Judge orders Maine governor to move on Medicaid expansion
Want to know how this will affect traveling healthcare professionals? Click here to read our take on the issue. After months of uncertainty following Maine’s passage of a voter-approved Medicaid expansion effort last year, a state judge on Monday ordered Gov. Paul LePage’s administration to officially move forward with expansion plans. In her ruling, Justice Michaela Murphy of Maine Superior Court ordered the administration to submit a state plan amendment that would update the terms of its Medicaid program and submit it to the federal government by June 11. The ruling cited the “complete failure to act” by Maine Department of Health and Human Services to establish a file a plan to expand Medicaid by the original April 3 deadline. Maine was the first state to expand Medicaid through referendum, and if Gov. LePage’s administration complies by next week, more than 70,000 eligible residents will be able to enroll for healthcare coverage by July 2. It would also trigger a federal cash flow of more than $500 million in federal funds to help the state cover healthcare costs of those with yearly incomes more than 138 percent of the poverty level, which is $16,642 for an individual or $24,600 for a family of four. A spokesperson for Gov. LePage’s administration told Politico that they are reviewing the decision and declined to say if they would appeal the ruling. The court order is a big win for Maine Equal Justice Partners, a progressive group that filed a lawsuit in April to force LePage’s administration to move forward on expansion after DHHS missed the deadline, according to a report in the Bangor Daily News. Gov. LePage has staunchly disapproved of Medicaid expansion efforts, vetoing similar measures multiple times in his two terms of office saying it will burden taxpayers and the state budget. His administration laid blame on the state legislature, arguing that they have not found adequate funding to implement the ballot measure. “Now that Medicaid Expansion is the law, it is my responsibility to implement it, and I will. But until they adequately fund it, there is nothing we can do,” Gov. LePage said in a press release. “Before we can proceed with expansion, DHHS needs both the staff to implement it and the money to pay the bills that will come due when the state plan amendment is approved.” The full cost of implementing the expansion is a disputed figure between Gov. LePage’s administration, which estimates as much as $100 million a year, and the nonpartisan Office of Fiscal and Program Review, which estimated a need of $45 million in state funds. How This Affects Travelers Similar to last week’s announcement that Virginia’s lawmakers successfully passed Medicaid expansion after a five-year battle, the new stream of funding for Maine hospitals could provide a boon to travel employment opportunities in the state. Newly insured patients who may not have had access to healthcare services will flock to hospitals, which could cause a spike in temporary staffing needs. The major difference with Maine, however, is that Maine’s enrollment will begin this summer if the court’s ruling stands, whereas Virginia won’t see an influx in new Medicaid patients until next year. We’ll keep tracking this story as it develops, but keep an eye out in Maine after mid-July and in August for a potential spike in job leads.
Still Looking For A Summer Travel Job Now? Stay Flexible, Industry Experts Say
With Memorial Day weekend behind us, summer is unofficially here, and some travel RNs who’ve banked their earnings are looking forward to fun in the sun. For others, their next step is getting ready to start their new contracts in early June. But what about the not-so-early birds; the travel nurses who, for various reasons, haven’t locked in a new assignment but still want to work during the summer? They aren’t alone—but that’s not a good thing for those hoping to land a dream summer job. New travel nursing job opportunities haven’t dried up completely, but market demand is stabilizing, meaning hospitals are posting new positions with less frequency compared to the first half of 2018, according to market data gathered by HCT Today. The slow trickle of new jobs has travel agencies fighting tooth-and-nail to get their nurses into hospitals, which, in turn, has caused a surge in the number of viable candidates hospitals can choose from. “We have some clients that will no longer take a (candidate) submittal with a single day off on it,” said Jennifer Pomietlo, a director of client advisory at LiquidAgents Healthcare. “Why? Because they are getting more than 40 candidate profiles for every job.” Travel nurses have several ways they can stay competitive during this high-volume period, according to feedback from staffing agency recruiters and sales staff. Keep preferences flexible and profiles sharp Two months ago, getting a recruiter to negotiate with a hospital for more approved time off or shorter contract length might have been an easier task. Now, nurses have to get in line with dozens of other candidates, some of which have no scheduling conflicts or contract stipulations. “Hospitals are also looking for more specific years of experience based on specialty,” Pomietlo said. “Instead of a nurse saying they have six years of RN experience, hospitals want to know if they have two or more recent years of experience in ER if that’s what they are being submitted for.” Nurses should work with their recruiter and agency to put their best foot forward–in other words, that means avoiding compliance delays, providing a clean resume with the right information, and prepping for the interview. Don’t wait when you see an opportunity If you find a job board posting that looks promising, contact your recruiter immediately and let them know you are interested, especially if the job was posted within the last 24 hours. You may have the best resume in the world, but you also might as well be invisible to hospital staff if your profile is behind more than 30 other nurses who managed to submit their information first. This may not apply to all specialties, but for more common specialties like medical surgical/telemetry, speed is important. If possible, try somewhere new Everyone wants to find a fun vacation state to work in this summer, but waiting for the perfect high-paying Florida contract may not be your best bet if you need a job now. Instead, look for states where travelers aren’t applying and see what opportunities are available. Your chances to find high paying jobs can be much higher in less popular summer travel states like Nevada or Arizona. If you’re having trouble finding good jobs in these states, talk with your recruiter. An experienced recruiter can help you track down a great opportunity that you may have missed.
How To Reach The Elusive $100K Travel Nurse Salary
One of the most pervasive myths in travel healthcare is the potential to earn a six-figure travel nurse salary while jet-setting across the country. It certainly sounds appealing, and plenty of recruiters or agencies will try to sell you with that exact same message–but do you actually have that much earning potential as a traveler? Here’s our semi-short breakdown of five tips you can follow to earn your way towards $100k. If you just got off a brutal shift and five tips are way more than you want to read right now, click here to skip to the summary with our take on the issue. 1. Find cold weather, small towns and high-paying states Earning the most as a traveler often means going where the money leads, regardless of the location or harshness of season weather. This means you’ll be headed north in the winter, swapping with the “snowbirds” in states like Illinois or Wisconsin to cover gaps in staffing. It can also mean working in small towns and underserved locations that have trouble recruiting travelers, retaining staff nurses or that just aren’t that popular destinations. Generally, working where people can’t, don’t or won’t will earn you more through potential bonuses and higher pay packages. You also need to be aware of what state offer routinely high pay packages year-round, like California, Texas and Massachusetts. Peppering in jobs from these states can help boost your earning potential. 2. Work when everyone isn’t Not many people want to work during the holiday season from November to January, so jumping on a short-term holiday contract is a great way to build your travel nurse salary. Holiday pay typically matches overtime rates. Speaking of overtime, adding in extra shifts is always an easy way to get more money from a travel assignment, so look for overtime opportunities when you can. Important note: Make sure you know the exact overtime stipulations of your contract before committing to more hours. Some hospitals may not offer overtime pay that matches up exactly with state laws. Some agencies may offer “blended” bill rates–which has no difference in pay between regular and overtime hours–in states that charge overtime when working more than eight hours a day, as opposed to 40 hours per week. You should be able to discuss these details clearly with your recruiter. 3. Always take the housing stipend If you’ve established a tax home and are eligible to take a tax-free housing stipend instead of using company housing, taking the stipend means more money in your pocket in most cases. It can be a bit risky and a huge hassle, since the task of finding housing now lands on your shoulders, but you can often find housing that’s less than the total stipend, letting you save the extra cash. There are tons of online resources (Airbnb is very popular among travelers) to find quick, affordable housing. You can check the rates for per diems, along with meals and incidentals by state by visiting the General Services Administration website. This shows the maximum rate offered by location, not the general rate, but it can still help you gauge how much you may receive for an assignment. 4. Look for rapid response or strike opportunities Nurses who stay flexible with their assignments can make great money responding to strikes or other unexpected staffing problems at a hospital. Crisis rate pay packages are often significantly higher than standard, adding up to $10 or more per hour to your pay. Keep in mind these jobs are fleeting and tough–you may get to the job to find the situation has resolved itself before you’ve even started, and you must have all necessary compliance docs ready at a moment’s notice to jump on job opportunities. You also won’t get tons of flexibility on job shifts, since you’re there to help during a critical period. 5. Specialize Nursing specialties that are more in demand or require extensive training will often pay more. Specialty bill rates between hospitals and agencies range from 2 to 10 percent higher than standard rates, which means higher pay packages overall. Specialties that commonly see these higher rates are ICU, L&D, CathLab, ER, OR, PICU, NICU and CVICU. Standard rates are associated with more common positions like Medical/Surgical, PSYCH, PEDS and Postpartum. Our summary If you skipped to the bottom, here’s the short answer if you want to make $100,000 a year as a travel nurse. Work as much as you can; at every available opportunity; in places you may have never wanted to visit; in economical housing; in extreme weather climates; during most holidays; with the lowest amount of downtime possible; in difficult or highly specialized positions. Also ignore the fact that a portion of those wages will go towards insurance, travel, compliance and tax home expenses, regardless of whether they are offered by your agency. If that’s not an ideal answer, it’s certainly not an ideal situation. There are travel nurses out there who do earn up to $100,000 a year, but they will be the first to tell you it’s not easy. It’s up to you to realistically decide what you want from your travel nurse career, and your recruiter and agency should be there to help you make informed decisions at every turn.
Cerner ranked top EHR by nurses in satisfaction survey
Cerner took the top spot among all electronic health record systems, according to Black Book Research’s 2018 EHR Loyalty Survey released this week. The market research company surveyed almost 15,000 registered nurses in three separate surveys across forty states and received 7,409 total respondents. Survey participants were asked to rank EHR systems on their overall usability and functionality in four areas. Those surveyed also had to have used one of these systems in the last four years. Cerner had the highest average usability and functionality rating of 93 percent, followed by Meditech and Allscripts in second and third place. Cerner is one of the top five most popular EHR systems in hospitals today, with 25,000 customers nationwide according to Capterra. eClinical Works, the largest EHR in the states by a total number of customers, received the lowest scores in all categories, earning an average rating of 39 percent. Overall average scores show an increasing level of confidence nurses have in using EHR systems. In BlackBook’s 2014 survey, the average rating across all EHR systems was 21 percent, which has jumped to 79 percent this year. Additionally, 96 percent of this year’s respondents said they would not want to back to using paper systems. Among different hospital roles, emergency room, oncology, labor and delivery, and operating room nurses reported the highest average satisfaction levels using EHR system. Medical-surgical, ambulatory and psych nurses reported the lowest average scores.
Trinity Health Selects Epic For New EHR Enterprise Platform
Trinity Health, one of the largest non-profit hospital systems in the U.S., announced today it will use Epic to implement an integrated electronic health record (EHR) and revenue cycle management platform. The company plans to roll out the new EHR platform to all of the system’s hospitals, ambulatory care centers, physician offices and continuing care programs in the coming years, according to their official press release. The Catholic healthcare system, based out of Livonia, Michigan, operates 94 hospitals and 109 continuing care locations across 21 states. Trinity’s goal is to create a single, comprehensive EHR for patients, consumers and employees. Patients and consumers will have access to online scheduling, e-visit, and simplified online bill pay tools, while physicians and clinicians will have a shared patient record which should improve patient safety and outcomes, according to the release. “People deserve customized and convenient healthcare experiences, including simple access to a complete health and billing record. At the same time, physicians and clinicians need tools that make it easier to practice medicine. We look forward to implementing a single, enterprise solution enabling us to deliver excellent, people-centered care,” said Mike Slubowski, president and chief operating officer of Trinity Health, in the press release. The company plans to train more than 100,000 employees on the new EHR platform, which could provide opportunities for Epic EMR conversion travel nursing jobs within the next four years.
Travel Nurse Market: High facility turnover expected as heavy flu season winds down
This year’s brutal flu season in the U.S. has lost its edge in recent weeks, according to the most recent Center for Disease Control data, but not without leaving a heavy impact on patients and facilities during the peak mid-winter months. An estimated 160 children died from the flu between fall 2017 and spring 2018, marking the deadliest flu season since 2012-2013 with 171 deaths, according to CDC data. That number is expected to rise once the data is finalized, according to a report on USA Today. <a href=’#’><img alt=’Laboratory-Confirmed Influenza HospitalizationsPreliminary cumulative rates as of 04-21-2018 * ** ‘ src=’https://public.tableau.com/static/images/CD/CDCFluData2017-2018/Sheet1/1_rss.png’ style=’border: none’ /></a> The season also saw cumulative hospitalizations across all age ranges of 105 out of every 100,000 people as a result of the virus. People age 65 and older were affected the most, with 454 hospitalizations out of 100,000 people at the peak of the season in mid-April. Facilities were swamped trying to meet patient care needs around the country, meaning travelers who locked down their contracts at the start of the year were offered extensions much earlier than expected, LiquidAgents Healthcare director of client advisory Oren Lavi said. “There was a major push for extensions early this year,” Lavi said. “On a typical 13-week contract, hospitals will wait 30 days or longer to offer extensions to travelers, but we were getting extension offers within two weeks of them starting at a facility.” During the seasonal transition in the next few weeks, travelers who impressed their facilities could potentially see additional extension offers as hospitals plan their summer staffing needs, Lavi said. The number of back-fill opportunities should also increase as hospital evaluate their staffing needs after the difficult flu season, Lavi said. “This is the time when hospitals will cut staff that didn’t perform as well as they hoped, but they still had to hire to meet patient care demands at the facility,” Lavi said. “Once those positions are cut, hospitals will have to back-fill to keep things running smoothly.”
Location and Legislation: Factors Impacting the Traveler Job Market (Part 2)
In this two-part series, HCT Today asked Oren Lavi, director of client advisory at LiquidAgents Healthcare, about what major factors impact where travel nurses tend to work and why. To read Part 1, click here. Fewer staff nurses, more jobs One of the more obvious factors that drive travel nurses to a location is to fill the gaps at understaffed or overworked facilities around the country. The aging Baby Boomer population is the primary catalyst for this staffing void; as the senior citizen population grows, demand for ongoing care will skyrocket. Aging also affects the staff nurse population, as one-third of the current nursing workforce is expected to retire over the next decade. It’s not all doom and gloom–the Bureau of Labor Statistics projects employment of registered nurses to climb 15 percent by 2026, meaning more than 435,000 nurses are expected join the workforce. Until then, hospitals will lean on travelers to ease the employment shift. “Just generally speaking there’s a nursing shortage,” Lavi said. “When I started in this market 10 years ago, there was a demand, but it has just exploded recently. The volume of needs has increased. Not only the numbers of facilities that use travelers in general but the number they’re asking for has actually increased.” Hospitals are also seeking travelers as a cost-effective stop-gap to hiring permanent staff, according to a 2017 U.S. hospital nursing labor cost study conducted by KPMG. While staff nurses typically see a much lower base wage, hospitals also have to account for insurance, training and recruiting costs–things that are handled by staffing agencies for travel nurses. Since these extra costs are handled by agencies, travel nurses actually end up costing less on average than staff nurses, according to the study. Mergers and acquisitions Hospital and staffing agency mergers were announced at a record-breaking pace in 2017, and that trend is expected to continue this year. These mergers can be a double-edged sword for the market, Lavi said. Hospital mergers could bring benefits to nurses, depending on if they are acquired by larger hospital systems. In most cases, a larger hospital system that is already used to having supplemental staff will implement the same policies at new facilities they acquire, Lavi said. Hospitals acquired by smaller entities will often try to cut down on supplemental staff to manage operating costs–but this usually has a negative effect on full-time nurses, which generates even more need for travelers. “It creates a complete 180 [degree] effect,” Lavi said. “Hospitals realize their permanent staff is overworked; they’re working with higher ratios; they’re working too hard, and they actually now need more supplemental staff than if they had supplemented just a little more in the beginning.” The goals of the traveler It’s up to individual nurses to decide where they want to work and why, but knowing these market factors can help travelers plan proactively, Lavi said. One of the best ways to stay informed is to find a source you can trust, like a good recruiter, and to ask plenty of questions. “If a nurse is not asking questions, sometimes their recruiter will be so focused on finding their next position that they forget to give them the information to make the proper decision,” Lavi said. Sometimes the best question a traveler should ask themselves is why they are traveling in the first place. “Some nurses want to go to a destination because that’s where they want to go,” Lavi said. “Some of them have family in the area and it’s a good way to spend 13 weeks. Some nurses want to try out a state before potentially relocating there, and some nurses just want to go for the adventure. “It could be just about anything, but really it’s the nurse’s individual preference as to what factors guide them to either get into travel nursing or traveling to certain destinations.”
Mergers & Acquisitions: How Agency Consolidation Will Affect Travelers
Global mergers and acquisitions reached a new milestone–2017 marked the third year that more than 50,000 deals were made, according to a report in Harvard Business Review, and the healthcare staffing industry was no exception. This trend is expected to continue through 2018, and the industry has already seen its first acquisition. Medical Solutions, one of the top staffing firms in the U.S. in terms of market share, announced the acquisition of PPR on Feb. 9. PPR provides travel nurse staffing and interim leadership for acute and post-acute markets. As part of the transaction, PPR will continue to operate as its own brand and will keep its offices in both Jacksonville and Tampa, Fla., according to a press release announcing the deal. For travelers, staffing industry mergers mean fewer choices As with any industry, consolidation means fewer choices, and that’s the case here. As these staffing companies merge and are acquired, the nurses that use them are faced with fewer and fewer options, said StaffDNA vice president Stephen Gillem. That could negatively affect pay rates and quality of service these agencies provide. The loss of choice could feel especially felt by a specific group of nurses, those who are labeled “Do not hire.” With fewer agencies representing more hospitals, if a nurse is marked “do not hire” by an agency it becomes harder for that nurse to find a new position just by moving to a new agency. Mergers and acquisition as growth strategy The Medial Solutions/PPR acquisition is somewhat surprising, Gillem said, because PPR, just last year, was one of the companies doing the acquiring when it bought 360 Healthcare Staffing. PPR wasn’t the only company to make major moves in past few years. Cross Country Healthcare acquired Advantage RN for $88 million, Travel Nurse Across America acquired Trinity Healthcare Staffing Group in January 2017, and Advanced Travel Nursing acquired both Rise Medical Staffing and IPI Travel Nursing in 2016. Gillem expects these medium to large players to continue consolidating with competing firms because it’s an easy way to spur company growth over organic methods, he said. “It can be hard if you’re a smaller company to compete now on the healthcare traveler national stage if you don’t have that reach,” Gillem said. “You’ve got to have the money for marketing, website optimization, and a robust back office for items like compliance.”
Location & Legislation: Factors Impacting The Traveler Job Market (Part 1)
The term “hot market” isn’t just a corporate buzzword; it’s a battle cry for travel nurses and travel staffing agencies across the country. Nurses want to know where the jobs are and recruiters watch the market like hawks, hoping to place their nurses in the right place at the right time. For Oren Lavi, director of client advisory at LiquidAgents Healthcare, regularly updating the recruiting team is how the agency makes sure its nurses stay on top of a fast-changing travel nurse job market. “‘What’s going on in this territory?’ ‘Do you see any changes in this state?’ ‘What hospitals made acquisitions?’,” Lavi said. “They want to know all the details because they want to inform their nurses so that when they’re making their next step, it’s a logical step.” Smart travel nurses should be asking similar questions of their recruiters because there are many factors that can affect which markets are hot and when. Flying south for the winter Just like birds seek balmy temperatures during harsh winters, travelers and their patients tend to do the same. “There’s a definite seasonality to market shifts,” Lavi said. “You have Florida, Arizona and New Mexico where people from up north spend time in the south. If they get sick, it’s not at home but down in these states instead, so these hospitals see a boom in patient loads and need nurses to take care of them.” The problem is nurses want to go where it’s warm too, so while demand for them is high, so is the supply. That pushes pay down. So, while it may be more comfortable spending winters at a Florida beach, travelers who brave the cold can make great money in northern states like Wisconsin, Illinois and Michigan. Hospitals in these states will often incentivize travelers to fill positions by paying more during colder months. Even with seasonal shifts, there are some states that stay “hot” year-round, like Texas and California, Lavi said. “With Texas being so big and the temperature so moderate, it will always have demand,” Lavi said. Affordable Care Act boom Lavi says there’s been no bigger boon to the market than the Affordable Care Act, specifically in 2015, the year after the tax mandate kicked in that required all U.S. citizens to buy health insurance or incur a penalty. The mandate, along with new access to tax credits for small businesses and federal subsidies for health coverage, caused a sizeable surge in insured Americans. “Everyone getting health insurance meant more people were actually going to see a physician when they needed to, which made demand even stronger,” Lavi said. “Patients benefited from getting the care they needed, hospitals benefited because they served more patients and travelers benefited because there was more opportunity out there.” Lavi expected the job market to drop at the start of this year after President Donald Trump signed the GOP’s tax reform bill into law in December of last year, which also repealed the health care coverage mandate. But so far demand has not dropped in 2018, Lavi said. “The territories I’m working right now are super hot,” Lavi said. “Travelers want to go there and we have more than enough positions for them. But if something like the Affordable Care Act (mandate) gets re-enacted, that could spur another market jump.” The nursing strike “vacuum effect” Hospital strikes are a fairly regular occurrence across the U.S. Nurses who feel they are overworked, underpaid or mistreated by management organize strikes to force hospitals into negotiations, leaving these facilities without necessary staff to take care of patients. It happens often enough that some staffing agencies specialize in placing nurses in strike areas. Hospitals will also offer significantly higher bill rates to quickly fill staff spots during a strike. While not all agencies necessarily fill strike positions, recruiters do still keep track of strikes because of the “vacuum effect” they can have on the market, Lavi said. “The strikes in Minnesota last year sucked up a lot of travel nurses…the number was in the thousands,” Lavi said. “That left a lot of other hospitals with unfulfilled needs. It was good for nurses who don’t want to work strikes because that meant less competition to get a job.” In Part Two, Oren talks about how the looming nursing shortage, hospital mergers and traveler goals also affect the market. Click here to read Part 2.