The Federal Trade Commission (FTC) recently issued a Second Request for information in its review of Aya Healthcare’s proposed acquisition of Cross Country Healthcare. While the deal remains on track to close in December, this additional scrutiny highlights broader concerns about competition in healthcare staffing—particularly in the Managed Services Provider (MSP) space.
Why the Delay?
Although Aya and Cross Country’s combined market share is estimated below 20%, the FTC’s attention appears less focused on overall size and more on market structure. Specifically, regulators are scrutinizing the degree of concentration in the MSP vertical.
- The top 10 healthcare staffing firms control over 53% of the market.
- At least five of these firms also operate an MSP, giving them dual control over both supply and the technology platforms that distribute demand.
- This creates a classic conflict of interest: MSPs that should serve hospitals neutrally are often owned by the very agencies competing for placements.
Lessons from History
The FTC’s caution isn’t without precedent. In 1973, the OPEC oil embargo exposed U.S. vulnerability from reliance on third parties for a vital resource. Congress responded with the Energy Policy and Conservation Act (EPCA) of 1975, which established the Strategic Petroleum Reserve. This was a proactive safeguard—ensuring the U.S. had its own buffer against future disruptions.
Hospitals may want to view the current MSP debate in a similar light. Full dependence on agency-owned MSPs exposes health systems to conflicts of interest and hidden costs. Building internal or vendor-neutral models can provide the same kind of long-term protection OPEC’s embargo forced the U.S. to adopt. Hospitals and health systems should also explore becoming their own MSP using a VMS like BlueSky Staffing Software to manage their contingent workforce.
Outlook for the Deal
Despite the FTC’s Second Request and the debate it has stirred, the likelihood of the Aya–Cross Country merger moving forward remains high. Both companies have complied fully with information requirements, and recent regulatory trends suggest that approval is more a matter of timing than outcome.
Key Takeaway for Hospitals
The FTC’s focus on MSP consolidation underscores a critical point: hospitals cannot afford to outsource total control of their contingent workforce to agency-owned platforms. Just as the U.S. built reserves to safeguard energy, health systems should invest in technology and models that secure independent access to their workforce supply.
