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

Affordable Care Act Actuarial Premise

Posted by Tim Teague on Tue, Mar 18, 2014 @ 04:30 PM

aca resized 600Open enrollment for the Affordable Care Act (Obama Care) will close at the end of March 2014. The original goal of 6 million enrollees will be tough to achieve. According to the Department of Health and Human Services there were four million enrollees through Feb. 25, 2014.
The actuarial science that accompanied the introduction of the new healthcare act is a complicated set of metrics that ultimately determined how much to charge to capture the costs associated with reimbursing medical expenses (less deductibles and co-pays). There are several revenue sources attached to the legislation that fall outside direct premium payment, but two expense factors associated with coverage will soon provide a clearer picture of the true cost of the program.
The first and most dramatic expense is the inclusion of applicants with serious pre-existing conditions. It is not uncommon for mounting medical bills to force a family into bankruptcy. The private markets have typically excluded applicants that had specific pre-existing medical conditions to limit the insurer's financial exposure. Part of the offsetting premiums to cover such catastrophic illness through the Affordable Care Act would be premiums from a large population of younger, healthier adults that would rarely need significant medical services.
According to initial objectives, the plan needed around 38 percent of the new enrollees to be under the age of 35. Both state exchanges and federal enrollment have hovered between 30 and 31 percent. This less than expected enrollment of younger adults breaks with preliminary actuaries and will lead to increased costs.
A secondary cost associated with expected enrollment involves subsidies for applicants below certain income thresholds. Currently, 83 percent of the applicants have qualified for federal subsidies. It is difficult to ascertain the government's expected levels of assistance, but early figures indicate this may be a larger expense than originally anticipated. Some of these costs are to be offset by higher taxes on higher wage earners and savings from Medicare.
The bottom line is that the cost of the plan will likely not conform to the original modeling provided, and additional revenue (taxes) will be needed in the future. Despite the continued debate, this plan may be modified in the future, but repealing it would be as likely as repealing Medicare.

Tags: BlueSky Medical Staffing Software, Affordable Care Act, ACA, Health Care Staffing

The Future of ObamaCare

Posted by Tim Teague on Fri, Jan 31, 2014 @ 09:23 AM

describe the imageIt all started with  the tension of the waiting game when the ultimate fate of the Affordable Care Act would be determined by the Supreme Court Justices. This hurdle was overcome by proclaiming part of the legislation as a "tax" instead of a mandate, and the voluntary participation by the states in the expansion of Medicaid. The next hurdle was the proclamation by some in Congress that this legislation would be repealed. When that didn't occur, word was the Act would never get the funding necessary to be executed nationally.
These bumps in the road are now in our rearview mirror, and thousands, or millions, depending on your source, are now enrolled in some form of the coverage presented via the Affordable Care Act.
Despite the current status of the plan, there are still significant rumblings about how to change course and derail the legislation. Early signs in the enrollment do not foretell a good trend for the economics of the plan. The hoped for young adults have not enrolled in the numbers expected, and the older, sicker demographics by far are the largest group of enrollees.
Will this trend create an economic burden on the U.S. Absolutely. Will this economic burden cause sufficient backlash to repeal the Affordable Care Act? Absolutely not! This horse has left the barn. The second after the first enrollee became insured through the ACA, the nature and future of the nation's health insurance industry was changed forever. Industry leaders that still resist, and hold out for a reversal of the current status do so at their own peril.
The current legislation will be amended and parts of the plan will be "tweaked" over time, but the overriding theme of the Act will not go away. Any economic realities that will surely come to the forefront as the plan grows will not be sufficient ammunition for legislators to "take back" the coverage that has now been provided to a distinct population of Americans.
In summary, from a strategic standpoint, best to move forward with the assumption that ObamaCare is here to stay, rather than "hope for change."

Tags: BlueSky Medical Staffing Software, healthcare staffing industry, Affordable Care Act

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