Medical Expert Panels Instill Occupational Health Excellence

M. L. Hopkins12/19/2023

In 2024, Concentra enters its 45th year dedicated to achieving a high standard of occupational health care that manifests in consistent, excellent outcomes, reduced costs through shorter case durations, and strengthened relationships among clinicians, employers, and payors.

One way Concentra supports this goal is the company’s innovative approach to developing and maintaining consistent, up-to-date resources that inform and guide Concentra’s clinicians in more than 540 medical centers, 160 onsite centers, and telemedicine visits in 43 states and the District of Columbia.

Concentra’s unique approach has many players

In 2011, then-Senior Vice President of Medical Operations Bill Lewis, MD, led the creation of Concentra’s Medical Expert Panels (MEPs), which are composed of medical doctors, advanced practice clinicians, and other subject matter experts.

Most serve on the MEPs as an adjunct to their Concentra clinical practice and contribute time beyond normal business hours to developing and regularly updating Concentra’s evidence-based knowledge library encompassing detailed clinical ‘best practice’ guidance, protocols, topic reviews, and policies. New and updated knowledge content is posted online internally and shared with all Concentra clinicians.

The documents, processes, and protocols developed by the MEPs are rigorously reviewed, first by the chair of the Clinical Content Committee (CCC) and then by the full committee. Scrupulous attention to detail, discussions, edits, and revisions take place before the knowledge content is finalized.

The MEPs are supported in all their work by administrative assistant Gloria Zambelli, who schedules and documents MEP meetings and facilitates the dissemination of all new and updated content to guide Concentra’s clinicians.

The MEP dynamic in providing quality care

Up-to-date clinical resources are used daily by Concentra’s occupational health clinicians to supplement their extensive training and support them in providing high-quality care while efficiently managing workers’ compensation cases and return-to-work processes.

Members of the MEPs are “at the top of the game” in occupational health care and stay well-informed of Occupational Safety and Health Administration (OSHA) requirements, regulatory testing and examinations, Department of Transportation (DOT) examinations and certifications, injury care, medical surveillance, rehabilitation, and more.

Communication of knowledge content to clinicians occurs through Concentra’s customized training, which includes a new hire learning plan and a robust catalog of online courses for ongoing guidance. New and updated knowledge is also communicated through daily clinical email messaging, a monthly clinical bulletin, monthly clinical leadership meetings, and online “Zoomside Chat” presentations conducted in the evenings.

Meet Concentra’s seven Medical Expert Panels

Employers and payors can appreciate the comprehensive scope of Concentra’s MEPs through an introduction to the panels and a brief glimpse of some of their recent accomplishments and goals for 2024.

The seven MEPs are:

  • Injury Care
  • Concentra Advanced Specialists
  • Travel Health & Infectious Diseases
  • Therapy
  • Regulatory Testing & Exams
  • Transportation
  • Pharmacy and Therapeutics

Injury Care

Longtime chair: Dr. Maja Jurisic (retired December 2023)
New chair: Dr. Richard Amegadzie (as of December 2023)

Members:
Dr. Lisa Figueroa, Dr. Cindy Ross, Dr. Phillip Calender. At-Large: Antonia McGarrah, ANP, COHN, Shelby Mendez, PT

Concentra’s Injury Care MEP develops guidance, protocols, and policy documents pertaining to the care of injured workers, with the goal of ensuring consistency and effectiveness of all Concentra clinical practices nationwide. This includes injury care, managing stay-at-work and return-to-work processes, and assisting employees in renormalizing their lives after the disruption of a work injury.

Among the recent work of the Injury Care MEP was the development of new clinical guidance on handling work-related mental health complaints that present as “injury care” needs. Mental health complaints are increasing in occupational health care. That points to the need, identified by the MEP, to sharpen the clinician’s skills in determining causation and compensability and how to provide the most efficient and effective handling of these cases. This is the type of guidance the Injury Care Medical Expert Panel provides.

In another recent project, the Injury Care MEP reviewed and updated clinical guidance on OSHA recordability and, of keen interest to employers and payors, best practice guidelines when, despite a rational treatment plan, the worker is not improving. “Our reputation is often based on how well we handle the difficult cases where patients are not recovering as anticipated,” says Dr. Maja Jurisic, who authored clinical guidance with Dr. Jeff Wainstein that supports Concentra clinicians in achieving worker recovery in difficult cases.

Concentra Advanced Specialists

Chair:
Dr. Thomas Moyad

Members:
Dr. Walter Lee, Dr. Barry Leshman. At-Large: Dr. Latha Brubaker, Dr. Arnoldo Bichara Tobar, Dr. Jhibu Thomas

The Concentra Advanced Specialist (CAS) MEP provides day-to-day operational support and oversight of specialists who work alongside Concentra occupational health clinicians.

The CAS MEP provides guidance that is inherently beneficial to employers and payors by achieving continuity of care when it is necessary for a clinician to make a referral to a specialist. The CAS MEP outlines the communication between clinician and specialist that must take place, not just when the referral is made, but throughout care. Effective, ongoing communication helps ensure that the case moves forward efficiently, only necessary care is provided, and costs and case duration are thoughtfully considered.

The CAS MEP has also communicated guidance that helps keep specialists aligned with Concentra’s primary care clinicians in the knowledge of strategies to expedite an injured employee’s functional recovery and return to work.

Several recent achievements by the CAS MEP include the creation of an enhanced specialist training program in the Learning Management System (LMS) and updated clinical guidance for specialists on return to work and temporary disability.

Travel Health & Infectious Disease

Chair:
Dr. Michael Holzer

Members:
Dr. Michele Fletcher, Dr. Rob Jones. At-Large: Dr. Andrea Andrews, Dr. Eric Gustafson, Dr. Jeff Kirkpatrick, Dr. Emory Warren, Melissa Hay

The Concentra Travel Health & Infectious Disease (TH&IP) MEP serves as an information resource for Concentra clinicians and stakeholders on travel health, infectious disease, immigration exams, and related policies and protocols. In 2020, this MEP led Concentra’s Coronavirus Task Force, which was responsible for creating infection control, testing, and return-to-work policies and guidelines to safeguard health and safety during the pandemic. The TH&ID MEP has consulted with employers and created protocols to meet their needs related to various infectious diseases, including herpes B virus, toxoplasmosis, and Q fever.

Additionally, the TH&ID panel updated Concentra’s bloodborne pathogen protocol to reflect the most recent expert opinions and CDC guidance. Concentra annually treats an estimated 20,000 cases of bloodborne pathogen exposure.

In 2024, the TH&ID MEP plans to update training for Concentra’s travel health specialists.

Therapy

Chair:Shelby Mendez, PT, DPT

Members:
Matthew Klinker, PT, DPT, Jennifer Klose, PT, DPT, Courtney Shinost, PT, DPT

Therapy, an integral part of Concentra’s full spectrum of care, creates a pathway for recovery that includes educating, engaging, and helping the injured employee overcome any fear or apprehension they may have about their injury. Concentra’s evidence-based early intervention of care and its unique, function-based approach to treatment support efforts to achieve better outcomes and shorter case durations.

Recent achievements by Concentra’s Therapy MEP include comprehensive guidance on the assessment and treatment of concussions. The guidance document includes appropriate work modifications that address job functions, physical and cognitive demands, and the nature of the work environment, as well as needed communication to stakeholders.

Concentra’s Therapy MEP has also published clinical guidance to standardize the application of blood flow restriction, a practice used by therapists to promote enhanced muscle-building and repair of injured tissue while reducing overall stress on an injured/recovering limb.

Concentra’s MEPs not only help keep Concentra on the leading edge of clinical practice, but members may also conduct and publish research to help advance the occupational health industry. In 2023, Therapy MEP members Jennifer Klose, Michael Morgan, and Courtney Shinost, and Therapy MEP Chair Shelby Mendez published a literature review on “Early intervention management of mild traumatic brain injury.”

Priorities in 2024 include research on the impact of early physical therapy intervention in acute work-related musculoskeletal injuries, as well as focused measurement of outcomes in occupational medicine.

Regulatory, Testing & Exams

Chair:
Dr. Ronda McCarthy
Vice Chair:
Jordan Graustark, PA-C

Members:
Stephen Mayer, PA-C, Dr. Jessica Perse, Dr. Deepa Rajakrishnan, Dr. Jay Sayani. At-Large: Melissa Hay, Kelly Olson

Concentra’s Regulatory Testing & Examinations (RT&E) MEP brings together experts in regulated medical evaluations, medical testing, and evaluations in developing guidelines and interpretations of federal standards and laws governing safety-sensitive occupations. Their work includes addressing standards on respiratory protection, silica, noise, asbestos, lead, heat, and other exposures. The RT&E MEP also provides vital guidance and consultation for clinical practice involving firefighters, law enforcement, commercial drivers, and multiple industries where hazardous exposures may be involved.

The RT&E MEP recently reviewed clinical guidance for occupational asthma, which it calls “the most prevalent lung disease related to work, yet often under-recognized in primary care and occupational clinic settings.” Work-related asthma includes both cases caused by specific agents in the workplace and cases of pre-existing asthma that worsens in the workplace environment.

Because occupational asthma is under-recognized while an estimated 17% of adult asthma is due to work exposures, the work of the RT&E MPE is invaluable in occupational health care and to Concentra’s customers. The RT&E MEP also dedicates itself to creating resources and presentations to communicate and raise awareness of occupational asthma.

In 2023, the RT&E MEP also reviewed clinical guidance for medical surveillance exams. Medical surveillance combines medical examinations and tests to help determine whether an employer’s administrative and engineering controls for hazardous exposure protection are effective. Concentra’s guidelines on medical surveillance ensure that these examinations and tests are standardized across all of Concentra’s more than 540 medical centers and compliant with Occupational Safety and Health Administration requirements.

Ensuring that employees who need respiratory protection are cleared to wear a respirator and that it fits properly is an ongoing high-profile need in industries with hazardous exposures. The RT&E MEP has prepared and continually updates numerous documents to assist Concentra clinicians in accurately and efficiently providing the needed medical clearance, fit tests, and spirometry tests to measure employees’ lung function. This includes clinical guidance documents, Frequently Asked Questions, training, and presentations.

Among the priorities for the RT&E MEP in 2024 are guidelines for high-altitude employees, medical evaluation of the gender-diverse employee, and interpretation of spirometry testing in the occupational setting.

Transportation

Chair:
Anne-Marie Puricelli, MD, JD

Members:
Dr. Denise Agatep, Dr. Sandra Fakult. At-Large: Dr. Scott Appleton, Melissa Hay, Joe Hittner, Emily Ward

Concentra’s Transportation MEP provides day-to-day consultations with Concentra’s more than 1,000 certified medical examiners in support of their role in effectively determining whether an interstate commercial vehicle driver meets the physical qualification standards set forth by the Federal Motor Carrier Safety Administration (FMCSA). Concentra’s medical examiners are certified and registered in the National Registry of Certified Medical Examiners (NRCME).

In 2023, Concentra’s Transportation MEP conducted several important activities, including:

  • Comprehensive revision of Concentra’s FMCSA NRCME training course, approved by the FMCSA NRCME, for new medical examiners, as well as 10-year recertification of existing medical examiners
  • Creation of multiple driver and carrier educational documents and videos covering new FMCSA regulations and FMCSA Medical Expert Panel and Medical Review Board recommendations
  • Update of state-specific resources covering intrastate regulations specific to commercial drivers and school bus drivers.

Among their priorities for 2024, Transportation MEP members will continue to develop educational materials for drivers and carriers and oversee processes to ensure that all eligible Concentra medical examiners achieve their 10-year recertification.

Pharmacy & Therapeutics

Chair:
Frank Juliano, PharmD

At-Large Members: 
Dr. Zaid Hanoudi, Dr. Vamsi Kanumuri, Dr. Barry Korn, Dr. Daniel Paloyan, Dr. Stanley Simon, Dr. Kevin Tomsic, Dr. Alexia Zgurzynski, Ashley Langdon, PharmD

The Pharmacy & Therapeutics (P&T) MEP maintains Concentra’s first-fill dispensing formulary for occupational medicine, composed of 100% generic, top-utilized medications in workers’ compensation. In recent years, this MEP has published multiple pharmacy-related clinical guidelines to improve patient care, including guidelines for Naloxone (used to reverse opioid overdose effects) and neuropathic medications such as Gabapentin and Pregabalin. It also published findings related to the use of topical anti-inflammatory medication.

The P&T MEP makes medication recommendations that are consistent with evidence-based guidelines, support individual patient needs, and maximize the use of nonopioid therapies.

In 2024, the P&T MEP plans to be involved in several initiatives to further enhance the prevention of drug-drug and drug-disease interactions.

Knowledge saves lives, as well as costs

Concentra’s dedication to consistent, excellent outcomes and reduced costs through shorter case durations is beneficial for all workers’ compensation stakeholders – and the commitment to maintaining clinical knowledge at the highest possible level also saves lives. On a regular basis, Concentra clinicians hear directly from the employees they treat how their medical acumen and recommendations had a life-saving impact.

Some examples are:

  • A Concentra physician in Texas made a finding during a routine Department of Transportation physical that led to an early-stage cancer diagnosis. Because of his finding, a rush to surgery saved the employee’s organ from a disease he was not aware was present.
  • A Concentra center therapy director in Pennsylvania acted on her observation at the check-out station of a woman with an unusually red leg. She discreetly talked with the woman and a Concentra physician ordered an emergency ultrasound that revealed a deep venous thrombosis. The patient had immediate surgery for a pulmonary embolus and returned to thank Concentra for saving her life.

These are just two examples of the attentive knowledge Concentra clinicians bring to their practice of occupational medicine – living Concentra’s mission of “improving the health of America’s workforce, one patient at a time.”

This knowledge and practice are fueled by the work of Concentra’s Medical Expert Panels and exemplary, innovative occupational health leaders.

Get the benefit of Concentra’s leading-edge clinical knowledge in occupational health care. Contact us today.