AM

ACAThe Affordable Care Act has some very specific implications to the world of managing multiple human capital vendors. (i.e. the VMS model and MSP). It should be a safe assumption that employees of staffing agencies are considered employees of that agency, and NOT the healthcare facility in which they provide services as a subcontracted agent. Anyone attempting to assume otherwise would be asking for trouble with the Department of Labor.

Unfortunately the safe harbor provisions can become unclear when a contracted employee is working for more than a year at the same client facility. It is a little early for legal precedents, as the ACA legislation has not been fully implemented.  Probably the greatest legal stretch that could possibly be made is shared employment, which is doubtful, but possible.

If you are a VMS/MSP do you need to revamp your contract with the facility?

A vendor of managed services or VMS must consider client concerns when establishing contracts.  Any provider of human capital should revise their existing agreements to attest to compliance with the Affordable Care Act. Another helpful measure would be verbiage delineating the worker as an employee of the agency as opposed to an employee of the client. This doesn’t guarantee comfort on the client side, but it certainly helps.

Another area the managed services providers (MSPs) should investigate with agencies is how they have structured their on-boarding process for employees to comply with the ACA.  A simple “front-end” solution would be a couple of “check-boxes” for employees to select. The first would ask if the employee had been offered health insurance, and the second would be if the person elected to accept, or reject same.  

This is obviously not necessary for agencies that fall below the minimum FTE threshold, but even then there is a potential negative side effect for the smaller entities.  If an agency that is below the compliance threshold is planning to provide workers for a client, that client may well be concerned that if that agency surpasses the ACA threshold, were systems in place by the agency to provide the necessary compliance?  

The (not so) Simple methods to test for FTEs - (Part Two)

Posted by Tim Teague on Tue, Oct 21, 2014 @ 11:30 AM

In the last blog ,The (not so) Simple methods to test for FTEs...,"we discussed both the “stability” period and the “measurement” period. As is the case in other Federal programs, consistency in the measurement periods is the key. Whatever period you select, (between 3 and 12 months), stay consistent in consecutive periods.

What sizes of businesses are pertinent to the administration of the plan?

There are 4 categories of size recognized under the Affordable Care Act.

  1. Self Employed
  2. Under 25 FTEs
  3. 25 to 50 FTEs
  4. Over 50 FTES

Each of these categories is affected in some way by the ACA, but for our purposes today we will only show the determination of Full Time Employees (FTEs).

Once you have determined your “measurement” period, you must follow these rules to determine how many FTEs you have employed.

  • A full time FTE is described as any employee that works at least 30 hours per week, or 130 hours per month. A caveat to this rule is that workers that are receiving payment for vacation, sickness, disability, jury duty, military duty, or leave of absence are included in these calculations.
  • All employees that do not have at least 30 hours per week, or 130 hours per month are put into a pool to sum their total hours. From this pool, all hours are added for the period counted and if the weekly hours are counted, this total is divides by 30, and if monthly hours are counted, 130 divide this total.  (i.e. 20 employees working only 15 hours in a month totals 300 hours-next, divide 300 by 130 to get 2.37-remember, fractions don’t count, so that adds 2  FTEs)

That covers the FTE count, next, we will dive into the four statuses of employee counts and what the ACA means for each.

Ebola Education Module Integrated with BlueSky

Posted by Julie Moore on Mon, Oct 20, 2014 @ 10:30 AM

Education is power during the Ebola Outbreak

Last week I wrote a blog entitled, “Healthcare recruiting during the Ebola outbreak,” and asked, “how are you handling this health emergency?”  Just a few days later, our strategic partners at Prophecy Healthcare launched an Ebola Education Module, called “Ebola: Communicable Disease Preparedness,” to all of their clients free of charge for 30 days.

This new Ebola Education Module is an awesome tool if you are a travel nurse staffing agency, who is concerned about recruiting healthcare professionals during this health crisis. It is a powerful and easy approach to educating your staff, even those who are spread across the United States, as it is a web-based clinical education module.

Did you know that if you are a BlueSky client setup with the Prophecy integration the module is available to send from your BlueSky system?  

To do this is very simple: First, choose a selected healthcare professional and send out an exam like you normally would.  Then click on “Other Mandatories” and you will see “Ebola: Communicable Disease Preparedness” as an option. This module will work like any others and when it is complete it will upload in the system and notify you as well.   It can be included into the profile when submitting candidates to positions showing that your agency is proactive in educating your staff.


Prophecy believes that educating nurses about infection control is crucial.  I encourage you to send out this module as well.  I feel that it helps restore the healthcare recruiting process by giving your healthcare providers the knowledge they need to feel safe and your customers the peace of mind that you are providing the best contingent labor possible.

If you have any questions on how to send the Prophecy Ebola module out of your BlueSky system please feel free to contact support and they can walk you through it quickly and easily.

Tags: healthcare recruiting, ebola, Prophecy Health

The (not so) Simple methods to test for FTEs...

Posted by Tim Teague on Thu, Oct 16, 2014 @ 03:31 PM

Under the Affordable Care Act – (Part One)

It seems a majority of organizations are safely under or over the minimum FTE requirements for complying with the ACA.  This blog is not comprehensive, but will give you a few guidelines to untangle some of the regulation.

One of the most important definitions to be concerned about is the “stability” period. In short, the “Stability” period was created as an alternative to offer some flexibility when counting full time employees, especially for those with erratic employee counts. (i.e. staffing firms)

The other side of the “stability” period is the “measurement” period. It is here that employers must pick their poison.

The measurement period may be between three months and the most recent year. If this were the only criterion for measurement, it would be simple math to see what period was most advantageous for the company. However, it’s not that simple. Once you have elected what “measurement” period to use, it will be used for future counting criterion. Here is how the “measurement” period affects your future counts.

  1. For employees that you determined “Full Time” during your “measurement” period, their “stability” period for future counts must be six months or the number of months in your “measurement” period, whichever is greater. 
  2. The stability period for non “Full Time” employees must be equal to or greater than your measurement period.

The significance in “choosing” your “measurement” period on the front end is the requirement that those employees must also be included in subsequent periods if they fall within the “stability” period. Although this is a very abbreviated discussion of the “Stability” and “Measurement” period, I will provide some examples in upcoming blogs. 

If you are interested in how BlueSky can help you measure your FTE's please click below for more information.

Tags: Affordable Care Act, Health Insurance Exchange

Don't be Stuck in the Stone Age with your Staffing Software

Posted by Julie Moore on Thu, Oct 16, 2014 @ 03:30 PM


As the Director of Sales for BlueSky, I hear many story’s about other providers and of course the 100 reasons why customers hate their current healthcare staffing software.  One of the biggest and newest complaints is certain company’s that are not staying current with new technology.

WHAT?  How can you stay in business, as a SOFTWARE company, if you don’t have the latest and greatest technology???

Healthcare recruiting practices are adapting as quick as technology changes and it is so critical for healthcare staffing software to stay up to date with new technology.   You may have even had some of your nurses at the Travel Nursing Conference ask about e-time or mobile technology, etc... If you are using BlueSky then you can say YES to all of those requests, if not then maybe you need to take a good hard look at your current staffing software solution.

It amazes me on the number of web based staffing and recruiting sofware that get complacent, thinking it is too hard for their customers to leave, and do not work to stay cutting edge.  BlueSky is always looking for ways to make our very complicated and inefficient business that we work in – EASIER and FASTER  - for everyone involved in healthcare staffing. 

A few of the latest features we have added recently are:

  • FREE Mobile App for Healthcare Professionals
  • Mailchimp email marketing integration
  • Resume Search and Resume formatting
  • Real-time taxes and Global Cash Card Integration
  • Updated servers with state of the art network
  • SMS staffing technology

If you are concerned you are not getting what you need to be out of your medical staffing software or they are stuck in the Stone Age, please don’t hesitate to reach out one of the members of our sales team to learn what it may take to convert your system to BlueSky.

It’s an easier process than you might think and the upside to being on top of technology is worth its weight in gold!

Tags: BlueSky, healthcare staffing and recruiting software, Global Cash Card, Credentialing Software, travel healthcare staffing, Email Marketing, Health Care Staffing, mobile app

Contract Labor: Two little curse words for hospitals

Posted by Julie Moore on Thu, Oct 16, 2014 @ 03:29 PM

Two little words, “Contract Labor” are almost considered curse words to hospital systems.



You are probably even scared to utter them publically.  
Many hospitals are concerned about MSPs and contract labor entering the ever-changing healthcare arena. But in this day and age of the Affordable Care Act we are all trying to navigate these unknown waters with the best possible route.  If you find your hospital is seeing corrective action or having a hard time maintaining FTEs then contract labor is a possible solution.  
There are many upsides in partnering with an MSP which need to be evaluated closely such as:
  • Find the BEST talent - Use a bigger pool of candidates to choose from to allow you to find the best candidate for the position.
  • Have a partner - Many hospital staffing offices are small and lack resources.  It is nice to have a large team at an agency to help you solve your contingent labor problems who will do the heavy lifting for you, including pre-screening, credentialing and paying sub-vendors.

  • Maintain better staffing levels - If you get a large surge of unforeseen patients, which many hospitals unfortunately experienced in 2014 , you can quickly release many needs out to ultimately have a optimum fill rate and better patient care.

BlueSky works with many MSPs across the country and has seen incredible partnerships created between hospital systems and staffing agencies.  How has working with an MSP helped your hospital system?

If you are interested in what to look for when finding an MSP, download our white paper here.   

Tags: Affordable Care Act, VMS, MSP, ASHHRA

Things to look for when finding an Spouse... I mean MSP

Posted by Julie Moore on Thu, Oct 16, 2014 @ 03:29 PM

Contract labor is a fact of life for many hospital systems, especially as the Affordable Care Act transcends among us, and bed count rises exponentially.  Using a managed service provider is one of the many ways acute care facilities and hospital systems are managing appropriate staffing levels.

If you read my previous blog, "Two Little Curse Words," then you realize that finding a partner to help manage your float pool and contract labor does not need to be as hard as some hospitals make it out to be.  Quite frankly, it can be very simlair to the dating game and finding a potential spouse.After working with many different MSPs and implementing many hospital systems over the last few years, here is some valuable advice I’d like to pass along to locate the right MSP partner.


Have specific measurable goals communicated during the research and discussion phase of the sales cycle. Then ask the MSP how they plan to reach those goals for you.

Goals I would possibly look for are:

  • Fill Rate

  • Staff Quality

  • Total Labor Cost Reduction


It is important, especially for hospitals in certain parts of the country, to have your FTE’s embrace the contingent labor pool because this can be the driving force for high cancellation rates.

Make sure the staffing agency providing the MSP . . .

  • Holds the same values as your hospital system.

  • Has a strategic culture alignment with cultural standards for the staff they are providing.

  • Evaluates and reevaluates those values and cultures before placement.

  • Has a history of providing great staff and plans a long partnership with you to manage that staff.

In summary, whether you are partnering with a vendor or you are the vendor finding the right partner is key, just like in a marriage.  In fact, BlueSky does the same thing when entering a partnership with staffing agencies that provide MSP services.  We focus on having clients who provide excellent nurses and hold their vendors to the same level of quality.  

If you are interested in hearing from any of our agencies, please CLICK below and someone will be in contact with you shortly.

Tags: Affordable Care Act, VMS, MSP, American Hospital Association, Contract Labor

Healthcare recruiting during the Ebola outbreak

Posted by Julie Moore on Thu, Oct 16, 2014 @ 03:25 PM

What is being called by the World Health Organization (WHO as, “The Most Severe Health Emergency in Modern Times,” the Ebola outbreak, is definitely putting the damper on healthcare recruiting and staffing.

According to the latest WHO figures, the Ebola epidemic has killed more than 4,000 people worldwide.  And as of Sunday, there is a healthcare worker in Dallas who contracted the deadly virus from her patient, who passed away last week. This is the first person-to-person transmission on US soil.

Nurses all over are scared that hospitals are not well prepared.  As many as 85% of nurses surveyed by National Nurses United last week say that their hospitals have not even had educational training sessions on Ebola. A VERY scary statistic.

If your medical staffing agency focuses on the Dallas or Texas region, as so many healthcare agencies do, then you may find it extremely difficult to recruit to that region of the country.

We would love to know what our healthcare staffing agencies are doing to help their nurses be prepared and ready for the Ebola outbreak.

  • Are you taking matters in to you own hands with your healthcare professionals providing them with training?
  • Are you reaching out to your clients to make sure the staff that you send there is trained and prepared to deal with an emergency situation? 
  • What are you saying to your healthcare professionals that are concerned?

Let us know in the comments below, how you are handling this health emergency.

Tags: ebola

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