Written by Kelly M. Pyrek for Immediate Care Magazine
Think about occupational health of yesteryear and you may conjure images of routine health screenings and pre-employment drug testing. However, occupational medicine of today poses new clinical and economic challenges and represents a growing opportunity for urgent care physicians who want to explore a new medical specialty or add services to an existing center.
Protecting the health of American workers is an ongoing challenge. In 2006, the latest figures available from the U.S. Bureau of Labor Statistics (BLS), there were 1.2 million cases of illness or injury requiring days away from work in private industry. The average number of days spent away from work was seven.1 According to the BLS:
Occupational medicine physicians face a diverse slate of issues, including ergonomics, toxic exposures, indoor air quality, workplace violence, wellness, productivity and absence management.
Contributing to the growing complexities of occupational medicine is the movement of care from an industrial in-plant or inpatient setting to university and community hospital-based clinics, multi-specialty group clinics, occupational medicine clinics working in tangent with urgent care operations, as well as private and government consultants. In many of these settings, the emphasis is on preventive interventions as well as treatment.
Tapping into both trends is Concentra, a healthcare company that has been serving the occupational medicine field since 1979. Concentra helps employers reduce healthcare expenditures and advocate for patient health and safety. The company, which began offering urgent care services this year in 40 Concentra Medical Centers in eight states, will continue its national rollout of urgent care services and plans to offer some form of urgent care service in each of its 320-plus medical centers by the middle of 2008.
Concentra is helping employers improve employee health, productivity and job satisfaction, by introducing its TotalCare program. This new offering focuses on preventing illness and injury, promoting health and productivity, and lowering the total cost of healthcare. TotalCare offers employers a customizable menu of primary, preventive, occupational and environmental services focused on their employees’ health. The program includes health screening, education, targeted lifestyle interventions, clinical preventive care, fitness assessments, coaching and enhanced physical activity, and the promotion of environmental health and occupational safety measures.
“Concentra developed TotalCare in response to our employer clients who were asking for a comprehensive approach to employee healthcare,” says Amy Khan, MD, MPH, medical director for Concentra’s TotalCare and Wellness services. “We have a very real opportunity to shift the paradigm of how healthcare is communicated, delivered, monitored, and measured.”
Wellness is increasingly becoming part of the occupational medicine portfolio of services. According to a position statement from the American College of Occupational and Environmental Medicine (ACOEM), “The role of the occupational and environmental physician has expanded to enhancing the productivity of the worker with absence management and increased emphasis on the overall health and wellness of the worker — not just at the work site but also at home and in the community.” One of the most important roles the occupational physician will play is the champion of worker productivity and wellness, since optimal health helps reduce absenteeism, disability and employee turnover, and impacts healthcare costs. The ACOEM states, “The occupational physician is uniquely qualified by medical training, experience, and knowledge of the work environment and workforce to champion this cause in managing the health of populations as well individuals. The occupational physician can play the pivotal role as chief health officer for employers in an integrated approach to health and productivity management across the illness/ wellness continuum in managing the health assets and human capital. The health of the workforce is inextricably linked to the productivity of the workforce and the health of the bottom line for the American economy.
Occupational medicine physicians have an unparalleled opportunity to assume this leadership role in the healthcare system on behalf of patients, employers, providers, and the communities they serve. From the perspective of both the large employer and the small employer, occupational medicine can integrate the health delivery model with a focus on explaining the business case of health and productivity and helping employers adopt a culture of health as well as safety.”
That culture of health and safety is one being embraced by the city of Wilmington, N.C. Charles Bolick, business development manager of the occupational medicine program offered by NextCare Urgent Care, says that the municipality uses one of nine NextCare clinics in North Carolina as the facility its employees and their dependents go to when ill or injured.
“The clinic was designed to be a benefit for city of Wilmington employees who have Blue Cross coverage,” Bolick explains. “The city contracts with us to provide a registered nurse at the clinic 40 hours a week and a physician’s assistant (PA) there 20 hours a week, and they are able to see patients for all kinds of medical needs. We are in the process of getting our PA licensed to be able to dispense meds, so instead of writing prescriptions for patients we will dispense meds right out of the clinic; the city will pay us for those meds, and we will avoid the process of filing with insurance carriers so claims rates should go down.”
While many occupational medicine clinics see a number of “white-collar” injuries such as computer-related strains or repetitive stress injuries, given its built-in patient demographic the clinic used by city of Wilmington employees sees a disproportionate number of individuals in manual labor jobs such as members of the city’s maintenance and sanitation crews. “Last year last year at Wilmington we saw about 2,500 patients, and it’s everything from suturing lacerations to X-raying for broken bones,” Bolick says.
In addition to providing care for these urgent care-type injuries, NextCare’s occupational medicine program offers a broad array of medical services and treatments, on-site screening (including pre-placement and drug screening), and comprehensive case management, all with an eye toward overall wellness and a strong return-to-work mission.
Bolick adds that because of the strides employers are making toward embracing better occupational health services, he is witnessing fewer workers’ comp claims. “What I am seeing in the field is a trend toward safer work places, fewer injuries, and more companies with longer strings of consecutive days without work injuries,” Bolick reports. “Companies are investing a lot of money into ongoing training and development of light- or limited-duty programs and return to work programs, as a result of that they are putting a lot of emphasis on not getting injured to begin with. Companies are looking to prevent injuries and chronic illness and to help get their employees well; after all, an ounce of prevention is worth a pound of cure.”
As with urgent care and much of healthcare in general, there is a significant movement toward patient-centered care in occupational medicine. “Patient satisfaction is the key to our success,” says P. Mona Khanna, MD, MPH, a strategic advisor and spokesperson for Concentra’s TotalCare and Wellness services. “The big trend is toward patient-centered care, and we have always been concerned about how the patient feels he or she has been treated.”
Alan Ayers, Concentra’s assistant vice president of product development for urgent care, points to renewed emphasis on the “customer experience” in the retail industry, and the implications of this concept for healthcare. “We are definitely seeing our industry incorporating retail thinking into the healthcare environment. The ‘patient experience’ is everything the patient sees, hears and touches,” Ayers explains. “We are walking through the patient experience ourselves at all of our clinics, looking at all of the touch points from the patient’s perspective. From the front desk all the way to the back exam room, we want to ensure that our facility meets the expectations of our patients and helps facilitate good clinical outcomes. In the past, healthcare’s focus moved away from meeting patients’ needs to processing patients through a super-efficient system. As those systems were built and perfected over time, the patient was left out of the process. Now, healthcare realizes that patients have choices, and facilities must develop long-term relationships and cultivate customer loyalty. The move toward improved customer service is happening in almost every industry. There are lessons to be learned by healthcare from almost every service-oriented business. Healthcare must identify what customers’ expectations are and build an experience that meets those expectations.”
“Anything that helps take care of patients the way they should be is looked upon favorably," Khanna says. "For example, there are many health assessment tools in the marketplace but for this kind of tool to work there must be good follow-up. When you give an employee an assessment to determine preventive strategies, conduct screenings and take their vitals, if all you do is give that information to the patient and tell them to take it to their primary care physician, without follow-up on those tests results, there is a low success rate for interventions. So Concentra provides a service line that performs the health assessment and the data crunching, and follows up on that assessment. If a patient has hypertension, there is the comprehensive need to prescribe medication, conduct a follow-up, and counsel the patient about wellness strategies.”
An important component of meeting patients’ needs is staffing facilities — whether it’s urgent care or occupational medicine — with quality people. “Having the right staff, medical professionals with exceptional people skills, is so important,” Bolick says. “For example, a young woman we hired at the Wilmington clinic took it upon herself to get trained in facilitating a smoking cessation program. She promoted the program among city of Wilmington employees and enrolled as many as 50 people. Because of her taking this initiative, many people have broken a bad habit.”
Besides offering these kinds of cessation and wellness programs, occupational medicine clinics are able to provide critical healthcare trend data, according to Bolick. “Employers want to know what percentage of their worker population has a potential chronic medical condition, whether it’s diabetes or hypertension. Last year at the Wilmington clinic more than 350 employees participated in a health risk assessment, where we drew their blood, did a full lab and other tests. As a result, we now have information on 350 people; the city can’t get that data individually because the Health Insurance Portability and Accountability Act (HIPAA) protects it, but they can look at the trend of that data, draw conclusions, and determine what kind of health programs are needed.”
Sometimes, an occupational medicine clinic can go above and beyond the call of duty. NextCare came to the assistance of the town of Apex, N.C., when it experienced a major chemical explosion that made the national news. “One of our occupational medicine doctors in Wilmington gathered all of the material safety data sheets for all of the chemicals, and administered liver and kidney tests to workers,” Bolick says. “The tests were designed to determine that their levels were not toxic and to give workers peace of mind that they were OK. We just finished a one-year check on those folks and everything looks good. That’s a rewarding experience.”
Physicians who want to practice occupational medicine in the outpatient setting have a number of opportunities with providers such as NextCare and Concentra. “Concentra is looking for physicians who can provide solid clinical and preventive services in occupational medicine and urgent care settings.” Bolick notes, “Our medical director is constantly open to reading a CV from a physician and seeing if they would be a good fit with us. Our philosophy as occupational medicine providers is that we truly become an employer advocate. While we provide the very best medical care to the injured worker through the provider/patient relationship, we don’t lose sight of the company footing the bill — the employer. The company has a vested interest in their workers recovering, and achieving that in the most cost-effective fashion. It all starts with providing good care and sending the employee back to work.”
1 U.S. Bureau of Labor Statistics. Nonfatal Occupational Injuries and Illnesses Requiring Days Away From Work, 2006.
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