Healthcare Roundup: Stories You May Have Missed
Healthcare continues to struggle with controlling rising costs. Headlines this week featured a few interesting solutions: Artificial Intelligence. Micro-hospitals. Those stories and more are highlighted this week in the stories you might have missed. Lyft teams with Allscripts to get patients to doctor appointments The ride-sharing service is integrating its software with Allscripts to make it easier for physicians to schedule rides to appointments for patients who need them. Want to use AI to impact healthcare? Give it the mundane jobs. “… the greatest opportunity for AI in the near term may come not from headline-grabbing moonshots but from putting computers and algorithms to work on the most mundane drudgery possible.” The real opioid problem may be in the hospitals Health officials report they are struggling to keep their pharmacies supplied with the opioids needed to treat patients, forcing them to find other courses of treatment and wondering when their supplies can be restored. Are micro hospitals the next step in controlling healthcare costs? These smaller facilities–some as small as 8 beds–are seen as good alternatives to larger community facilities, performing the same procedures at a lower cost. They are also considered realistic options for more rural areas that can’t support bigger hospitals. A study says babies that resemble their fathers are healthier Why? Because when the baby looks like the dad, the dad knows with more certainty the child is his and spends more time with the child. That means he is more in tune with the baby’s health needs.
Compact License Update: Kansas Makes Progress; Low Demand for Wyoming Licenses
The Kansas legislature has moved quickly on HB 2496 in the past two weeks, meaning Kansas could join the 29 other states in the enhanced Nursing Licensure Compact as early as next year. The bill was introduced to the House on Jan. 17 and promptly moved to the Committee on Health and Human Services the next day. After a small amendment bumping up the implementation date, the bill passed the House with almost unanimous support last Thursday. The Senate pushed the bill to the Committee on Public Health and Welfare this week, and legislators will resume session after the weekend. If the bill passes, Kansas nurses could potentially obtain new compact nursing licenses by January 1, 2019, according to the bill supplement. Kansas is one of seven states attempting to pass legislation to join the eNLC, which went into effect on Jan. 19 this year. The other states are Illinois, Michigan, Massachusetts, New York, New Jersey, Rhode Island and Vermont. Wyoming: Low demand makes for easy eNLC transition Wyoming’s had an easier time addressing multi-state license demand compared to the others as one of the five new states to join the compact, Jennifer Burns, practice and education consultant for the Wyoming State Board of Nursing, said there have been less than 100 applications for new compact nursing licenses or upgrades from normal licenses. There are approximately 13,000 registered nurses and 1,100 licensed professional nurses in the state as of December 2017. “We’re a small state in number of licensees,” Burns said. “We’re not seeing any delays in processing applications. We were well prepared. To be honest, most of our home-state nurses like to live in the communities where they work.” Despite the low numbers, Burns said the state still sees traffic from travelers on a fairly consistent basis. Wyoming jumped significantly in the rankings for most applications submitted from travelers by state for February, moving from the 45th most popular state to the 37th, according to StaffDNA data. “I don’t know if there will be an increase in opportunity for travel nurses, but it will certainly decrease the time it takes for travelers (with compact nursing licenses) to come here,” Burns said. “A lot of travelers come to our state, so there’s the benefit of that for us being a part of the eNLC.”
Travel Nurse Jobs: Where Nurses Applied In February
Digging into the application numbers from travel nurse jobs posted to the StaffDNA job board in February, we saw things that we expected to see as well as a couple of surprises. First, let’s look at what was expected. The overall number of applications was down by roughly 30 percent over January. However, most travel nurses start looking for new placements in January, so the volume to start the year is always high. Look for another spike in March when nurses will be coming off of their first-of-the-year contracts. Now, for a few of the surprises from the February list: Movement inside the Top 10 The top states on the list remained mostly unchanged. Florida, California, Texas, Tennessee, and North Carolina remained the top five states for travel nurse applications. In fact, the only new entry into the Top 10 was Illinois, jumping up four spots to No. 8 for February. That means one state had to bounce out of the Top 10, and this month that was Michigan, falling all the way to 17. The eNLC Effect Two of the new eNLC states – Wyoming and West Virginia – made significant jumps in February. West Virginia moved all the way up to the 13th most-applied-to state for February. In January, West Virginia was solidly in the middle of our list at No. 24. Wyoming moved up eight places, from 45 to 37. Top 3 Movers While the top spots on our list are often some order of the same 10 states, there is often significant movement a bit lower. Here are the three locations that made big jumps in February. Not coincidentally, all three of these locations should be beautiful once the weather starts warming up for spring. Maine bounced up nine spots to land at No. 30 on the list for February. Vermont also jumped nine spots, moving from nearly the bottom of our list in January, all the way up to 39 in February. Not a state, but Washington D.C climbed 10 spots to No. 36. February’s Top Markets This list is created by analyzing the number of travel nurses applying for jobs in these individual states and Washington D.C. Is not necessarily an indicator of traveler interest in these states and is not necessarily and indicator of job volume. Application data comes from the StaffDNA jobs database. Florida California Texas Tennessee North Carolina Georgia South Carolina Illinois Virginia New York Alabama Ohio West Virginia Arizona Indiana Nevada Michigan New Jersey Pennsylvania Louisiana Missouri Oklahoma Oregon Arkansas Colorado Iowa Kentucky Washington Maryland Maine Minnesota Mississippi Wisconsin Hawaii Massachusetts Washington D.C. Wyoming South Dakota Vermont Connecticut Idaho Utah Montana Nebraska New Hampshire New Mexico Alaska North Dakota Kansas Delaware Rhode Island Looking for your next adventure? Explore opportunities at the StaffDNA Jobs Board.
Oklahoma, West Virginia, Florida Adapt To Compact Nursing License Demand
More than a month has passed since five new states–Florida, Oklahoma, Wyoming, West Virginia and Georgia–joined the Enhanced Nursing Licensure Compact, which allowed these states to issue compact nursing licenses to new and practicing nurses. Nursing and licensure boards in these states are working to meet the demand for compact nursing licenses by adapting their procedures to process federal background checks, with varying levels of success. Today, we look at the process in three of the new states. We’ll have updates from Wyoming and Georgia next week. Oklahoma: Preparation, early applications make process smooth The Oklahoma Board of Nursing has received 859 applications from existing license holders and 76 for endorsement, said Jackye Ward, Deputy Director of Regulatory Services for the Oklahoma Board of Nursing. Oklahoma has 56,490 registered nurses and 18,381 licensed practical nurses, according to their FY 2017 Annual Report. The board squeezed processing time down to an average of 1.78 days, thanks to a combination of a well-prepared staff and early application acceptance date, Ward said. The board worked with state staff to accept compact nursing license applications as early as Jan. 5. Applicants “are getting fingerprints in for background checks so quickly,” Ward said. “It’s going really well. We’ve worked very closely with applicants and provided calls and callbacks to keep people updated on the process.” West Virginia: Interest strongest with nurses near state borders West Virginia’s Board of Examiners for Registered Professional Nurses is seeing similar demand, with about 1,500 out of 34,000 RNs applying for compact nursing licenses, executive director Sue Painter said. Most of the applicants live near the border and are looking for work opportunities in nearby compact states like Kentucky and Virginia, Painter said, which is precisely why the board pushed for the state to join the eNLC. “I was a nurse in another state and held a multistate license for a short period of time, and when I returned I went from being able to work in 25 states down to two,” Painter said. “The board has been in support of joining the eNLC for some time.” Application turnaround time has also been fairly rapid, Painter said, mostly because of the board’s ability to accept background checks electronically, which was implemented by a stringent approval process prior to the eNLC launch. This helped cut down a potential 18 week waiting period for returned background checks to five days. Misinformation has been the biggest speed bump in this process, as some staffing agencies have demanded for their nurses to still apply for single state licensure to work in West Virginia, but this has only happened for a handful of cases, Painter said. Florida: Criminal background check slowing licensing process Florida, the largest new state to join the eNLC–in terms of both active nurses and number of compact nursing license applications–is still struggling to meet the demand. As of Feb. 19, the Florida Board of Nursing has received 9,064 applications from current RNs and LPNs to upgrade to the compact nursing license, Florida Department of Health deputy press secretary Brad Dalton said. More than 5,000 applications were received in the first eight days after eNLC implementation. Of that number, 1,253 new compact nursing licenses have been issued, Dalton said. “The primary deficiency with the pending applications is the Livescan (fingerprint) criminal background check,” Dalton said. “Some applicants are also having to provide additional documentation for claiming Florida as their primary state of residence.” To address filing and processing issues, the board has revised information in their applications and on their website to hopefully help applicants better understand the background screening requirements, Dalton said. eNLC critical to addressing nursing shortage, patient care Despite the challenges, the boards a in new eNLC states are happy to be able to provide these new licenses for their state’s active nurses. “Florida, along with many states in the U.S., is committed to addressing nursing shortages,” State Surgeon General and Secretary Dr. Celeste Philip said in a press release. “By joining the enhanced Nurse Licensure Compact we are reducing regulatory burdens on nurses with the goal of increasing patient access to quality nursing care.” eNLC implementation probably won’t have a major effect on travel nursing in West Virginia, since most travelers would’ve already had their single state license, but the joining the compact will help reduce costs and time waiting for the old license, Painter said. “One of the most beneficial things is that the law (eNLC) makes the practice across state lines safer because we are allowed to share discipline information,” Painter said. “It’s easier to protect the public and provide the best professional care.”
Here’s Why Establishing A Tax Home Is Important For Travelers
Thanks to President Donald Trump’s approval in December of the most extensive changes to U.S. tax law in the past 30 years and the recent start of income tax filing season, millions of U.S. citizens have taxes on the brain, travel nurses included. The new tax changes won’t affect the filing process for 2017 taxes. They do eliminate employment expense deductions starting this year, but they won’t affect the tax-free stipends available to travelers, as long as they’ve established a tax home. But what is a tax home? For a busy professional who regularly has to travel for business, qualifying for tax-free stipends is a simple process, but for travelers, it’s a bit more complex. Definition and benefits of a tax home The IRS Tax Code defines a tax home as the geographical area where workers earn most of their income, which may not be the same place as their permanent residence–the place where they own a home, where their family lives or where they’ve been issued a driver’s license. As an example, say an employee works for a company in Michigan eight months out of the year, but that person owns a home in Wyoming to stay close to relatives. The employee’s company asks him to travel back to Wyoming for a business-related reason, so he decides to stay at home because it’s easier than booking a hotel for a weekend. Even though this person traveled to their personal residence, the employee’s travel expenses are still technically deductible because he is leaving his tax home on business. Having a tax home means big savings in terms of a travel nurse’s ability to accept tax-free stipends, or per diems, which can add up to anywhere from $20,000-$50,000 in tax-free benefits. “This can result in $6,000-$9000 per year in tax savings,” said Joseph Smith, a travel nurse tax expert and owner of TravelTax.com. “But then you have to remember to subtract your living expenses from that (savings figure),” Smith said. “If you’re paying 600 a month for an apartment, which is then $7,200 a year, that’s a significant amount from savings. That’s why you don’t see travelers living in places like San Francisco unless they have a tax home due to a regular job in the area.” Some travel nurse staffing agencies also won’t give contracts to nurses who don’t have a tax home in order to avoid being penalized during an IRS audit because of a travel nurse who accepted tax-free stipends without a tax home. Criteria to qualify for a tax home If this geographical definition was the only one used to determine who has a tax home, travelers would never qualify since the job requires frequent relocation, meaning there’s not one place where they earn a majority of their income. Thanks to clarifications of the code in IRS Publication 463, three factors are used to determine tax home status. At least two of these three criteria must be satisfied in order to qualify for a tax home. If only one factor is met, that person is considered an itinerant worker, meaning their tax home is their permanent residence and they don’t qualify for tax-free stipends or reimbursements. You perform part of your business in the area of your main home and use that home for lodging while doing business in the area. You have living expenses at your main home that you duplicate because your business requires you to be away from that home. You have a member or members of your family living at your main home or you often use that home for lodging. Since most travelers don’t work at home, they often try to meet the second and third criteria to establish a tax home. The third criteria is easy enough to meet by returning regularly to a home or apartment owned or rented, but their tax home status could be disrupted by not matching duplicate expenses. Duplicate expenses While it’s not stated in bold print, duplicate living expenses need to be significant enough to meet the second criteria. For example, say a traveler rents an apartment for $800 per month in their home state of Arizona, and leaves for a five month job in Colorado. They have a friend in Colorado who owns a home and will let them stay in a spare room for $50 a month while they’re working. Even though the traveler is paying the friend to stay there, that incredibly low “rent” charged by their friend won’t qualify as duplicated expenses. That traveler would need to at least pay fair market value for rental of the space, which differs based on location but can be determined by comparing local rental listings for similar properties. Temporary worker status It is possible for travelers to avoid paying duplicate expenses and still qualify for a tax home by meeting the first criteria and planning to work some in their home state, but they must make sure they are a significant distance away from their permanent residence or risk losing their temporary worker status. A temporary worker is someone who fulfills job appointments lasting 12 months or less, according to the U.S. Department of Labor Statistics. If a traveler works for more than a year in a single geographic area, it’s considered an indefinite job appointment. That means their previous tax home is moved to their current job because it’s their new primary location of income, and they are classified as an “itinerant” worker. This rule applies even with short-term contracts. If a traveler plans to work in a location for eight months, then accepts another five month contract in the same area but at a different hospital, the job assignment would still be considered indefinite rather than temporary since they planned to stay for 13 months total in the same geographic region. Unfortunately, there isn’t a specific distance a traveler needs to be away from their previous placement to be considered safe, and the “50-mile” rule travelers might hear about is not
EMR Conversions: Ongoing Jobs Near Knoxville, Tennessee
The Covenant Health System, with hospitals located primarily in and around the Knoxville, Tennessee area, is completing an EMR conversion over the first three quarters of 2018, and it needs travel nurses to help with the transition. The system is switching from McKesson EMR to Cerner EMR and will need help with at least four specialties: Med/Surg, Telemetry, ICU, and ER. There is a potential for other needs. Covenant System hiring officials say they’re looking for candidates with recent McKesson experience. While Cerner experience would be nice, it’s not a requirement. Covenant will provide training on the Cerner system for nurses that it chooses to extend. Candidates should also be open to the idea of floating between other facilities within 50 miles of their home hospital while on assignment. Floating will not occur mid-shift, and nurses will be given notice of the need to float at least two hours prior to the start of a shift. Two and three hospitals will be converting each quarter, starting with Methodist Medical Center, Roane Medical Center, and Rhea Medical Center in the first quarter. Methodist Medical Center in Oak Ridge, Tennessee is a 301-bed facility 25 miles east of Knoxville. Roane Medical Center is in Harriman, Tennessee, 42 miles west of Knoxville. It’s a 52 bed short-term acute care facility. Rhea Medical Center is a 25 bed critical access facility located in Dayton, Tennessee, 80 miles southwest of Knoxville. Hospitals included in the second phase of the conversion, happening in the second quarter of the year, are Parkwest Medical Center, Fort Loudon Medical Center, and Cumberland Medical Center. Parkwest Medical Center is a 400-bed facility in southwest Knoxville. Fort Loudon Medical Center is 30 miles south and west of Knoxville in Lenoir City, Tennessee. It’s a 30-bed, short-term acute care facility. Cumberland Medical Center has 73 beds and is located 70 miles west of Knoxville in Crossville, Tennessee. Two hospitals will convert in the third phase, occurring in the third quarter of 2018: Fort Sanders Medical Center and LeConte Medical Center. Fort Sanders Medical Center is a 352-bed hospital located in Knoxville near the University of Tennessee campus. LeConte Medical Center is in Sevierville, Tennessee, 30 miles southeast of Knoxville. It’s a 111-bed facility. Two hospitals in the system haven’t been assigned a phase–Claiborne County Hospital and Morristown-Hamblen Hospital. Claiborne County Hospital is in Tazewell, Tennessee, 50 miles north of Knoxville. It has 129 beds. Morristown-Hamblen Hospital is a 128-bed facility located 50 miles northeast of Knoxville in Morristown, Tennessee.
Travel Nurse Market: Texas Jobs are Returning
If you’re looking for a travel nurse market that seems to be emerging quickly from the hiring slowdown that affected most of 2017, consider Texas. Like hospitals in many other states, facilities in Texas slowed their hiring in the spring of 2017 thanks to uncertainty around the future of the Affordable Care Act. Combine that with an abundance of applicants for fewer positions, and suddenly the Texas market was glutted with nurses but few jobs. Eventually, with the lack of jobs that glut of nurses eased. Now, recruiters say, with the ACA uncertainty behind us and hospitals hiring again, there are opportunities in Texas and fewer nurses applying for them. So for someone looking to get hired quickly, Texas is a location to consider. Positions available across the state These jobs aren’t relegated to just one region of the state. The flu is forcing some hospitals in Amarillo to pay crisis rates to get travelers into positions there. But hospitals in the eastern part of the state, in areas like Longview, are hiring. So are hospitals in central Texas near Austin and down near the coast and Houston. Hospitals are also looking for a broad range of specialties. Why Travel to Texas For the traveler motivated by adventure, Texas is unique. It’s a bit of everything in one state. It has a good mix of both rural and urban settings, often within easy driving distance of each other. So for the traveler who wants to explore the outdoors, with the Piney Woods in the East, Big Bend National Park in the West, and the Gulf Coast in the south, there’s no lack of adventure. But, with four major metropolitan areas, it can also provide the bright lights and cosmopolitan feel if that’s more of your style. And for the financially motivated, Texas has a cost of living that is regularly ranked in or near the top 10. That means those expenses not covered by stipends are going to cost you less.
Heavy Flu Season Prompts More Opportunities For Flexible Travelers
States are offering free vaccines, along with school districts, all in an effort to combat a flu season that statistically is proving to be one of the worst in recent years. Chances are that anyone working in a hospital doesn’t need statistics to tell them that this flu season is worse than most. Still, the numbers are sobering. In 49 states and Puerto Rico, the flu outbreak is considered widespread. Only Hawaii and the District of Columbia haven’t been given that designation yet. This is the first time that all 48 contiguous states have reported widespread flu in the same week. Nationally, 37 pediatric deaths so far are being attributed to the flu. The number of flu-related deaths in Texas has topped 2,300. It’s even taken the life of a 42-year-old nurse in West Virginia. 6.6 percent of everyone seeking medical care are presenting with flu symptoms, according to data from the Center for Disease Control. During an average flu season, that number is closer to two. It’s gotten so bad that six school districts in Oklahoma closed because so many staff and students were out. Flu season creating an opportunity for the flexible While hospitals in some regions are adding staff to deal with facilities that are over capacity, recruiters say they aren’t seeing a widespread increase in staffing travelers to help augment the permanent staff. “The chatter I’m hearing is that the hospitals are super swamped due to the flu and need help, but the managers are not getting permission to open positions for us to fill,” said Richard Dunn, a recruiter with Liquid Agents Healthcare. “So most of my people are saying the units are super busy, and understaffed.” For the traveler, that means that there may be more opportunity as long as you remain flexible about location and are open to places like Texas, Illinois, California, Arizona, or Georgia. Get your flu shot. This year, it’s required. Experts at the CDC are expecting the flu season to peak in the next few weeks, so these conditions should soon subside. Until it does, some hospitals and staffing agencies are doing what they can to support staff that they know are stretched thin. Travelers have taken to social media to share stories of gifts when they succumb to the illness themselves and meals for those staff that is working with a higher-than-normal number of ill patients. The CDC also reminds that with weeks of flu activity still to go, it’s not too late to get the vaccine if you haven’t already. Recruiters say that’s good advice for a different reason–this year, you need it to get a job. Many hospitals that had, in years past, made a flu vaccination optional are now calling it a requirement for employment.
2018 Travel Nurse Job Market Starts Strong
The uncertainty around a repeal of the Affordable Care Act slowed the travel nurse job market for much of 2017, according to recruiters we talked to about the outlook for the first quarter of 2018. But, the recruiters said, the market seemed to loosen up almost immediately once the new tax bill was passed in December. That tax bill included a repeal of the controversial ACA insurance mandate. While there is still uncertainty around the ACA, that late-year pick up in hiring doesn’t seem to be slowing, according to recruiters, and the market is still growing. Hospitals are buying again. While that is great news for traveling healthcare professionals, the recruiters did offer some insights for travelers to keep in mind while mulling placements for 2018. The job market will continue to get younger. More and more young travel nurses will continue to enter the job market, chasing the storied dollars they’ve heard about, making the job market much more crowded for everyone else. Recruiters said that these young travel nurses should remember that it will help them hit the ground running if they have a variety of experience. Don’t get blinded by the promise of dollars. While there is good money to be made, if you are a young nurse with only a few years of work behind you, it may be difficult to get a job when you are in a pool of other candidates who have many more years of experience. You have two options. You can take another permanent job and build your resume by learning new skills and exploring other specialties. Or, you can work with your recruiter and find travel jobs that will do the same thing. There are hospitals that will hire less experienced nurses, but you may have to sacrifice location or pay to get those positions. The job market will favor the flexible. Not only is the travel nurse job market crowded, it’s a crowded buyer’s market. The advantage, at least for now, belongs to the hospital. That means the nurses who want to work are going to need to be flexible, according to the recruiters with whom we spoke. Only chasing dollars won’t get you hired, they say, especially as a young travel nurse. If the trifecta is pay, location, and shift, don’t hold out waiting for a contract with all three–good pay, good location, and preferred shift–to suddenly appear. You won’t likely get it. Instead, determine which of those you can be flexible on. It’s going to make it easier for your recruiter to find you that next contract. There is one combo that is going to be difficult to find, the recruiters said. If you want good pay and good location you won’t get that. The bad locations are paying more; the good locations are paying less. The recruiter and travel nurse relationship will be more critical than ever. Recruiters also told us that they’ve seen the number of applicants for jobs going up two- and three-fold over the last year to six months. This requires recruiters to move fast, and, the recruiters said, it highlights the need for a close relationship between nurses and their recruiters. For Scott Dromgoole, a recruiter with Liquid Agents Healthcare, that starts with communication and setting expectations early. “Tell me what you want,” he said. “Tell me what you need when you need it. That way I can make you happy.” Dromgoole said that type of communication is even more important now that the market is crowded. When he knows what his nurses are looking for and what will make them happy, he can submit them to jobs he knows they will like before they fill up without it requiring a long discussion. That increases their likelihood of landing a contract.
The eNLC: How To Get A New Compact Nursing License
The National Council of State Boards of Nursing implemented the enhanced Nursing Licensure Compact on January 19 this year. On that day, five new states joined the compact. For those who already had compact nursing licenses that means you now have five more states where you can practice without having to get an in-state license: Florida, Georgia, Oklahoma, West Virginia, and Wyoming. For nurses with single state licenses in those five states, compact nursing licenses are now available. In almost every state, acquiring one starts with the same two things. The nurse must meet the new uniform licensure requirements (including completing a criminal background check) and have a proof of residency. Florida Florida is charging nurses with current active licenses $100 to convert to a multi-state license, a fee that seems to be middle of the road. The board will accept fingerprints done within the last 90 days when applying for a license upgrade. Fingerprints older than that will have to be redone. Florida nurses ready to apply can do so online through the state board’s website. The state board has also created a list of frequently asked questions for Florida nurses who want to know more. Georgia In addition to requiring proof of residency, Georgia requires applicants for a multi-state license to be fingerprinted for a background check through the COGENT Systems at least 48 hours before applying. The state board also reminds applicants that they can not leave fields on the application blank, that they need to download and complete the GBON Criminal Background Check Release Form to submit with their application, that they should enroll in e-Notify at nursys.com, and to include an accurate email address so that they can communicate with the board about their application. More information is available on the Georgia Board of Nursing website. Oklahoma Oklahoma is charging nurses with an existing license a $150 fee to transition to a new multi-state license. You can download the forms needed to verify Oklahoma as your state of residence from the state board website. You can also apply for a multi-state license online. West Virginia West Virginia has been accepting applications for a multi-state license since November. The process for West Virginia nurses is four steps and explained in more detail in a flow chart on the state nursing board’s website. West Virginia has by far the lowest fee for transitioning a license, approximately just $7, assuming the nurse has already paid for a license renewal for this year. After the fee has been paid, nurses should save their receipt. It indicates their application is pending board approval. Nurses interested in applying for a multi-state license must schedule an appointment to submit fingerprints for a state and federal background check with identtogo.com. An application for a multi-state license can be completed on the state board website. Since West Virginia has two separate nursing boards for registered and licensed practical nurses, LPNs need to visit a different website. Wyoming Wyoming nurses will need to pay $85 in fees to transition their license to a multi-state. Like the other states, an application is available on the state board website.