The latest challenge to the Affordable Care Act

Posted by Tim Teague on Fri, Jan 16, 2015 @ 02:21 PM

Silly Photos-3Late last year the Supreme Court decided to hear the latest legal challenge to the Affordable Care Act. One item at issue is the Act’s provision to pay health insurance companies subsidies to help offset the cost of out-of-pocket expenses for low income policyholders that purchase insurance through a government exchange.

In short, the suit claims that paying these subsidies out of an account that has not been appropriated by Congress is a breach of the separation of powers, and by passes Congress’ authority to hold the purse strings.

The anti-ACA activists see this as a means to dismantle the Act in piecemeal fashion, whereas the supporters believe it nothing more than a partisan move to curry favor with a certain segment of the population.

From an objective view, the likely outcome of the suit will create some language changes in how the law is executed, but will have minimal impact on the intended delivery of service.  The Supreme Court has already facilitated continuance of the law despite similar challenges, and it is unlikely to render a decision that would cripple the program. Love it or hate it, it’s here to stay.

Tags: Affordable Care Act

Manage The Margin Killers in Healthcare Staffing!

Posted by Tim Teague on Wed, Jan 07, 2015 @ 09:21 AM

dollar_on_fireIn a prior post we discussed two areas that can greatly affect margins in the healthcare staffing world; unemployment and workers compensation. These two components of the cost of labor are directly applied to actual payroll amounts, thus decreasing the gross margin.

Both premiums are calculated based on historic figures, and proper tracking for both items is the key to managing cost. Proper tracking is required for auditing purposes, but the real work in managing these figures pro-actively is to have your system set up beforehand to mitigate unnecessary costs.

The workers compensation premium is largely a component of three variables;

  1. Claims History
  2. Type of worker
  3. Location of worker

Workers Compensation

It’s too late to consider last year’s claims history, but moving forward, it is important to take the other two items into consideration. Assuming you have in place sufficient health and safety education and protocol, the only other two variables are the type of worker placed, and where this worker is placed.  There are standard rates that most insurance companies employ to assign degree of risk for what type of worker you have sent, and where they are performing their duties.

You should be able to address both of these factors in your staffing software.  Considering there are hundreds of potential rate groups based on the job type, and location, it is imperative that both of these factors are inputted as templates for all possible scenarios.  As an example, it would not be impossible for a registered nurse to work in an acute care hospital, a doctor’s office, in a nursing home, or even in home healthcare in any given year.  The typical rates for each of these scenarios is likely to be quite different, with location of greatest risk to be assigned the highest premium per payroll dollar. Accuracy in reporting these locations along with the applicable type of worker can save thousands in premiums after an audit.

Unemployment Insurance

The unemployment insurance rate is also calculated based on historical claims, and is typically a charged percentage on total payroll dollars. Again, it is done on an historical basis, but moving forward you should have tools to more effectively manage these claims. Payments for unemployment claims are a necessary safety net for millions of displaced workers, but unfortunately there are those that will try to “play” the system.  In the event you believe a claim has been made under false pretenses, there should be tools within your software platform that can identify many of these. Upon the receipt of a claim, you should be able to immediately generate a report with time and date stamp that;

  • Verifies the last time the claimant was notified of work
  • Verifies the response received from the claimant 

This tool should be available in a simple report to eliminate wasted time looking through memos, emails, or personal notes. This won’t eliminate valid claims, but will certainly cut down on the number of fraudulent requests.

Tags: margins in healthcare staffing

Two of The Leading Reasons for Gross Margin Erosion

Posted by Tim Teague on Wed, Dec 10, 2014 @ 10:45 AM

permafrost-erosionAs discussed previously, gross margins are the fuel that drives the healthcare staffing industry. Cash flow, growth, and debt financing are all greatly impacted by the slightest change in basis points. Assuming you are in the ballpark of industry standards for pricing and pay rates, there are two items that can seriously erode the margins you have worked so hard to maintain.

These two items are rates for the unemployment tax and worker’s compensation. From our earlier example of chasing better margins, these two items can easily rob you of hundreds of basis points.

The first item, the unemployment insurance rate, is a historical figure based on claims paid through identified quarters of payroll.  Poor administration of these claims is the number one reason for unnecessary rate increases. The effective management of these claims does not mean attempting to deny a worker benefits that are rightfully due, but to protest claims that may not be valid. 

The second margin killer is the rate for worker’s compensation. Aside from safety measures that include both mandatory and internally generated policies and procedures, proper classification of workers and their work location are critical for these annual audits. It is not unusual for one classification of worker to carry a premium percentage that is several multiples of other employees with slightly different job descriptions.  If safety policies are in place and followed, the only variable that a staffing firm has control over is the proper classification of what theh employees to on their job, and where they do it.

In our next blog, we will discuss methods to keep both of these figures as low a possible.

Tags: Gross Margin

Why margins are so important in healthcare staffing

Posted by Julie Moore on Wed, Dec 03, 2014 @ 03:24 PM

piggybankMany healthcare staffing company owners tend to focus on the rounded number for gross margins in their business. There are important reasons for firms of any size to carefully examine and “chase the basis points”.  A basis point is one hundredth of one percent, and to many, may seem too minor to track. After all, why micro-manage those tiny one-hundredth percentage points when whole numbers are much easier to work with?

The most important reason for chasing small margin increments is the ability to fund future growth. The healthcare staffing industry, unlike many industries, does not have the luxury of 30-day terms on most payables. Employees have to be paid in a continuous 1 to 2 week cycle and depending on contract terms, payment from clients may occur as much as 45 days AFTER the cash has been expended for the payroll period billed.

Two ways these basis points affect growth are cash flow and debt financing. Say, for instance, you are able to add 10 basis points, or 1/10th of one percent to your margin. Suppose you are running $1M a month in billing, this tiny percentage adds $12,000 per year to your cash flow. If debt financing is your choice, an additional $12,000 in interest over a year would provide close to an additional $200,000 for payroll funding.  Next blog we will talk about ways to chase those basis points

Tags: margins in healthcare staffing

7 Apps Travel Nurses Can Use for Scanning Timesheets

Posted by Julie Moore on Tue, Dec 02, 2014 @ 06:30 AM

Managing payroll for hundreds of healthcare professionals all over the country can be a huge headache.  This is especially the case if you are waiting for a nurse to reach a fax machine to send in a paper timesheet or the quality of the picture of the timesheet is not good enough to decipher a 3 from an 8.

You all know what I am talking about, don’t you!

Statistically over 58% of adults in the United States (Jan 2014) have smartphones and I bet the statistics are higher for travelers. This means that you should be getting more than half of your timesheets via email from a “scanned in” timesheet. 

Here are 7 great apps you can have your travelers use that should increase the quality of the timesheet turning any mobile device into a scanner.  This might even make a good holiday present for them!

Genius_Scan_IconGenius Scan

What I love about Genius Scan?

The app will let you choose what file type to save it in and with a quick email optioni.  It also has a great way to store scanned documents and search for them later.          

What I don’t love about Genius Scan?

You will have to fork out the cashola if you want to integrate with any other apps like Dropbox.

Plus Version - $6.99 



What do I love about TinyScan?

It is a quick and easy app to use. It allows you to view the document in black and white, grey scale and the original photograph to choose the best option.

What I don’t love about TinyScan?

Lite version only lets you have so many scans stored before you need to upgrade to the pro version.  But everyone needs to make money too, right?

Pro $4.99



What I love about Scanbot?

Its an all in one app.   Not only is it a document scanning app but it is also scans QR codes.  And I love the OCR option for the pro-version


What I don’t love about Scanbot?

Its not quite as intuitive as some of the other apps there.



What we love about CamScanner?

Easy to use and optimizes the scan quality automatically.  It is also jam packed with TONS of features including OCR, advanced document editing, quick search and syncs seamlessly with multiple applications.

What we would change about CamScanner?

There is a watermark on the free version so I would think this would not fly with most of the facilities that need the scanned timesheets.  Most likely this app would need to be upgraded to use it.

Full Version - $4.99


turboscaniconTurbo Scan

What I love about TurboScan? 

You can take up to three pictures of the same image and combine them into the best possible scan.

What I would change about TurboScan? 

There aren’t many integrations if your travelers like to organize their timesheets for future reference so they would have to quickly email it off to save it.

Full Version - $2.99



What I love about BlueSkyMSS? 

It integrates with your time and attendance for BlueSky Medical Staffing Software so the nurse punches in the time and uploads a picture of their signed timesheet.  This is a HUGE timesaver for the traveler and the payroll team plus it is included in your BlueSkyMSS subscription.  No fee to your nurse!

What I would change about BlueSkyMSS?

BlueSkyMSS would integrate with any of these scanning apps or allow the traveler to choose from one of their “scanned” timesheets to upload into they BlueSky system.


myscansMy Scans

What I love about My Scans?

It’s one of the easiest apps to use on the market and great for people who have a hard time with technology. It is also FREE! The text also is crisp and clean out of the box with little extra work to clean it up manually.

What I would change about My Scans?

Because it is so simple it is missing a lot of big features that some of your travelers may want.  I would definitely choose this app though for people who are afraid of more than just the basic scanning features.


Will the Affordable Care Act Inject More Funding for Hospitals?

Posted by Tim Teague on Mon, Dec 01, 2014 @ 10:55 AM

money_hospitalsAmidst the uncertainty, delays, and administration of the Affordable Care Act (ACA), a valid question remains as to the reimbursement effects on hospitals nationwide. Given the outreach of the plan to assist in providing insurance to millions who currently can’t afford coverage, a quick assessment would assume an increase in reimbursements to hospitals.

A closer look at the plan reveals a less clear picture of expected reimbursement.

Despite the uncertainty in the industry, one fact is clear: Hospitals will exist in a world where they are rewarded more for quality of care than the volume of patients treated. Through this transition, hospitals must operate within two plans — one where they still earn money per procedure and another that views the treatment of patients with successful outcomes the most important measure of a hospital's performance. The ACA will offer financial incentives to hospitals that perform well. The government determines good performance through a combination of clinical outcomes and patient satisfaction surveys. The ACA will penalize hospitals that appear to perform poorly. The government has already started cutting Medicare reimbursement for hospitals with readmission rates considered excessive. In 2015, hospitals that have high rates of hospital-acquired infections will see a further reimbursement rate cut.

The aforementioned variables surrounding reimbursements make it nearly impossible to derive a true revenue picture for hospitals nationwide, and there will not be a straight-line comparison from one hospital to the next. In summary, it is still too early to know the long term revenue impact to hospitals for the Affordable Care Act.

Tags: Affordable Care Act

Tips for a healthcare staffing agency to prepare for the holiday season

Posted by Julie Moore on Mon, Nov 24, 2014 @ 03:15 PM

Ahhh... Thanksgiving week and the kick off to the holiday season is finally upon us, but for those of us in healthcare staffing we know that this is truly the silly season. 

Have you ever felt this way?


Here are five tips to help you make it through the holidays without losing your mind:

  1. Double check your travelers contracts verses their schedule to make sure that there wasn’t a miscommunication between the facility’s scheduler and what is in your travelers contract. This is a very proactive step to take as it helps to do this ahead of time thus not having any fires to put out the week of a holiday. 

  2. Have a strategic plan for payroll. We all know the short weeks combined with the end of the year can make payroll extremely hectic and stressful. This may result in coming in on a Sunday to enter timesheets and over-communicating to your healthcare professionals the deadlines for timecard submission.  Use your texting feature in BlueSky to alert your staff as to when the timecards are due to the payroll department and your missing timecard list to hound those that haven’t turned their timecards in.

  3. Get your holiday cards to arrive on-time and to the right address.  Many systems including BlueSky can create mailing labels.  Do not wait until last minute to print these. Know how to get your addresses together for holiday cards and make sure you have the right address for your travelers. You want your cards to actually arrive to where they are actually for the holidays, right?

  4. Make sure that your facilities, especially any new contracts in 2014 are setup with the correct holidays start and end. Some facilities have different rules that apply to when they start holiday pay and you don’t want to be fixing this after the first of the year or the week of Christmas so be sure proactively check these facility’s holiday time calculation rules.

  5. Plan your holiday party and invite everyone including your healthcare professionals then do something fun for your travelers that can’t make it to the party.  If it were me, I would do something extra for those working during Christmas or New Years.  It will mean a lot and something little goes a long way especially for those travelers who are away from their family and friends during the holidays.

If you have any tips on what you do to prepare for the holidays please feel free to share them here!


Tags: healthcare staffing payroll, Happy Holidays

Don’t Let the Affordable Care Act Penalties Sneak Up on You!

Posted by Tim Teague on Wed, Nov 19, 2014 @ 06:30 AM

sneak-upAmidst the back and forth, the delays, and the political posturing surrounding the Affordable Care Act, DON’T FORGET THERE ARE SIGNIFICANT PENALTIES for employers for non-compliance.   The penalties are only for employers of 50 or more FTEs, but if your firm suddenly hits the 50 FTE threshold, penalties can accrue monthly. 

In simple terms, if you offer health insurance that covers at least 60% of costs, and the cost to the employee is not more than 9.5% of their family income, you should be safe. However, if just one employee elects to participate in an exchange, or receive a tax credit outside your company, your company will be flagged for non-compliance. Despite proof of valid coverage, you will need a paper trail that confirms compliance for every employee. This is where electronic signature technology can uncomplicate your administrative burden and provide a legal paper trail to assist in complete compliance. The penalty could be a minimum of $3,000, but for a small firm with 50 employees, it could be as much as $40,000 annually!

We have a sample document that is already loaded by our suppler, YouSignHere. This assures that each employee has been offered coverage, and what their election was.  

If you are interested in seeing that document and how to use YouSignHere for your healthcare election coverage forms please click below and we will be happy to send it to you for download.

Get my Free ACA Election Form

Tags: Affordable Healthcare Act, YouSignHere

3 Features of YouSignHere medical staffing agency’s can’t live without

Posted by Julie Moore on Tue, Nov 18, 2014 @ 06:00 AM

It is no secret that You Sign Here, an electronic signature system, and BlueSky Medical Staffing Software are tightly integrated.  In fact, You Sign Here was developed by one of our owners in response to support issues we had with other e-Signature platforms. But over the years we have worked hard to make the You Sign Here integration so seamless that it is almost too good to be true.

What makes You Sign Here so special for healthcare staffing? 


1.  Save time and energy with the signature sequence workflows 

In healthcare staffing, agencies run into the issue of needing a thousand signatures on a million documents before a healthcare professional can go to work.  Now that maybe a bit of an exaggeration, but you know what I am talking about, right?  Not only does the HCP need to sign a contract and other documents, but so does the facility and if you are an managed service provider (MSP) then the subcontracting agency needs to sign many documents as well.

With the BlueSky/You Sign Here integration documents can be pre-configured to have roles.  What are roles?  It’s where certain signers fill out and sign certain fields before it moves to the next signer.  For example, if you are an MSP the facility signs the contract first, then it is sent to the subcontractor to fill out and sign, then onto the healthcare professional before it finally lands in the agency’s email for a final signature. After all of that is complete the signed and completed document automatically uploads into your BlueSky system.

Imagine all of the Fedex fees and time involved with a paper contract?

2.  Error Free Documents – yes this is possible!

One of the biggest issues with a standalone e-signature platform is someone has to take information and type it into the document before sending it for signature.  Anytime a human is involved and needs to type data from one system to the other system leaves the document open to errors.

The “mail merge integration” with BlueSky allows users to insert information from their BlueSky Medical Staffing Software system into any document.  No, this is not too good to be true.  This is what happens when you have a tight integration between two systems.

For example, some fields can be preloaded into any document such healthcare professional demographic information like names, date of birth, address, specialty to name a few as well as contract information such as start date, facility address, credentials required to start and rates.

At BlueSky we know the hold up a healthcare staffing agency can have when the I’s are not dotted and the T’s are not crossed on a contract.  Without an accurate contract the HCP could miss a start and cause a domino effect of problems for every party involved.  This is how the mail merge feature comes to the rescue by eliminating errors and getting HCPs to work faster and easier!

3.  Have complete documents and never have an missed field again

We have seen the frustration when a long awaited contract lands in our inbox with incomplete or wrong information loaded by the signer.  For example the signer has missed a digit on their social security number or forgot to initial a page.  Who know how many days it will take to get back in touch with this person and get it complete.

You Sign Here has very configurable behaviors and the ability to enforce rules before a document can be signed and completed.  It is so advanced that a user can preconfigure a document to have if/then statements in a document. You are probably thinking, “What is an IF/THEN statement... I am not a programmer.”  In normal terminology this means if a user marks a certain field like “Yes or No” to one of your fields THEN they must answer another subsequent field.  What a timesaver for all those involved to keep careless costly mistakes from happening!

Many medical staffing agencies are finding that the Affordable Care Act is already causing more paperwork for 2015 and there needs to be an efficient way to complete this paperwork. Using all of the features listed above could really help you get ready for 2015 with minimal effort.

If you are a BlueSky user be sure to attend the Community Training on Friday and we will be discussing how to integrate You Sign Here to streamline your staffing life!

You Sign Here Community Training!

Tags: electronic signature, YouSignHere

7 items not to miss when choosing a healthcare staffing software

Posted by Julie Moore on Thu, Nov 13, 2014 @ 06:30 AM

There are questions that should be asked during every sales demo for healthcare staffing software and these questions are missed almost every time I do a demo. There are some basic questions that I think NEED TO BE ASKED that people just DON’T ASK. 

Shhhh... It’s my secret

So listen up if you are searching for new healthcare staffing software, because I am going to tell you my secret.  Everything that you need to be asking my competition and me before buying.    

If you don’t know me you are probably thinking, “Who is this girl and what gives her the authority to tell me the questions I am forgetting to ask.”  I have been in IT related sales for almost 10 years serving as the Director of Sales four of the last six years at BlueSky.  And I can tell you after working the help desk and as an implementation specialist at BlueSky the software you choose needs to be a good fit.  Period.

Here are 7 questions that you can’t forget to ask when choosing a healthcare staffing software.

1.  List of references with at least one that is no longer a client

My guess is you are asking for references but taking references to the next level is so important. Talk to a client that has left the software and what forced them to move systems.  If you cannot get this type of reference then this is an immediate red flag.

2.  The cost may not seem what it really is kind of like Amy in Gone Girl (ha ha)

gone_girl_imageHidden Costs.. they are everywhere. I call it the cell phone company affect. Does the company charge for integrating systems already in place like Facebook and Twitter? How are these charges applied?  Are they upfront about their costs and is there price protection for the future? You don’t want a huge bill the first month and not sure where it came from or find out that you cannot do half the items the salesperson demoed to you because there will be a significant increase in cost.

3.  100% Rule BEWARE!

A very wise CIO of a public staffing agency once told me that if you can get your software to cover 80% of what you need out of the box then you are doing great.  If a salesperson says that their amazing software can do everything they are lying – it’s just not true.  There is not one staffing agency I have come across in my tenure that staffs the same way as the other guy.  Each healthcare staffing agency is unique and has unique scenarios. Insist the salesperson show you how to do your job by teaching the salesperson about your processes so they can show you how to business in the new system.  This is crucial because you don’t want to stick a square peg in a round hole.  

4.  What is the SLA and does the software have a strong history of SLA Performance?

Your staffing software will be running your business and if this software has downtime then you could have some serious side affects and costs associated it such as payroll not getting out on time or worse your business comes to a complete halt.  So this is so important to ask and again while you are talking to the references ask this question too. 

5.  Can you demonstrate successful similar deployments?

I cannot begin to explain how important the rollout process is for a successful adoption of the new software. The salesperson should be able to explain or demonstrate a successful deployment and how they see the implementation working.  Oh, and while you are at it... ask the references in detail about the deployment process and overall adoption from your staff. 

6.  Can I configure the system and put controls in place through the interface without development costs?

There are things that a system should be able to do without a huge development fee.  In BlueSky we have over 1200 permissions that can be turned on and off without the need of developers.  This is huge because you do not want to be paying development costs every time you need a small change done.  I always say BlueSky is configurable to a fault as most SAAS systems should be!

7.  If I choose to leave, how easy is it to get my data and files?

Cloud-BackupThis is a problem I run across time and time again.  Companies want to leave a certain staffing software but they are unable to do anything because there data and files are being held hostage.  This is a wrong approach on so many levels because the data is technically yours and you should be able to have a backup at anytime.  We have worked around this problem when converting clients into BlueSky and if you leave we are not holding your data hostage. It is yours and you should have a backup of data as often as you need. 

Take my warning...

I always say at the end of the day if I do not feel if the customer is a good fit for BlueSky then I don’t want their business.  I am not trying to be harsh but why would I want to put you and my team through a forced sale.  It never works out well. 

So please heed my warning and take my final advice: Buying staffing software is like buying a house – it’s a HUGE decision and you wouldn’t move into a house that has two bedrooms when you need four.  Don’t rush the process and make sure that you are a good fit for the software. Ask the tough questions and make sure that you are not just being sold into something that isn’t what it seems to be.

Click Here For More Info

Tags: healthcare recruiting and staffing software, Data Converstion, web-based staffing software, BlueSky Demo

Free Whitepaper

Social Media in Healthcare Staffing

Subscribe via Email

Follow Me