VISIONSVolume 21, Number 5

March/April 2011

The Periodical of the

National Association

o f O c c u p a t i o n a l

Health Professionals

“Management worksin the system; leadership works on the system.”—Stephen R. Covey

By Karen O’Hara

Todd Baker distills hisapproach to clinic man-

agement down to a few criti-cal, inter-related concepts:philosophy, entrepreneurship,economies of scale and com-munication.

Mr. Baker, executive direc-tor of ambulatory care serv-ices at Proctor Hospital,Peoria, Ill., is a proponent ofthe mixed-use model. Hebelieves occupational medi-cine complements immediatepersonal care, and vice versa.

Under his direction,Proctor First Care operates anetwork of five geographicallydispersed clinics offering pri-mary, urgent and episodic careand occupational medicineservices on a walk-in basisand by appointment.(Episodic care is defined ascare provided when apatient’s own doctor is notavailable or when a patientdoes not have a primaryprovider.)

While the patient mix

varies by location, about 8 percent of Proctor FirstCare’s business is true urgentcare and 30 percent is occu-pational medicine. Theremainder is primary orepisodic care, Mr. Baker saidduring a presentation atRYAN Associates’ recentseminar on Integrating UrgentCare and Occupational HealthServices.

“I submit to you that blend-ing urgent care and occupa-tional medicine is a philoso-phy that requires a certaintype of leadership,” Mr. Bakertold the assembly of occupa-tional health professionals atthe seminar.

The following is a “Baker’sdozen” of recommendationsfor the successful operation ofa blended clinic network:

Challenge 1:CompetingAgendas

In any community healthsystem, it is not unusual tofind an urgent care managerwith one agenda reporting toa hospital executive, an occu-pational health programdirector with another agendareporting to the same or a dif-ferent executive, and clinicsthat “go into the never-neverland where doctor’s offices

owned by hospitals seem to goall the time,” Mr. Baker said.In such cases, multiple enti-ties vie for resources withinthe same organization, poten-tially creating an “us-against-us” scenario.

Baker’s Solution: “Topmanagement should makeone person responsible for allthose businesses. When thatis the case, all of a sudden thepolitics start to crumble andwe can get to economies ofscale.”

Challenge 2:Provider Coverage

Physicians working inemergency departments oftenhave sporadic, unpredictable

continued on page 4

A Dozen Tips for Managing Blended Clinics…and Arguments in Favor of Pure Play

INSIDE

2 Industry Leaders Share Views

3 Member Mentions

10 TrendsettersTotal Worker Health

13 Outcomes Workforce Presenteeism

14 Regulatory Agenda

16 Legal Advisory

17 Recommended Resourcess

19 Calendar

20 Vendor Program

24 Job Bank

T. Warner Hudson III, M.D.T. Warner Hudson III, M.D., was

installed as the American College ofOccupational and EnvironmentalMedicine’s (ACOEM) president for2011-2012 during the college’s 96thannual membership meeting inWashington, D.C.

In his acceptance remarks, Heading inthe Right Direction: An ACOEM TravelGuide, Dr. Hudson compared his recenttrip to Antarctica with the journey ofoccupational and environmental medi-cine (OEM). Dr. Hudson explored thediversity of the specialty in terms ofpractice settings, expertise and deliv-ery (i.e., as public health officers,experts in emergency preparedness,MROs). Dr. Hudson also noted thatdespite this diversity, OEM physiciansare united in their roles as primary, sec-ondary and tertiary clinical prevention-ists as well as population preventionists.

Occupational physicians are nowmore than ever front-line clinicianswho care for the health of millions ofemployees, their dependents andretirees, he said.

He also noted that ACOEM andOEM face numerous challenges including:• the need for training and funding;• meeting market demands and pro-

viding the educational resources tofill jobs with physicians qualified inOEM;

• continuing to develop the best evidence-based practices and healthoutcomes in ways that change practitioner behavior;

• addressing the unpredictability and“re-jiggering” of health care reformby focusing on underlying causes;

• becoming even more involved in thepublic policy arena;

• continuing to help build a modelthat pays for prevention and goodhealth outcomes in addition to illness care;

• building stronger partnerships withfederal government health andsafety agencies;

• working together in the most coordi-nated and effective ways possibleover the next five to 10 years to rein-vent OEM physicians as populationhealth leaders and preventionists;

• remembering that what OEM physi-cians do is for those who work, andto further help to make work some-thing which fosters health, safetyand the environment.

Dr. Hudson is medical director of theOccupational Health Facility at theUniversity of California Los Angeles.He is on the medical staff at RonaldReagan Medical Center and is responsi-ble for occupational health for UCLACampus and Health System employeesat the Westwood and Santa Monicacampuses.

Other officers installed for one-yearare President-elect, Karl Auerbach,M.D., and Vice President Ronald R.Loeppke, M.D.. Members installed asdirectors for three-year terms (2011-2014) are Drs. Alan Engelberg, DeanGean, Amanda Trimpey and MarkTaylor, who fulfills a new position ofYoung Physician Director.

NIOSH and the Occupational Safetyand Health Administration (OSHA)observed their 40th anniversaries onApril 28. The following is excerptedfrom a longer message. Refer towww.cdc.gov/niosh/enews/enewsv8n12.htmlThe Second 40 Years: From the Desk of John Howard,M.D., Director, NationalInstitute of OccupationalSafety and Health

“After 40 years, one can take themeasure of an organization with somedegree of confidence in assessing howwell it has carried out its assigned andongoing mission: Has it been suffi-ciently flexible to meet inevitablesocial, economic and technologicalchanges? Has it provided the benefits tosociety that it was intended to provide?Is it well-positioned to meet ongoingchanges that the next 10, 20, or 40years will bring?

“We at NIOSH are proud of ourrecord, which spans many dramaticchanges in the nature of work in the

2

Executive EditorFrank H. Leone

Editor in ChiefKaren O’Hara

Graphic DesignErin Strother • Studio E Design

PrintingOjai Printing

VISIONS is published bi-monthly by the National Association of

Occupational Health Professionals,226 East Canon Perdido, Suite M

Santa Barbara, CA 93101(800) 666-7926 • Fax: (805) 512-9534

Email: info@naohp.com • www.naohp.com

NAOHP and RYAN Associates are divisions of Santa Barbara Health Care, Inc. © pending VISIONS may not be copied in whole or in

part without written permission from NAOHP.

Volume 21, Number 5March/April 2011

Industry Leaders Share Views on State of Occupational Medicine, Workplace Safety

continued on page 11

Coming in the spring editionof the NAOHP’s new publication, Product LineIntegration Quarterly:

Connecting the Dots to Sleep Medicine

Visit www.naohp for subscription information

3

Doug Benner, M.D., HonoredLongtime NAOHP member Douglas A.

Benner, M.D., received the AmericanCollege of Occupational and EnvironmentalMedicine’s most prestigious honor – theWilliam S. Knudsen Award – at the college’srecent annual meeting.

The award, established in 1938 by Mr.Knudsen, who was then president of GeneralMotors, recognizes an individual who hasmade an outstanding contribution to the fieldof occupational and environmental medicine.

Dr. Benner was recognized for exemplaryefforts as a member on various ACOEM com-mittees and for his leadership in the WesternOccupational Environmental MedicineAssociation (WOEMA). He is known for hisexpertise on such diverse topics as utilizationreview, medical provider networks, and thepermanent disability rating schedule, and forhis vast knowledge of OEM.

“As Coordinator of Occupational Health atKaiser Permanente Regional OccupationalHealth in Oakland, California, Dr. Bennerhas given freely of his time and expertise tothe state of California’s efforts on workers’compensation reform,” ACOEM PresidentNatalie Hartenbaum, M.D., said in presentingthe award.

Aegis Gets New President Pearson Talbert has been appointed president of Aegis Health Group,

Nashville, Tenn., a member of the NAOHP Vendor Program, Chairmanof the Board Roland Wussow announced. Mr. Talbert was serving asAegis’ chief development officer. He replaces Henry Ross, who steppeddown to pursue other interests. Mr. Ross will remain on the company’sboard of directors.

Aegis is a leading provider of revenue growth strategies for hospitals.“Aegis is uniquely positioned to help hospitals of all sizes, regardless of

affiliation, attract profitable market share and build physician loyalty,” Mr.Talbert said. “I look forward to continuing the legacy of leadership Aegishas forged in helping hospitals build revenue growth and market share.”

Mobile Application IntroducedHealthagen,® developer of a leading mobile consumer healthcare

application iTriage®, announced a partnership with Practice Velocity®, a member of the NAOHP Vendor Program. Practice Velocity specializes inmedical software solutions for the urgent care industry. The partnershipwill enable iTriage users to make appointments and pre-register for urgentcare visits through Practice Velocity’s ZipPass® function. Integrating thisfeature into the iTriage application allows patients to register and “get in line” for an urgent care visit using their mobile device, company officials said.

“Physician appointment setting and pre-registration are emerging trendsin the health care industry. iTriage is leading this trend by empoweringthe patient with convenient access through mobile devices,” said DavidStern, M.D., CEO of Practice Velocity. “Since iTriage has both the largestinternational database of health care providers and smart phone usersfinding health care through mobile technology, patients will be able toeasily and instantly book urgent care appointments.”

Occupational Health Program Directors Denia Lash of Blount Memorial Hospital, Maryville,Tenn., and Greg McQueary of Beloit Memorial Hospital, Beloit, Wis., confer over lunch atRYAN Associates’ recent conference in Nashville, where they spoke on onsite services.

schedules. When they transition tourgent care settings (as is often thecase), they may bring along the expec-tation of working without a stableschedule, not realizing the customer values a greater degree of provider consistency.

Baker’s Solution: “Create a fixedschedule for providers. It’s a matter ofnot putting the physicians into ablender, pouring them out into the icecube tray and whoever lands in the trayworks the shift that day. Instead, Dr. Xknows what days of the week he or shewill be working in the clinic.

“We are talking about the same docs,in the same box, in the same day, allworking a full shift. We have very fewone-day-a-week docs in those boxes.”

Challenge 3: Managingthe Mix

In a busy blended clinic, providersmust learn how to adjust to the varietyof patients who walk in the door on anygiven day. “That is going to be hard foryour physicians,” Mr. Baker said. “Theyare not necessarily going to be able toshift hats on the fly, because your salesand marketing team will be doing such

a great job filling up the waiting room.” In addition, a treating clinician may

wonder: What exactly is the differencebetween treating a woman who sprainedher ankle while mowing her lawn andtreating the same woman who sprainedher ankle while pushing a cart at work?Regardless of the source of the injury,the patient is always the customer, butas occupational health professionals arewell aware, there are numerous addi-tional clients when managing a workers’compensation case.

Baker’s Solution: “Allow yourphysicians to focus on the patient and

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The following are 13 trends in occu-pational health and urgent care citedby Roy Gerber, senior principal, RYANAssociates, at a recent conference onProfiting from Product Line Diversity:Integrating Urgent Care andOccupational Health Services:

Occupational HealthTrends1. Continuing movement toward

urgent care or mixed models driven by such factors as:• The changing nature of jobs, e.g.,

more temporary and part-timeworker without benefits

• Economic conditions• Declining work-related injury and

illness rates• Research that shows chronic

disease and obesity is responsiblefor 75 percent of health care cost increases

• Growing awareness of links between health risk assess-ment and targeted interventions

2. Product line expansion to incorporate a comprehensive slate of wellness offerings.

3. Product line expansion toward the expansion of onsite service capabilities.

4. Increasing utilization of nurse practitioners and physician assistants.

5. Sharing of health data:• Incentives under the HITECH Act are accelerating the

adoption of electronic health record systems, even bythose who do not qualify for incentives

• Tech savvy patients are demanding electronic access totheir data

6. Renewed emphasis on sales and marketing as a result ofcompetition and other factors including:

• Improved understanding of employerrelationships and downstream referralbenefits• Quality and performance expecta-tions being set by for-profit organiza-tions and franchises• Availability of training, coaching and mentoring for sales professionals7. Provision of episodic care for clientcompany employees and family members is convenient, reduces grouphealth expenditures and provideseconomies of scale.

Urgent Care Trends1. Continued robust growth in the

urgent care clinic market driven bysuch factors as:• nation’s primary care physician shortage• health care reform

• emergency department costs• a shift to high-deductible plans

2. Expansion into occupational health/workers’ compensa-tion to produce incremental revenue, be more competi-tive, and improve clinic value and community perceptions.

3. Chain drug stores/retail-based clinics. For example, CVSCaremark has about 550 Minute Clinics in 55 markets and plans to have 1,060 clinics in 100 markets within five years.

4. Incorporating specialty care to take advantage of availablespace and improve access for patients requiring referrals

5. Potential role as a key access points in Accountable CareOrganizations and the potential for contracts with hospitals that do not have an urgent care division.

6. Using technology to attract and serve patients, e.g.,telemedicine, smart phone applications, online registration and test results.

13 Trends Driving Changes in Practice Settings

VISIONS

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provide the best possible care. Givethem tools to help them work througheach patient’s specific concerns. Ratherthan say, ‘Write the patient’s limitationon this blank piece of paper,’ give thema template with restrictions so they cancheck, ‘Do this, don’t do that,’ whetherit is at work or at home. The templateprovides the foundation for excellentfollow-up care.”

Challenge 4:Centralization

Human resource managers and otheremployer representatives frequently saythey prefer a “one-stop shop.” With fiveclinics, they may be confused aboutwhich site to contact.

Baker’s Solution: “You need acouple of key people who are the pri-mary contacts for occupational medi-cine. We have a service line director foroccupational medicine and centralizedstaff dedicated to managing all employerrelationships, so the employer doesn’thave to figure out which clinic to call.They serve as our liaison with compa-nies, and they can offer employers a customized package of services inresponse to their specific circumstances.To appear seamless and reduce the number of follow-up calls that we needto make, we give the customer one num-ber to call.”

Challenge 5: Establishing Relationships

While employers appreciate a central-ized point of contact, they also want anestablished relationship with clinic staff.

“With five clinics, we have observedthat employers will evolve toward oneclinic and use it all the time,” Mr. Bakersaid. “We go out and talk aboutextended hours, 24/7 service for drugscreening, picking the location nearestyou, etc., and we will still have a busi-ness on the north side of town that usesa clinic 15 minutes away instead of theone that is a three-minute drive. Why?Because they like it and the relationshipthey have established there.”

Baker’s Solution: “We don’t carewhich clinic they use, as long as they areusing one of ours. Established clinic rela-tionships give our dedicated occupa-tional health staff more time for market-ing and sales. So, you could say we havefive independent clinics with a programin each clinic, supported by a centraloffice, run by an individual and somesupport staff. That is great, because wecan meet our customers’ expectations bygetting people in and out right now.

Challenge 6: Being Responsive

In a mixed-use clinic, front office staffoften complain about being too busy torespond in a timely fashion to occupa-tional medicine patients and employers’questions or concerns, while providerstypically are with patients and notimmediately available. The challenge ishow to make both the patient and clientcompany feel special at the time oftreatment.

Baker’s Solution: “First, I alwayschallenge the statement: ‘I am too busy,’but I understand where that comes from.In our clinics, every receptionist hasaccess to employer profiles that includeall the information we need to conveyback to the employer. When an occupa-tional health patient comes in, they pullup the profile and it follows that patientall the way through the process. Wehave one receptionist per provider onthe phone, entering charges, creatingbills and collecting information. Theyare not just processing patients. It is animportant position. You need excep-tional staff in each clinic to figure that out.”

Challenge 7: Improving Profitability

Mr. Baker said he generally finds thatprofessionals who are accustomed torunning occupational health programs asa business entity tend to be more entre-preneurial in nature than personnel whotransition into clinic management fromother hospital departments.

“When you work in a hospital youdeal with politics all day long just tryingto figure out which way is up,” he said.“They move slowly in hospitals, andthey are used to doing things a certainway. You have to be entrepreneurial toput this together. If you don’t have thatspirit, you are going to struggle, becauseyou are doing something different fromthe norm.”

When a health system operates urgentcare and occupational health clinics asdistinct facilities, it becomes harder tosustain profitability, especially in rural tomid-sized markets with a finite numberof prospective clients. Many hospital-based occupational health programs alsoare encumbered by overhead. The resultis an occupational health program thathas to repeatedly justify its contributionto the health system to get the supportand resources it needs to be successful.

Baker’s Solution: “Combine serv-ices. If you have a building with examrooms and dedicated staff, there is noreason not to cross-train the staff tohandle both urgent care and occupa-tional health. Again, there has to be aleader to act as the driving force. Yearsago, we added occupational medicine toincrease volumes and produce additionalrevenue.”

Two other suggestions:1. “When a non-client company recom-

mends our clinic to an injuredworker, our sales representative fol-lows up with that company to upsellour services.”

2. Base physician compensation partlyon production: “I say, doctor, here iswhere the money is. During thetimes when you are not seeing fouror five patients an hour, I can giveyou an hour to perform work-relatedphysical exams…it pays, it is gravy.”

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Challenge 8:Documentation & Billing

Group health documentation andbilling differs from employer-paid andworkers’ compensation documentationand billing.

Baker’s Solution: “We push theinformation out electronically. Inessence the patient is the payer forurgent care. The occupational medicinepatient is not the payer, so we have sep-arate financial classes set up in our sys-tem: employer-paid/billed and workers’compensation billing to the employer orcarrier. Same staff, same window. It’s atraining and implementation issue. Weare introducing an electronic medicalrecord system this summer that willallow us to use templates.”

Challenge 9: Wait TimesPatient and employer surveys suggest

an expectation of no more than 15 min-utes wait time and a total time of 45minutes in the clinic for a routine visit.What if you know the clinic will bebusy with walk-in patients at 8 a.m. anda client company wants an 8 a.m.appointment? What do you do whenyour clinic gets overrun with patients?How do you handle urgent care patientswho complain when an injured workerappears to be given priority?

Baker’s Solution: “If the companywants an 8 a.m. appointment, give it tothem, because that is good money. Ifyour clinic gets overrun, communicatewith the patients who are waiting.During flu season, ramp up providers;bring in a retired physician. We ‘park’anyone who needs an X-ray in a treat-ment room (they are not going to be

out of there in an hour anyway) andthen process the other patients who are waiting.

“Some physicians prefer a ‘first-in,first-out’ system. That doesn’t work in ablended clinic. Sometimes a staff personhas to help the doctor understand theflow: ‘This one is going to be here a bitlonger, this is a school physical, this is asore throat,’ and queue things up in theright way. We have to remember we arepushing our doctors and they have tochange hats. We match every physicianwith a nurse, because it helps keep theflow going. Hospital executives want toknow why we need a nurse for everydoctor. I tell them it is because other-wise the doctors would end up perform-ing nursing duties for which we cannotbill. You have got to make that point.”

Also pay attention to site-specific uti-lization and staff accordingly.

Challenge 10: Physician Expertise

Board certified occupational medicinephysicians are difficult to find and thereis a risk of under-utilizing their expertisein a mixed-use setting.

Baker’s Solution: “We have oneboard certified occupational medicinephysician who works at a single loca-tion. The rest of our physicians are family practitioners.”

This was not the original model:“Early on we made a huge mistake: wethought we needed a centralized occu-pational medicine clinic that wouldserve as the hub and the urgent careclinics would be the spokes. It turnedout the doctors on the spokes thought,‘Why would I send my revenue to occu-

pational medicine when I get paid tosee that patient? What does this personknow that I don’t know?’ We ended updissolving the spoke-and-hub concept.Now the other physicians use our occu-pational medicine physician as aresource and we market his credentials.”

Challenge 11:Competitive Threats

Many blended clinic operators findthemselves competing with a new cropof start-up operations and/or retail-basedwalk-in clinics. Some are getting intothe quick-clinic business themselves inorder to remain competitive, whichpresents its own set of challenges. “Youcan’t swing a dead cat without hitting anew urgent care center, but when thereis that kind of growth, there is going tobe shakeout,” Mr. Baker predicted.

Baker’s Solution: “I respect the‘Minute Clinics.’ I am even a littleafraid of them, although in our townWalgreens has downsized their clinicsand released a number of nurse practi-tioners. I don’t know if you can sit inWalgreens sick while everybody else isbuying newspaper and gum. We had aplan to operate our own cash-only,quick clinic, but we put it on the shelfbecause we didn’t want to confuse ourbrand. I am glad we did that now.”

Regarding the WalMart model inwhich a local provider organization entersinto a contract to operate an in-storeclinic, Mr. Baker’s says: “For those whoare operating a clinic in the WalMart inyour area, good for you. I thought theirexpectations were oppressive, so webacked away and the goliath hospital inour community is now in there.”

Challenge 12: Adapting to Trends

Occupational health professionalswho are experienced with integrateddelivery models are trying to determinewhere they fit within an AccountableCare Organization or medical homemodel in their organization.

Baker’s Solution: “I see urgentcare as the front door to the ACO. Our operation is positioned that wayand that is the direction we are going. I have no idea how it is all going to turn out, but I don’t want to be behindthe curve.”

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VISIONS

Robert L. Broghammer, M.D., M.B.A.,M.P.H., of Allen Occupational Healthin Waterloo Iowa and Jeffrey A.Westpheling, M.D., M.P.H., of St. Luke’sWork Well Clinic, Cedar Rapids, Iowa,are among those who do not favor themixed-used model, as outlined in thefollowing letters to RYANAssociates/NAOHP:

From Dr. Broghammer:“It was with some dismay that I saw the

announcement of the Ryan Associates’seminar regarding mixing occupationalmedicine with urgent care. I realize thisis a ‘trend’ currently, especially withConcentra, but I must vehemently dis-agree that the two are complementarylet alone easily integrated.

“While it is true that much of whatwe do has an ‘urgent’ basis (i.e. lacera-tions, traumas, chemical exposures, etc.),occupational medicine is a distinct andseparate discipline with its ownAccreditation Council for GraduateMedical Education-approved post-gradu-ate medical training programs and sepa-rate board certification process. As youknow, occupational medicine trainingfocuses on toxicology, epidemiology, sta-tistical analysis, orthopedics, surveil-lance screening, impairment and disabil-ity, wellness and a host of other specificareas dedicated to the care of workersand their companies.

“Urgent care is nothing more than adescriptor for a clinic that will see youASAP for a perceived medical problem.There is no specific knowledge base,even rudimentary, for urgent careproviders who may provide services forinjured workers covered by the workers’compensation system or for the myriadof other occupational-specific issues thatneed to be addressed and taken care of.

“Urgent care providers may haveextremely diverse backgrounds and thereis no formal standardization of trainingto practice in an urgent care setting –one simply needs a license and apulse. Family practitioners, internists,pediatricians, physician assistants, nursepractitioners, general surgeons andobstetricians are just a few of the disci-plines that I know of personally that

have/do practice in urgent care settings. “Likewise, occupational medicine

providers, such as myself, have very littleor no training in the variety of medicalproblems that may present to an urgentcare center which have no relationshipto work. Imagine an infant presentingwith a fever versus a normally healthyworker. The differential diagnosis forthe two is vastly different. For instance,the worker may have metal fume feverbut it is highly unlikely the infant does.

“No, the integration of the two sepa-rate and distinct services will only serveto confuse the clients and dilute thevalue of providing specific occupationalmedicine services. The trend is nothingmore than attempting to squeeze a cou-ple extra bucks out of clinics by short-sighted administrators.

“Not one of my colleagues who Itrained with and who are board certifiedin occupational and environmentalmedicine would consider working insuch a clinic long-term.”

From Dr. Westpheling:“I completely agree with the above

statements and would add the followingcomments:

“An advantage of a stand-alone occu-pational medicine clinic is avoiding thepatient wait times typically associatedwith urgent care centers and emergencydepartments. Companies and theiremployees look to have issues addressedin a timely and efficient manner toreduce time away from work.

“I have always emphasized that urgentcare centers are meant to see minoremergencies/urgencies as a backup toprimary care providers and overcrowdedemergency rooms. They are notintended, nor should they be, to providelong-term follow-up or primary care.When this occurs, the worker ends upseeing multiple providers over severalvisits resulting in poor continuity of care.

“The mixing of patient types also raises several concerns including well or injured workers sitting in waitingrooms with coughing/sneezing sickpatients and continually having to shiftthought processes from work injury topersonal care.”

Observations from Pure-Play Proponents

Responding to the Market

RYAN Associates and theNAOHP recognize the meritsof all points of view on theshifting paradigm for thedelivery of personal andwork-related care. To a con-siderable extent, economiccircumstances and health carereforms are driving employerand employee interest in apopulation health manage-ment approach, whateverform that may take at theclinical delivery level.

Providing occupational andepisodic care in a customer-centric environment (and asan alternative to the emer-gency department) is oneway to reduce costs and pro-vide the total health focuscustomers seek. Whether aphysician trained in occupa-tional medicine works in amixed-used setting or a dedi-cated practice, he or she pro-vides a high level of assess-ment, treatment and caremanagement expertise.

Blended Clinic Models on Conference Agenda

RYAN Associates 25th AnnualNational Conference, Oct. 17-19 in Atlanta, will feature a half-day course on Urgent Care andOccupational Medicine Services:Perfecting the Balancing Act.The course is designed forthose already operatingblended clinics and programsconsidering the integration ofurgent care and occupationalmedicine services in response tomarket and economic demands.

To learn more, visitwww.naohp.com.

Q:What is your background andthe nature of your organiza-

tion’s mixed-use clinic model?Dr. Thomas: I started out in aca-

demic medicine with training in inter-nal medicine and a sub-specialty ininfectious diseases. I taught for about adozen years, wound up in private prac-tice for awhile and then started doingurgent care/occupational medicine withOH+R in the Nashville area (OH+Rwas acquired by Concentra HealthServices in 2005). I like the mix. Theaddition of urgent care is a relativelynew development for Concentra, and insome ways we are still learning how todo it. I believe the blended model ishere to stay, because a lot of your occu-pational medicine patients will needpersonal medical services at some time.If you can provide those services, theycan simply go from one set of paperworkto another set of paperwork.

Dr. Cranfield: I decided to try urgentcare starting in 1985 after serving as aflight surgeon in the Air Force. I havealways worked with the blended modeland never known another way for it tobe. About 70 percent of our practice isurgent care and 30 percent is occupa-tional medicine. It’s a hybrid system.We do have an onsite presence, and Iencourage other providers to look intothat. It has been a long road and I haveseen a lot of changes in the field.Urgent care started out as a substitute

for the emergency department. It hasgone through a transition and hasbecome its own “specialty.”

Ms. Brock: Our hospital-affiliatedprogram has been providing occupa-tional medicine since 1994 on theTennessee/Kentucky line, balancing dif-ferent state regulations and laws. It is arural area without a lot of industry, sowe have had to add some service lines(to keep it viable). In 1998 we startedphasing in a rehab component(PT/OT/speech therapy) and have donewell with that. We moved the occupa-tional medicine practice to the hospitaldiagnostic center in 2005. In January2010 we moved into a new buildingoffering urgent and episodic care andfollow-up, occupational medicine,rehab, a full lab and a diagnostic centerwith CT scanning capabilities. Nextmonth we are adding primary care.

“The paperwork for workers’ compensation is very different, but a patient is still a patient.”

Q:Our urgent care clinic is prepar-ing to phase in occupational

medicine services. What do you rec-ommend we offer and build on?

Dr. Cranfield: If you are providingurgent care services and trying to incor-porate occupational medicine, it is

going to be easiest to add the injurycare component first, because youalready do that for your urgent carepatients. Drug screening is another serv-ice you probably have to be able tooffer. That requires additional expertiseother than just collecting urine for aurinalysis. There is a lot to it.

Dr. Thomas: Occupational medicineis not as simple as folks would like tomake it out to be. Get a feel for thecompanies around you and what theirneeds are. You may want to start withthe small to mid-sized companies first,then develop your services so you couldgo into a larger company later. Get yourprocesses down. The paperwork forworkers’ compensation is very different,but a patient is still a patient. That ishow I look at it. We are trying to satisfytheir need and return them to a sense ofwell-being. More specifically, you mayalso want to incorporate someDepartment of Transportation (DOT)medical exams in your practice. Therules are important. It would be usefulfor your provider to attend a DOT medical examiner’s course.

Ms. Brock: If you start with injurytreatment that automatically will growinto drug screening and/or physicals.

Q:What can we do to manage lack of occupational medicine

provider experience in the urgent care realm?

Dr. Cranfield: Again, start with thelittle things. You don’t necessarily wantto say, “I have got my doc who has beenpracticing occupational medicine for 30years and now I am suddenly going toopen the doors to people with a fever of102 and lower abdominal pain.” Setparameters for the types of patients youare comfortable seeing in the clinic.Then, as a provider learns more, youcan expand from there. About 75 per-cent of what we see in urgent care isupper respiratory infections, runnynoses, coughs, earaches, sore throats.Those are pretty easy to manage; mostof them get better whether you do any-thing or not. You may want to limityourself to that – like what the MinuteClinics do–before you start expanding.

Dr. Thomas: I agree – you can set

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Panelists Share Wisdom on Mixed-Use Clinic Model

Tawnya Brock, Director,Occupational Health, JellicoCommunity Hospital,Williamsburg, KY

Robert Cranfield, M.D.,President, Tennessee UrgentCare Association, Madison, TN

Frank Thomas, M.D., CenterMedical Director, Concentra,Murfreesboro, TN

The following is excerpted from a panel discussion held during RYANAssociates’ recent seminar on Profiting from Product Line Diversity:Integrating Urgent Care and Occupational Health Services. The panelists are:

9

VISIONS

parameters. A lot of doctors aren’t com-fortable dealing with children. You cancut it off at a certain age and stick withit. As you know, the number of trainedoccupational medicine physicians inthis country is dropping. They are notas readily as available as they used to be.So, you are going to have to depend onphysicians with family, emergency orinternal medicine training. It is not thatdifficult a transition, but I think it ismore difficult for the occ med physicianto see urgent care than the opposite.

Q:How do you recommend handling different levels of

comfort with different patient populations among practitioners in ablended practice?

Dr. Cranfield: As long as it is notsomething that has to be handledacutely, if you have two providers withdifferent comfort levels and they don’twork at the same time, you can havecross-referrals – tell the patient to comein when this doctor is here. In any case,we have established a standard: Whenwe hire a doctor they go through a cre-dentialing process in which they haveto agree to demonstrate a certain levelof proficiency before we will hire them.Our preference is that our clinicianshave a certain comfort level from the start.

Ms. Brock: When we started ouroccupational medicine program, we didnot have access to an occ med physi-cian. We contracted with a board certi-fied occupational medicine physician toeducate our medical director and affili-ated family practice and emergencyphysicians. Later, it was relatively easyfor us to transition into urgent carebecause we were staffed by family prac-tice and emergency physicians.

Q:How can we best satisfy theexpectations of multiple

constituencies? Dr. Cranfield: You have to realize

that when you are dealing with aninjured employee you don’t just havethe employee as a client, you also havethe employer as a client, and theemployer has needs that may make youthink about that patient in a little bitdifferent way.

Ms. Brock: There are a lot of regula-tions, guidelines and national standardsout there. Do your homework and makesure you are meeting that standard of

care and offering the correct quality tothe employer and the patient.

Dr. Thomas: There are more layers ofpeople involved in occupational medi-cine than there are in urgent care. Notonly do you have the injured person,you have to deal with the employer,adjusters, nurse case managers…youhave to make an effort to satisfy all ofthem at some level, even though thetreatment may be no different from whatyou would provide to any other patient.

“Set parameters for the typesof patients you are comfort-able seeing in the clinic.”

Q:Using DOT physicals as an exam-ple, how would you handle an

examinee with high blood pressure ordiabetes? Would you refer him or herto a primary care physician for follow-up? What if the examinee does nothave his or her own doctor?

Dr. Thomas: You can handle that acouple of ways: I usually try to get themset up with a primary care physician. Ifthey want to see me they have to cometo me as an urgent care patient; I can’tmix the two entities. If a driver’s bloodpressure is not too bad, you can give himup to 90 days to get himself togetherbefore coming back for a re-check. He islikely to be motivated; if he is not driv-ing he is not making any money.

Dr. Cranfield: For those people whocome in with uncontrolled diabetes orhigh blood pressure, regardless ofwhether you are going to start treatmenttoday or send them to a primary carephysician, the fact is they are not goingto get a full DOT card at that time.They may fail completely to get theircard initially. As a practical matter, wedon’t send them out to sign them backin again. If we take the examinee as apatient rather than just a DOT physical,he or she has to be logged in differently.I have my staff get the information weneed and try to make it as seamless as possible.

Ms. Brock: If they have a primarycare physician, we get on the phone andtry to get them in to see their own doc-tor as quickly as possible. If they do not,our provider will see the employee andstart whatever process they need. Weprovide follow-up visits, so they wouldcome back for monitoring until they gotto the point where they could qualify.

Q:Some employers in our marketare asking for primary care serv-

ices for their workforce. What is thedifference between primary care andurgent care?

Dr. Cranfield: With urgent care youhave episodic care and with primarycare you are also going to be gettinginto managing the people with diabetesand high blood pressure and heart dis-ease and making sure they are main-tained on their medicine, getting theirannual checkup, annual blood tests andthat type of thing. There are someurgent cares centers that do that. Ourmodel is not to do chronic care; wesend those patients to the family doc-tors. We have enough people who wantto see us for their acute care needs thatwe don’t have to do that. There are alot of physicians who bill themselves asurgent care providers when their goal isto open a practice, get patients to comein without appointments until theybuild up their practice and then switchover to family care.

Dr. Thomas: If you get patients wholike the provider (in a blended clinic),they will try their best to attach them-selves to that provider and will comeback no matter what you do. You canget them set up with an internist or afamily practitioner, but they just keepcoming back. What I have done is tellthem, “We do not do primary care man-agement. I am happy to serve you whenyou come in, but I am telling you upfront I am not your primary care physi-cian and I do not see myself that way.”

Dr. Cranfield: There are certain peo-ple who use you routinely and consideryou as their primary care physician,even though you are really are not. Wemay give those people a 30-day supplyof medication to give them enough timeto get them back to their primary caredoctor or to find someone to help man-age their chronic condition.

Dr. Thomas: The first time theycan’t get an appointment with their PCthey will be back.

Q:Do you recommend having thecapability to offer in-office

medication dispensing?Ms. Brock: We had to deal with that

issue in our rural area when weextended our hours to 10 p.m. All ofthe pharmacies within a 40-mile radiusof our clinics close at 6, or even as earlyas 4 or 5 p.m. So, we dispense some spe-

Continued on page 17

10

By Karen O’Hara

In a symbolic move, the NationalInstitute of Occupational Safety andHealth (NIOSH) plans to change thename of its WorkLife division to TotalWorker Health to better reflect the unit’sobjectives, reports L. Casey Chosewood,M.D., WorkLife senior medical officer.

WorkLife/Total Worker Health seeks toeliminate artificial divides between “atwork” and “non-work” by examining theintricate web of work and home life, pub-lic and personal protection, and overallhealth and well-being. For example, asworkplace conditions affect employeehealth and well-being at home and in thecommunity, activities and conditions out-side of working hours can substantiallydetermine health, productivity andresponses to exposures during work,NIOSH researchers say.

The concept of Total Worker Health isstrategically aligned with theAccountable Care Organization (ACO)and medical home delivery models pro-moted in the Patient Protection andAffordable Care Act. (An ACO is a col-lection of local providers held account-able for the cost and quality of care deliv-ered to a particular population. Seerelated article on page 12.)

While some say Total Worker Healththreatens to dilute NIOSH’s fundamentalpurpose “to understand and decrease therisk of injury and illness in the work-place,” Dr. Chosewood said the federalagency’s primary worker protection mis-sion remains unchanged. However, hesaid NIOSH recognizes the need to cre-ate new avenues to better understand andmanage other factors affecting workerperformance, such as stress, poor diet,limited exercise, smoking, medicationand/or alcohol use, and a plethora ofother physical, social, cultural and eco-nomic conditions.

“Worker protection has to be at thecore of any program,” Dr. Chosewoodsaid during a presentation at the recentannual American College ofOccupational and EnvironmentalMedicine (ACOEM) conference inWashington, D.C. “The first dollar needsto be spent on decreasing hazards theworker will encounter at work. After youhave done that, then it is appropriate toinvest in health promotion activities thatwill produce the end benefit of makingthe population as a whole healthier andsafer.”

Speaking directly to occupational med-icine physicians, Dr. Chosewood said:“We think there are missed opportunitiesin the clinic setting. There is a need forcomprehensive health screenings forwork-related and non-work-related risks.There also is growing interest in combin-ing occupational health with a work-place-based primary care home model.

“You need to do all that you can toincrease the percentage of preventiveservices that are part of the overall deliv-ery model and encourage full integrationin clinics, including the incorporation ofbehavioral health and traditional safetyactivities. We hope you will come alongwith us on our journey toward TotalWorker Health.”

NIOSH Acknowledges Importance of Total Worker Health

Study Showsan EmployerCan InfluenceFamily Well-Being

In a 12-week program atIBM, 11,631 employees com-pleted a voluntary, web-based program and earneda $150 rebate.

Participants chose familygoals from a list of optionssuch as limiting fast food toonce a week, walking chil-dren to school at least oncea week, limiting videogames to 30 minutes a dayor involving children in mealpreparation once a week.

Results:• Family physical activity

increased 17.1 percent;• Eating healthy dinners five

nights a week increased by11.8 percent;

• Limiting screen time to amaximum of one hour/dayincreased by 8.3 percent.Study authors suggest the

results show that employerscan improve short-termbehaviors in children andparents in physical activity,meal planning and screentime.

Reference: AnObservational Study of anEmployer Intervention forChildren’s Healthy WeightBehaviors; Pediatrics,November 2010.

11

Best PracticesOn a parallel track, Pamela Hymel,

M.D., chief medical officer, Walt DisneyParks and Resorts and ACEOM pastpresident, told physicians the college’sWorkplace Health Protection andPromotion Committee is developing aresponse to the NIOSH total healthprogram that will highlight best prac-tices in the integration of protectionand health promotion.

“We have found that workers withadverse health conditions such as obe-sity, hearing loss, poor eyesight andfatigue are more likely to sustain work-related injuries,” she said. At the sametime, “there is often an abyss betweensafety and wellness. It will be importantfor ACOEM members to begin to buildthose linkages. At Disney, I have ameeting set up with our vice presidentof safety to begin conversing on thisvery issue.”

Dr. Hymel said occupational medicinepractitioners can add value to the con-versation by:• reaching out to segments of the

population, such as non-insuredemployees, who may not have easyaccess to information;

• designing targeted programs for at-risk groups in the workplace; and

• working within organizational hier-archies to introduce procedures,practices and norms.

Dr. Hymel said the ACOEM commit-tee is studying public policy options thatsupport integrated health protection andpromotion efforts and incentives. It alsois interested in synergies amongACOEM and government and privatesector employers, opportunities forstrategic alignment with emerginghealth care delivery models and evi-dence-based medicine, and NIOSH’sWorkLife Center of Excellence program.

In a related action, Dr. Hymel saidACOEM plans to waive the subscriptionfee for its health and productivity man-agement (HPM) toolkit for collegemembers to encourage greater utilizationin the coming months. The toolkit features a collection of educationalmaterials and is intended for use by professionals involved in the implemen-tation of HPM programs. To learn moreabout the toolkit, visithttp://hpm.acoem.org/index.html.

VISIONS

U.S. since the year of Super Bowl V, Apollo14, and the founding of NASDAQ. NIOSHworked closely with its diverse partners in thestart-up years of the early 1970s to address thepriority safety and health needs of an econ-omy driven at that time by manufacturing.Through the decade of the 1970s, NIOSH’sresearch helped to reduce hazardous exposuresto asbestos, lead, benzene, vinyl chloride, andother substances produced or used every dayin factories, plants, and steel mills…

“…For all of our progress, many of the tra-ditional hazards of the 20th century work-place still persist. Research remains vital foreliminating coal workers’ pneumoconiosis, sil-icosis, work-related hearing loss, motor vehi-

cle fatalities on the job, lead poisoning, and other legacy problems. At thesame time, new concerns demand our attention so that the mistakes thatoccurred too often in the last century are not repeated, such as the rush to usenew technologies, materials, and practices without first understanding theirimplications for worker safety and health. Nanotechnology, work organization,and safe green jobs are examples of those areas where NIOSH has establishedstrategic research programs.

“We also face the challenge and opportunity of helping to shape a new busi-ness paradigm for the 21st Century. In this model, the prevention of work-related injuries and illnesses is correctly counted as an asset to business ratherthan a cost. We are working closely with partners to develop this business casefor safety and health, predicated on the fact that safe, healthy, and secureworkplaces are efficient workplaces and integral to profitability and economicgrowth. Having an able and motivated workforce is critical to success intoday’s environment, as the economy recovers, as high-quality jobs are cre-ated, as the public and private sectors develop strategies for containing health-care costs, as the baby boomer generation begins to retire, as small businessesare nurtured, and as the workforce becomes more diverse.

“Predictions are difficult, but I am confident that the investments we makenow will pay great dividends for society over the coming years and decadesand that the next 40 years will be as challenging and gratifying for NIOSH asthe last 40 years were.”

Related Resources1. Centers for Disease Control and Prevention and National Institute for

Occupational Safety and Health collaborative workplace health protectionand promotion website: www.cdc.gov/workplacehealthpromotion.

2. Moving Science Into Coverage: An Employers’ Guide to PreventiveServices; National Business Group on Health:www.businessgrouphealth.org/preventive

3. NIOSH WorkLife Centers for Excellence that conduct multi-disciplinaryresearch, training and education: • University of Iowa Healthier Workforce Center for Excellence:

www.public-health.uiowa.edu/hwce• Center for the Promotion of Health in the New England Workplace at

the University of Massachusetts: www.uml.edu/centers/cph-new and theUniversity of Connecticut: www.oehc.uchc.edu/healthywork/index.asp

• Harvard School of Public Health Center for Work, Health and Wellbeinghttp://centerforworkhealth.sph.harvard.edu

4. Guide to Community Preventive Services, systematic reviews on programsand policies designed to improve health and prevent disease:www.thecommunityguide.org

Industry Leaders, continued from page 2

12

The following is excerpted fromAccountable Care Organizations:Distinguishing Rhetoric from Reality, areport prepared earlier this year forthe California Association of Healthplans by Phil Polakoff, M.D., and PeterBoland, Ph.D., of Polakoff/ Boland,who specialize in translating complexhealth care reform provisions intopractical implementation strategies.Refer to www.polakoffboland.com/ACO White Paper.pdf.

Dr. Polakoff is experienced in healthcare delivery, operations and policyformation, with 20 years as a clinicianand 25 years as an executive and con-sultant. He is board-certified in pre-ventive medicine, with a sub-specialtyin occupational and environmentalmedicine. Dr. Boland is internationallyknown and has 35 years of experienceas a management consultant to hospi-tal systems, integrated delivery net-works, health plans, employers andtechnology companies.

In their paper, they define an ACOas a local health care organizationwith a related set of providers such asprimary care physicians, specialists andhospitals that are accountable for thecost and quality of care delivered to aparticular population. They say thepurpose of an ACO is to deliver moreefficient and coordinated care that isrewarded with a financial bonus forachieving performance benchmarksestablished by the Centers forMedicare and Medicaid Services (CMS).

Ten Selected Observations1. Provider-sponsored ACOs will ini-

tially focus on Medicare beneficiariesthrough demonstration pilots butare expected to compete for com-mercial lives through HealthInsurance Exchanges offered bystates in 2014.

2. ACOs will have a cascading effecton the market. Medicare pilotsbased on shared risk (2012) will leadto other financial risk models such asbundled service and episodes of pay-ment (2013).

3. It makes strategic and businesssense for health plans and providersto collaborate on how to take sub-stantial costs out of the delivery sys-tem. Health plans and providersshould commit to reasonable clinicaland cost goals, and share resourcesto minimize expense and financialrisk. The alternative of providerorganizations going it alone will notnecessarily lead to lower costs.

4. ACOs represent an opportunity to“cross the chasm” from fee-for-serv-ice to bundled payment.

5. As payer reimbursement incorpo-rates global payment and differentforms of capitation, most providerorganizations will need additionalcapital, information systems and clin-ical decision support from insurers.Health plans understand this reality;relatively few providers do.

6. Both payers and providers needACOs to succeed in order to staveoff ongoing pressure for a govern-ment-run health care system.

7. If providers are left with the pri-mary responsibility to “police” them-selves without the threat of seriousfinancial penalties agreed to inadvance with payers, then efforts toalign the incentives of physicians

and hospitals will not be more suc-cessful than previous efforts byPhysician-Hospital Organizations(PHOs) to reduce costs.

8. It is in the interest of provider-ledACOs to partner with payers in earlystages to jointly develop risk-rewardstrategies that are reasonable andthat replace point-counterpointnegotiation over rates.

9. Conversely, it is in the interest ofhealth plans to partner with ACOsearly because they need time todevelop and refine the necessaryenrollment and risk analytics to beeffective partners.

10. There is a significant delivery gapthat requires every stakeholder tobecome engaged so they are 100percent committed to each other’ssuccess.

Report Interprets Significance of Accountable Care Models

Accountable Care Cost-Control Methods

Primary Care Physicians (may be applicable to primaryoccupational medicine):

Health promotion

Early diagnosis

Unnecessary testing

Unnecessary referral

Preventable ER visits

Preventable admissions

Preventable readmissions

Care coordination

Medical home-care management

Chronic care management

Complimentary medicine treatment

Group visits

E-visits

Telemedicine visits

After-hours and weekend clinics

Staffing urgent care as an alternative to ERs

Proctoring “minute clinics”

Specialist selection (most efficient)

Practice efficiency

Group practice design

Phil Polakoff, M.D.

Peter Boland, Ph.D.

13

VISIONS

Understanding the Impact of Workforce Presenteeism

Presenteeism is a concept many inthe field of occupational healthconsider to be significant but dif-

ficult to quantify – somewhat akin tocatching lightning in a bottle.

It means being present but not fullyproductive at work, primarily because ofintervening physical and/or mentalhealth conditions.

While there are a number ofapproaches being used to measure theimpact of presenteeism in the U.S.workplace, findings remain inconclu-sive. In response, the American Collegeof Occupational and EnvironmentalMedicine (ACOEM) and the IntegratedBenefits Institute (IBI), an organizationthat works with employers to demon-strate the business value of health, arepreparing to test the reliability of surveyinstruments used by supervisors andemployees to rate productivity.

The ACOEM-IBI study is a byprod-uct of an investigative process launchedin November 2008 when more than 40leaders from public and private sectororganizations convened in Santa AnaPueblo, NM, for a national summit onhealth and productivity management(HPM). Summit participants issued 10consensus statements and a series of rec-ommendations in 2009, including a callto examine presenteeism as a tangiblefactor affecting the bottom line.

Kenneth Pelletier, M.D., Ph.D., of theUniversity of California, San FranciscoSchool of Medicine and the Universityof Arizona School of Medicine, reportedat the recent annual AmericanOccupational Health Conference spon-sored by ACOEM that study objectivesinclude:• assessing the reliability and length of

survey instruments such as shortquestionnaires;

• evaluating the validity of specificmeasures of employee performance;

• identifying factors that contribute tovariability in results;

• estimating the cost of absenteeismand presenteeism beyond wagereplacement;

• calibrating measurementranges/scales used in self-reportinstruments; and

• converting performance measures to ratios such as days lost to dollarslost.

“We have found that some self-reporttools work better than others at detect-ing degrees of presenteeism,” dependingon their purpose or application, Dr.Pelletier said. “We need to developmethodologies to determine relation-ships between scores generated by self-assessed health-related work perform-ance surveys to supervisor evaluationsand employee work performance.”

ProductivityMeasurement Tools

Companies need new and better toolsfor measuring employee productivity to“highlight important productivity meas-urement issues for consideration in anoverall business strategy,” according toan article by Steve Schwartz, Ph.D. ofHealth Media, Inc., and John Reidel,M.P.H., M.B.A., of Reidel andAssociates.

They outline key issues in the designand use of productivity measurementtools with real-world applications in anarticle published in the Journal ofOccupational and EnvironmentalMedicine. (Refer to Productivity andHealth: Best Practices for BetterMeasures of Productivity, S Schwartz, JRiedel; JOEM, 52(9):865-871,September 2010.)

The ability to identify the “best” toolfor measuring productivity depends onhow and why the information will beused. “Descriptive measurement” looksat the effects of health on worker per-formance, while “comparative measure-ment” examines the impact of various

health risks and conditions. A third cat-egory, “evaluative measurement,”focuses on changes in productivity overtime – a critical consideration in judg-ing the benefits of employee health programs.

Companies need norms or bench-marking data to evaluate health andproductivity improvements that can berealistically achieved. In addition, someway of monetizing the productivityimpact of health conditions, and thepotential for improvement, is necessaryto assess the effect on the bottom line,the authors said.

Worker health and productivity dataalso must be formatted in a way thatmakes it usable by decision makers.Dashboard formats are considered a par-ticularly promising approach becausethey present data in a concise manner.

The authors said they hope their arti-cle will help prompt the maturation ofhigh-utility instruments for measuringworker productivity, and for using theinformation to improve worker healthand the financial outlook for employers.

14

Hospital-PhysicianManagement Agreements

More hospital administrations areentering into co-management agree-ments that pay physicians to run a spe-cific department to improve its perform-ance, according to Report on MedicareCompliance. Under such arrangements,physicians and the hospital establishand jointly own a limited liability com-pany, which the hospital may contractwith to manage a specific service line.The hospital pays the LLC a manage-ment fee, which is split between theparties. The physicians in the co-man-agement arrangement typically receivepay for general compensation and per-formance incentives.

Illinois Comp Law Repeal Proposed

House Bill 1032, introduced by stateRep. John Bradley, would repeal theWorkers’ Compensation Act and putworkers’ compensation cases intoCircuit Courts in Illinois, LRPPublications reports. While the proposalhas support from a legislative panel, sev-eral groups are opposing it, includingthe state Chamber of Commerce. ARepublican legislator called the idea a“nuclear bomb.” Meanwhile, federalprosecutors are investigating reportsthat hundreds of employees at anIllinois prison received awards, as didsome arbitrators who decided workers’compensation disputes.

Paycheck FairnessThe Paycheck Fairness Act re-intro-

duced in Congress calls for increasedemployer liability for compensationdecisions and heightened governmentinvolvement in remedying pay inequal-ity. The latest bill, which is identical toa previous proposal, was introduced inthe U.S. Senate (S797) and the U.S.House of Representatives (HR1519) onApril 12, “Equal Pay Day, 2011.” Ifenacted, the legislation would alter keyprovisions of the Equal Pay Act of 1963,which amended the Fair LaborStandards Act to prohibit employersfrom paying women less than men forperforming the same or “substantiallyequal” work in the same establishment.Gender-based wage discriminationremains a problem and a percentage ofthe wage discrepancy cannot beexplained by non-discriminatory factors,government and private experts saidduring a public forum held recently atthe U.S. Equal EmploymentOpportunity Commission office inWashington, D.C.

Scientific Response to Emergencies

A federal advisory board has approvedrecommendations related to the scien-tific responses to major public healthevents such as the 2009 H1N1 pan-demic and the Deepwater Horizon oilspill. The draft recommendations devel-oped by a work group of the NationalBiodefense Science Board will be for-warded to Health and Human ServicesSecretary Kathleen Sebelius and NicoleLurie, M.D., assistant secretary for pre-paredness and response. The group saidscientific investigations should be fullyintegrated with disaster planning andresponse to ensure that critical knowl-edge gaps are addressed in a timely man-ner. Refer to www.phe.gov/preparedness.

Secondary PayerMedicare Secondary Payer (MSP)

compliance requirements affect injuredworkers, employers, carriers and third

party administrators. The SMART Act(HR1063) pending in the House couldhave a significant impact on this issue,industry observers said. The SMARTAct would create a pathway for theCenters for Medicare and MedicaidServices to calculate and provide to settling parties the MSP repaymentamount before settlement so parties areaware of and can promptly pay theirobligation.

Translators NeededHealth care providers are advised to

prepare now for an increasing demandfor the translation of information tolanguages other than English under aJuly 1 health care reform law deadline.Meanwhile, in Guitron v. Santa FeExtruders (Cal. W.C.A.B. 2011), theCalifornia Workers’ CompensationAppeals Board held that the employerwas required to pay for interpreter serv-ices provided during medical treatmentappointments.

OSHA Actions

Fall ProtectionThe U.S. Court of Appeals for the

Seventh Circuit rejected a challenge bythe National Roofing ContractorsAssociation to an Occupational Safetyand Health Administration (OSHA)directive on the use of fall protection in

VISIONS

residential construction. The directivewithdrew an earlier one that allowedcertain residential construction employ-ers to bypass some fall protectionrequirements. A compliance directiverequiring contractors performing resi-dential construction to comply with theresidential fall protection standard wasscheduled to take effect June 16. Thestandard generally requires thatguardrails, safety nets or personal fallarrest systems be used on residentialjobsites that are more than six feet offthe ground.

Hair Product AlertThe agency issued a hazard alert to

hair salon owners and workers aboutpotential formaldehyde exposure fromworking with some hair smoothing andstraightening products. Visitwww.osha.gov/SLTC.

Outreach ProgramOSHA has revised its voluntary

Outreach Training Program require-ments to improve the quality of coursesand ensure the integrity of authorizedtrainers. The voluntary program, part ofOSHA’s Directorate of Training andEducation, involves a national networkof more than 17,000 independent train-ers who teach workers and employersabout agency regulations, workers’rights and how to identify, avoid andprevent workplace hazards. Trainers arenow required to verify that the trainingthey conduct is in accordance withapproved procedures. Other programenhancements involve limiting class-room size to a maximum of 40 students,limiting the use of translators to thosewith safety and health experience, andlimiting the use of video presentationsduring training.

Prevention Efforts As residents recovered from damage

caused by storms throughout the South,OSHA urged employers, workers andthe public engaged in cleanup activitiesto protect themselves against a varietyof hazards. The agency also announceda national outreach initiative to edu-cate workers and their employers aboutthe hazards of working outdoors in theheat and steps to prevent heat-relatedillnesses.

15

California Workers’ CompensationInstitute Reports on OpioidPrescription Patterns

The top 10 percent of doctors who prescribeextremely potent, highly addictive Schedule IIopioids for injured workers in Californiaaccount for nearly 80 percent of all workers’compensation prescriptions for these narcoticdrugs, according to a study published by theCalifornia Workers’ Compensation Institute(CWCI). The study also found nearly half of theprescriptions were for minor back injury claims.

In a follow up to that study, CWCI followedprescribing patterns for fentanyl, the mostpotent of the Schedule II opioids. Using theclaim sample from the earlier study, the fol-low-up report analyzes prescription data from16,890 California work injury claims in whichSchedule II drugs were prescribed, as well as5,253 non-surgical medical back claims fromthe sample, to measure the extent to which

fentanyl is being used in California workers’ compensation. Among the keyfindings: • More than one out of five injured workers who received Schedule II opi-

oids were prescribed fentanyl. Among those with non-surgical medicalback problems (strains and sprains) who received Schedule II opioids, morethan one out of four were given fentanyl.

• Fentanyl accounted for 20.3 percent of all Schedule II opioid prescriptionsgiven to injured workers and 21.8 percent of the Schedule II prescriptionsdispensed to non-surgical medical back claimants.

• More than a quarter of the doctors who wrote Schedule II opioid prescrip-tions for injured workers prescribed fentanyl, while 3 out of 10 doctorswho wrote Schedule II prescriptions for non-surgical medical back patientsprescribed fentanyl.As in the earlier analysis, the new study found that most of the fentanyl

prescriptions for injured workers were written by a small percentage of theSchedule II opioid prescribers, with the top 10 percent accounting for 84percent of the prescriptions. Use of fentanyl to treat non-surgical medicalback problems was more widespread, however, as the top 10 percent ofSchedule II prescribers accounted for 72 percent of the fentanyl prescrip-tions written for these claimants.

Most of the fentanyl prescriptions were transdermal patches, which havelimited FDA-approved uses and have been the subject of multiple FDAwarnings. California workers’ compensation pain management guidelinesalso say the patches should only be used for chronic pain patients requiringround-the-clock therapy, who have developed a tolerance for other opioids,and whose pain cannot be managed by other therapy.

Furthermore, there was no evidence of cancer-related illness or injuryamong any of the injured workers in the study sample, indicating that off-label use of fentanyl lozenges or tablets, which are only FDA approved forbreakthrough, chronic cancer pain, has become an issue in the Californiasystem.

The study found that off-label use of fentanyl was concentrated in the 10percent of claims (1,690 cases) with the highest volume of Schedule II opioidprescriptions, where nearly 12 percent (199 cases) had prescriptions forlozenges or tablets. A closer look showed the rate of off-label use was evenhigher for the top 10 percent of non-surgical medical back cases with themost Schedule II opioid prescriptions, where 77 of the 525 patients, ornearly 15 percent, were prescribed fentanyl lozenges or tablets.

Refer to Prescribing Patterns of Schedule II Opioids Part 2: FentanylPrescriptions in California Workers’ Compensation, posted at www.cwci.org.

16

In a class action suit approved by afederal judge in Colorado, retail giantWal-Mart Stores, Inc., is accused of

conspiring with Concentra HealthServices, Inc., Claims Management Inc.(CMI), American Home Assurance Co.(AHA) to lower its costs by controllingthe nature and timing of workers’ compensation medical treatmentreceived by its employees.

The suit alleges violations of the fed-eral Racketeer Influenced and CorruptOrganizations Act (RICO) andColorado laws prohibiting employersfrom dictating medical care for injuredworkers. As many as 6,900 current andformer Wal-Mart employees inColorado may be affected. Attorneyssaid Wal-Mart also could face similarclass action lawsuits in states with simi-lar laws if the plaintiffs prevail.

The defendants deny the allegations. The suit alleges that Wal-Mart gave

authorized treating physicians (ATPs) atConcentra “protocol notes” that statedcertain treatments were not covered anddirected them to call Wal-Mart’s claimssubsidiary before referring patients toother physicians or prescribing morethan five physical therapy sessions.

According to court documents, Wal-Mart argued that a class action was notjustified because some employees had“obtained treatment, suffered no denialor delay in treatment, and suffered noharm caused by the allegedly unlawfulpolicies.” Wal-Mart also argued that thepolicies challenged by the plaintiffswere modified, effective January 2008,and that the plaintiffs’ claims “are notrelevant to the defendants after thepolicies were modified.”

Among possible ramifications in thecase (Josephine Gianzero, et al. v. Wal-Mart Stores Inc., No. 09-656, D. Colo.)is a legal determination regarding thepoint at which employer involvementin medical care delivery jeopardizes

provider independence, said BillNewkirk, M.D., medical director forPureSafety, who spoke about the case ata recent RYAN Associates’ seminar. “Youneed to know your state laws,” he said.

More About the CaseMs. Gianzero, a Sam’s Club employee

in Colorado, suffered multiple injuriesin a fall at work on Nov. 26, 2005. Shewas treated at a Concentra MedicalClinic and later developed lingeringwrist and thumb pain. A suit subse-quently was filed March 24, 2009 in theU.S. District Court for Colorado onbehalf of Ms. Gianzero and also JenniferJensen, another Wal-Mart employeeinjured in a separate job-related incident.

Under the Colorado Workers’Compensation Act, workers who areinjured on the job are entitled toreceive medical treatment for theirinjuries “without interference or dicta-tion” by their employer or theemployer’s insurance carrier. In citingexamples of the “unlawful dictation ofmedical care,” the suit alleges:• Wal-Mart, CMI and/or AHA as part of

a pattern and practice, unlawfullyand improperly dictate(s) and/orinterfere(s) with the type and dura-tion of medical treatment receivedby injured Wal-Mart workers.

• CMI, AHA and Concentra, as part ofa pattern and practice, aided andabetted Wal-Mart in implementingpolicies, practices and proceduresdesigned to unlawfully and improp-erly dictate, withhold, delay, denyand/or interfere with the medicaltreatment of injured Wal-Martemployees.

• Concentra assisted with the develop-ment of and/or agreed to followWal-Mart, AHA and/or CMI’s imposi-tion of unlawful and improperrestrictions on the treatment ofinjured Wal-Mart workers.

According to court documents,Concentra allegedly required ATPs to

adhere to treatment restrictions and/orrequirements in the course of treatingand/or making referrals for the treat-ment of injured Wal-Mart employees.For example, protocol notes requiredthe ATP to obtain pre-authorizationfrom CMI for referrals to other treat-ment providers (e.g., specialists), delay-ing patient treatment and the receipt ofbenefits in violation of state law.“Flowsheets” and protocol notes alsoallegedly prohibited the ATP from pre-scribing any chiropractic treatment andlimited work schedules.

In addition, CMI is accused of rou-tinely denying authorization for treat-ment referrals by challenging medicalnecessity during the required pre-authorization process.

Attorneys for the plaintiffs said plain-tiffs and class members “have sufferedand will continue to suffer damages” inan amount to be determined at trial.

Refer to: www.lexisnexis.com/docu-ments/pdf/20090728102108_large.pdf.

Class Action Suit Alleges Restrictions on Medical Care

Family Leave CaseThe Ninth Circuit Court of

Appeals in San Francisco heldthat the employer, not theemployee, has the burden of prov-ing a legitimate reason for notreinstating an employee to a for-mer position following an absenceunder the Family and MedicalLeave Act (FMLA). An employerwho denies reinstatement to anemployee must be prepared toprove the employee had no suchright, according to Jackson Lewis,a national employment law firm.Refer to Sanders v. City ofNewport, No. 08-35996, 9th Cir.Mar. 17, 2011.

VISIONS

17

cific medications. We are not keepingany kind of scheduled drugs, just a mini-mal amount of antibiotics to get themthrough a day or two. It is not a profitcenter; it is a value-added service.

Dr. Thomas: The reimbursement youwould get from dispensing would benegligible. There is also the hassle factor.

Dr. Cranfield: We can still do it foroccupational medicine patients, but it isnot as easy on the urgent care side, pri-marily because most insurance plansinclude pharmacy. Unless you have apharmacy with pharmacists on staff andhave signed up with that insurance planto dispense, you are not going to get alot of that business. It used to be reallybig, but it has tapered off quite a bit.

Q:What have you found is themost effective way to market

your centers?Ms. Brock: One of the first things we

learned when we added urgent care wasthere was a lot of confusion in the mar-ket as to what we had become: “Are youseeing primary care?” “Can I bring thekids over?” We thought we had mar-keted it very well. Our mistake was thatit was not a clear, consistent message,and I don’t think we did enough mar-keting, either. We did a massive market-ing campaign when we first opened.Then we just assumed that because wehad been there for so long, everybodywould know who we were originally. Wefound that was not so.

Dr. Cranfield: It seems as if it is stillthe roadside sign, word of mouth andthe Yellow Pages, believe it or not, thatbring people in. My office is located justsouth of Hendersonville, which is a rap-

idly expanding community. Five yearsago, in order for people to get the thingsthey needed, they had to come down tomy part of the woods. WhenHerdersonville got its own (major chainstores), it kept people there up to apoint. We ended up using a strategicallyplaced, visually appealing billboard rightat the cutoff point.

Another thing we have found to besuccessful are television ads. I am usu-ally the one who speaks in them. Youget groupies who say, “I saw you onTV!” even long after the ad stops running.

Dr. Thomas: Our surveys show a lotof the public doesn’t understand whaturgent care means. If you tell themwalk-in, that means one thing. Some ofthem think of urgent as more for emer-gencies. You have to realize that whenyou do your advertising and marketing,it is helpful to have your providerinvolved in the marketing, particularlyin occupational medicine. Having theprovider involved in what you are tryingto do to promote your facility is impor-tant to your survival and success.

“We learned there was a lot of confusion in the marketplace as to what we had become.”

Q:When Concentra was marketingitself as a pure-play occupa-

tional medicine specialty practice andthen converted to the blended model,how did you deal with the switchfrom a marketing perspective?

Dr. Thomas: The trick is for a com-

pany that has been a pure-play modelwith a directed focus to get the providersto switch directions. For me it was not aproblem because I was used to seeingsick people – that was my background.For some physicians it is almost as ifthey have to go back to medical school,in their minds at least, to accept it.

Q:What is your best piece ofadvice for operators of mixed-

use clinics or those who are consider-ing introducing the blended model?

Dr. Cranfield: I didn’t start skiinguntil I was 34 years old. I started on thebunny slope and quickly moved up themountain. Don’t be afraid to try some-thing new. It is going to be hard whenyou first start, but once you learn howto do it, it will be an easy ski down theslope after that. You have to start on thebaby slopes but don’t wait too long toget to the top of the mountain.

Ms. Brock: Either you control theday or the day controls you. Given thenature of the competition and what ishappening to our profession, I wouldrather be on the forefront and control-ling my own destiny than have someonedo it for me, even if I am speeding downthe ski slope. Move forward. Even if youfall on your face, you are still movingforward. Go with it.

Dr. Thomas: Try to know where youhave been before you try to know whereyou are going. Have a feel for what hashappened in the past in your area. Get afeel for the landscape. Pick a path, starton that path and stick with it. Don’tdeviate too much from the original planfor your journey.

Panelists, continued from page 9

Asbestos Roadmap; provides aresearch framework to address scien-tific uncertainties for asbestos andother particles to allow NIOSH toupdate its recommended exposurelimit (REL); http://www.cdc.gov/niosh/docs/2011-159.

Fact sheets on spirometry testsissued by OSHA and NIOSH;www.cdc.gov/niosh/docs/2011-132/and www.cdc.gov/niosh/docs/2011-133.

Non-fatal Occupational Injuriesand Illnesses Among OlderWorkers – United States, 2009;although older workers had similar orlower rates for all injuries and illnessescombined compared with youngerworkers, the length of absence fromwork increased steadily with age andwas highest for older workers;Morbidity and Mortality Weekly Report60(16); 503-508, April 29, 2011;http://cdc.gov/mmwr/preview/mmwrhtml/mm6016a3.htm.

Occupational HighwayTransportation Deaths, UnitedStates, 2003-2008; report on preven-tion related to highway transportationcrashes, the leading cause of fatalinjuries in the United States for bothworkers and the general population;Morbidity and Mortality Weekly Report60(16);497-502, April 29, 2011;http://cdc.gov/mmwr/preview/mmwrhtml/mm6016a2.htm.

Recommended Resources

18

The curriculum for RYAN Associates’ 25th AnnualNational Conference, Oct. 17-19 in Atlanta, is posted in detail at www.naohp.com.

October 17 Highlights

Keynote Address: The Evidence Is In: OccupationalHealth as the National Medical Delivery Model

Kathryn Mueller, M.D., M.P.H., Medical Director, Colorado Division of Workers’ Compensation andProfessor, Department of Surgery and School of PublicHealth, University of Colorado

Concurrent Sessions-Morning and Afternoon1. Program Diversification • Delivering Services Outside of the Clinic• Complementary Products and Services• Responding to the Increasing Demand for Prevention and

Chronic Disease Management

2. Occupational Health Business Management:National Best Practices for Clinicians

• This full-day program is designed for clinicians (and thosewho work closely with them) who wish to hone their busi-ness management skills.

3. Core Components for Profitable OccupationalHealth Program Operations

• This three-day seminar-within-the-conference is a NEWand UPDATED version of RYAN Associates’ popular occu-pational health operations overview course.

General Session: Expanding Your Organization’s Capabilities ThroughVendor Alignment

October 18 Highlights

General SessionEmeritus Faculty Panel:

Been There Since Day One – Benefitting from 25 Years of Experience and Knowledge

The Georgia Provider SummitGeorgia has some unique requirements with respect toworkers’ compensation and the delivery of occupationalmedicine services, including the mandated use of providerpanels. This two-hour session will feature lectures andpanel discussion.

Concurrent Sessions-Morning1. Special Topics for Hospital-Affiliated Programs 2. Special Topics for Freestanding Clinics and Other

Non-hospital Affiliated Programs

Concurrent Sessions-Afternoon1. Update on the NAOHP Benchmarking Pilot Project.2. Cultivating the Interface Between Clinical and

Administrative Perspective3. What Customers Tell Us: Lessons from 25 Years of

Employer Market Research4. Transitioning to a Medical Home/Accountable Care

Organization (ACO) Model5. Core Components for Profitable Occupational

Health Program Operations, continues

Discussion Groups:1. Concurrent Jam Sessions: What Is On Your Mind?

Conference participants will be invited to complete a sur-vey in advance to rank selected topics of interest/value tothem. Multiple facilitated roundtable jam sessions will bebased on the top-ranked topics.

2. Mentor-Protégé “Speed Dating”

October 19 Highlights

NAOHP Open Board Meeting: Using the Association to Advance Your Objectives

General Session: Insights from the Centers for Disease Control andPrevention (CDC)

Concurrent Sessions:1. Urgent Care and Occupational Medicine Services:

Perfecting the Balancing Act2. Legal, Regulatory and Ethical Issues Facing Medical

Providers and Employers3. Core Components for Profitable Occupational

Health Program Operations, concludes

Annual Software User Group Meetingsand Updates:

Integritas, Inc. (Agility EHR and Stix)Pure Safety (Occupational Health Manager and SYSTOC)

RYAN Associates’ National Conference CurriculumFocuses on Demonstrating Business, Clinical Value

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VISIONS

To list your event, email information to Karen O’Hara,VISIONS Editor: kohara@naohp.com

MAYMay 14-19Innovate. Integrate. Inspire:annual American IndustrialHygiene Association conferenceand exposition; sponsored byAIHA® and ACGIH®; Portland, OR;www.aihce2011.org.

May 17-19Occupational HearingConservation Course; sponsoredby Washington OccupationalHealth Associates; Washington,DC; www.woha.com.

May 24-26Drug and Alcohol TestingIndustry Association annual conference; sponsored by DATIA;Doral Resort & Spa, FL:www.Datia.org/conference2011.

JUNJULJune 6-8NIOSH-Approved SpirometryCourse, followed by CAOHC-approved Hearing ConservationCourse; sponsored by M.C.Townsend Associates, LLC;Pittsburgh, PA;www.mctownsend.com.

June 7-84th National Health CareErgonomics conference; spon-sored by Washington State SafePatient Handling SteeringCommittee, Oregon Coalitionfor Healthcare Ergonomics,Northwest Center forOccupational Health and Safetyand University of Washington;Tacoma, WA; https://osha.deohs.washington.edu/index.cfm.

June 12-15 Safety 2011: ASSE PDC & Expo;sponsored by American Societyof Safety Engineers; McCormickPlace Convention Center,Chicago, ILwww.asse.org/education/pdc11.

June 20-23 Public Health Leadership: TheKey to a Healthier Nation; sponsored by U.S. Public HealthService; New Orleans, LA.;www.phscofevents.org.

July 12-13 National Occupational ResearchAgenda (NORA) Symposium2011; sponsored by NationalInstitute for Occupational Safetyand Health; Hyatt RegencyCincinnati, OH; www.team-psa.com/NORA2011/aboutNora.asp.

July 18-21National Workers’Compensation and OccupationalMedicine Conference; sponsoredby SEAK; Resort and ConferenceCenter at Hyannis, Cape Cod,MA.; www.seak.com.

ASSOCIATIONS

Urgent Care Association of America(UCAOA) UCAOA serves over 9,000 urgent care centers.We provide education and information inclinical care and practice management, andpublish the Journal of Urgent Care Medicine.Our two national conferences draw hundredsof urgent care leaders together each year.Lou Ellen Horwitz • Executive DirectorPhone: (813) 657-0508lhorwitz@ucaoa.orgwww.ucaoa.org

BACKGROUND SCREENING SERVICES

Acxiom You can’t afford to take unnecessary risks.That’s where Acxiom can help. We providethe highest hit rates and most comprehensivecompliance support available–all from anunparalleled, single-source solution. It’s a customer-centric approach to backgroundscreening, giving you the most accurate information available to protect your company and its brand.Michael Briggs • Sales LeaderPhone: (216) 685-7678 • (800) 853-3228Fax: (216) 370-5656michael.briggs@acxiom.comwww.acxiombackgroundscreening.com

CONSULTANTS

Advanced Plan for HealthAdvanced Plan for Health has a plan and aprocess to reduce the rising costs of healthcare. By partnering with APH, you can providecustomized plans to help employees of thecompanies, school systems and governmentoffices in your market. You can show theorganizations how to improve their healthplan, finances and employee productivity.Rich Williams Phone: (888) 600-7566 Fax: (972) 741-0400 richwilliams@aph-online.comwww.aph-online.com

Bill Dunbar and Associates BDA provides revenue growth strategies toclinics and hospitals throughout the U.S.BDA’s team of professionals and certifiedcoders increase the reimbursement to itsclients by improving documentation, coding,and billing. BDA offers a comprehensive, cus-tomized, budget-neutral program designed tofocus on improving compliance along withnet revenue per patient encounter.Terri Scales Phone: (800) 783-8014Fax: (317) 247-0499 ts@billdunbar.com • www.billdunbar.com

Medical Doctor Associates Searching for Occupational Medicine Staffingor Placement? Need exceptional service andpeace of mind? MDA is the only staffingagency with a dedicated Occ Med team ANDwe provide the best coverage in the industry:occurrence form. Call us today.Joe WoddailPhone: (800) 780-3500 x2161Fax: (770) 248-6701woddailj@mdainc.comwww.mdainc.com

Reed Group, Ltd.The ACOEM Utilization ManagementKnowledgebase (UMK) is a state-of-the-art solution providing practice guidelines infor-mation to those involved in patient care, uti-lization management and other facets of theworkers’ compensation delivery system. TheAmerican College of Occupational andEnvironmental Medicine has selected ReedGroup and The Medical Disability Advisor asits delivery organization for this easy-to-useresource. The UMK features treatment modelsbased on clinical considerations and four lev-els of care. Other features include ClinicalVignette – a description of a typical treatmentencounter, and Clinical Pathway – an abbrevi-ated description of evaluation, management,diagnostic and treatment planning associatedwith a given case. The UMK is integrated withthe MDA for a total return-to-work solution. Ginny Landes Phone: (303) 407-0692 Fax: (303) 404-6616 glandes@reedgroup.com www.reedgroup.com

Refer aVendor— Earn $100

Vendor, individualand institutionalmembers of the

NAOHP will receive a$100 commission forevery referral theymake that results in anew vendor member-ship. The commissionwill be paid directly tothe referring individualor their organization.There is no limit to thenumber of referrals. In other words, if fivereferrals result in fivenew memberships, thereferring party willreceive $500.

If you know of a vendor who would benefit from joining the NAOHP VendorProgram, please contactStacey Hart at 800-666-7926 x12.

The following organizations and consultants participate in the vendor program of the NAOHP,including many who offer discounts to members. Please refer to the vendor program sectionof our website at: http://www.naohp.com/menu/naohp/vendor/ for more information.

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RYAN AssociatesServices include feasibility studies,financial analysis, joint venture devel-opment, focus, groups, employer sur-veys, mature program audits, MISanalysis, operational efficiencies, prac-tice acquisition, staffing leadership,conflict resolution and professionalplacement services.Roy GerberPhone: (800) 666-7926x16Fax: (805) 512-9534rgerber@naohp.comwww.naohp.com

ELECTRONIC CLAIMMANAGEMENTSERVICES

Unified Health Services, LLCUnified Health Services provides com-plete electronic work comp revenuecycle management services from“patient registration to cash applica-tion” for medical groups, clinics, andhospitals across the country. Thisincludes verification and treatmentauthorization systems, electronicbilling, collections, and EOB/denialmanagement. Provider reimburse-ments are guaranteed.Don KilgorePhone: (888) 510-2667Fax: (901) 255-6797dkilgore@uhsweb.comwww.uhsweb.com

WorkCompEDI, Inc.WorkComp EDI is a leading supplier of workers’ compensation EDI clear-inghouse services, bringing togetherPayors, Providers, and Vendors to promote the open exchange of EDI for accelerating revenue cycles, lower-ing costs and increasing operationalefficiencies. Marc MenendezPhone: (800)297-6906Fax: (888) 454-2681MMenendez@WorkCompEDI.comwww.workcompedi.com

LABORATORIES &TESTING FACILITIES

Clinical Reference Laboratory Clinical Reference Laboratory is a pri-vately held reference laboratory withmore than 20 years experience part-nering with corporations in establish-ing employee substance abuse pro-grams and wellness programs. In addi-tion, CRL offers leading-edge testing

services in the areas of Insurance,Clinic Trials and Molecular Diagnostics.At CRL we consistently deliver rapidturnaround times while maintainingthe quality our clients expect.Dan WittmanPhone: (800) 445-6917Fax: (913) 492-0208wittmand@crlcorp.comwww.crlcorp.com

eScreen, Inc. eScreen is committed to delivering innovative products and services whichautomate the employee screeningprocess. eScreen has deployed propri-etary rapid testing technology in over1,500 occupational health clinicsnationwide. This technology creates theonly paperless, web-based, nationwidenetwork of collection sites for employ-ers seeking faster drug test results.Robert ThompsonPhone: (800) 881-0722Fax: (913) 327-8606 marketing@escreen.comwww.escreen.com

MedDirectMedDirect provides drug testing products for point-of-care testing, lab confirmation services and DOTturnkey programs.Don EwingPhone: (479) 649-8614Fax: (479) 648-3246dewing@gomeddirect.comwww.gomeddirect.com

MedTox Scientific, Inc.MEDTOX is committed to providingthe best service/testing quality in theindustry. MEDTOX is a SAMHSA certi-fied lab and manufactures our owninstant drug testing products–the PRO-FILE® line. Our expertise also includeswellness testing, biological monitor-ing, exposure testing and many moreservices needed by the occupationalhealth industry.Jim PedersonPhone: (651) 286-6277Fax: (651) 286-6295jpederson@medtox.comwww.medtox.com

National Jewish HealthNational Jewish Health, world leaderin diagnosis, treatment and preventionof diseases due to workplace and envi-ronmental exposures offers practical,cost effective solutions for workplacehealth and safety. We specialize inberyllium sensitization testing, diagnosis and treatment, exposureassessment, industrial hygiene

consultation, medical surveillance and respiratory protection. Visit www.NationalJewish.org. Other metal sensitivity testing is available. Wendy NeubergerPhone: (303) 398-1367800.550.6227 opt. 6neubergerw@njhealth.orgwww.njlabs.org

Oxford ImmunotecTB Screening Just Got Easier withOxford Diagnostic Laboratories, aNational TB Testing Service dedicatedto the T-SPOT.TB test. The T-SPOT.TBtest is an accurate and cost-effectivesolution compared to other methodsof TB screening. Blood specimens areaccepted Monday through Saturdayand results are reported within 36-48 hours.Noelle SneiderPhone: (508) 481-4648Fax: (508) 481-4672nsneider@oxfordimmunotec.comwww.tbtestingservices.com

Quest Diagnostics Inc.Quest Diagnostics is the nation’s lead-ing provider of diagnostic testing,information and services. OurEmployer Solutions Division provides acomprehensive assortment of programsand services to manage your pre-employment employee drug testing,background checks, health and well-ness services and OSHA requirements.Aaron AtkinsonPhone: (913) 577-1646Fax: (913) 859-6949aaron.j.atkinson@questdiagnostics.comwww.employersolutions.com

MEDICAL EQUIPMENT,PHARMACEUTICALS,SUPPLIES AND SERVICES

Abaxis®

Abaxis® provides the portable PiccoloXpress™ Chemistry Analyzer. The analyzer provides on-the-spot multi chemistry panel results with compara-ble performance to larger systems inabout 12 minutes using 100uL ofwhole blood, serum, or plasma. TheXpress features operator touchscreens, onboard iQC, self calibration,data storage and LIS/EMR transfercapabilities.Joanna AthwalPhone: (510) 675-6619 Fax: (736) 262-6973joannaathwal@abaxis.comwww.abaxis.com/index.asp

VISIONS

VENDOR PROGRAM, cont.

AlignMedAlignMed introduces the functional and dynamic S3 Brace (Spine andScapula Stabilizer). This rehabilitationtool improves shoulder and spine func-tion by optimizing spinal and shoulderalignment, scapula stabilization andproprioceptive retraining. The S3 isperfect for pre- and post- operativerehabilitation and compliments physical therapy. Paul JacksonPhone: (800) 916-2544 Fax: (949) 251-5121pjackson@alignmed.comwww.alignmed.com

Alpha Pro Solutions, Inc.Internationally recognized leader ofDrug Free Workplace and handhygiene training and consulting.Occupational Health clinics make greatre-sellers to employers (DERs, supervi-sor signs and symptoms, employeeawareness). Drug Collector, BAT andInstructor training via WEB andClassroom. Breathalyzer and screeningdevices. Instructor tools: WEB,PowerPoint, Manuals, Tests, Videos. Sue ClarkPhone: (800) 277-1997 x700Fax: (727) 688-2727sue@alphaprosolutions.comwww.alphaprosolutions.com

A-S Medication Solutions LLCASM, official Allscripts partner, intro-duces PedigreeRx Easy Scripts (PRX), aweb-based medication dispensingsolution. Allowing physicians to elec-tronically dispense medications at thepoint-of-care with unique ability tointegrate with EHR or be used stand-alone. PRX will improve patient care,safety and convenience, while gener-ating additional revenue streams forthe practice.Lauren McElroyPhone: (888) 990-6510info@a-smeds.comwww.a-smeds.com

Automated Health CareSolutionsAHCS is a physician-owned companythat has a fully automated in-office rx-dispensing system for workers’ com-pensation patients. This program is avalue-added service for your workers’compensation patients. It helpsincrease patient compliance with med-ication use and creates an ancillaryservice for the practice. Shaun Jacob, MBAPhone: (312) 823-4080Fax: (786) 594-4645sjacob@ahcs.com

Dispensing SolutionsDispensing Solutions offers a conven-ient, proven method for supplyingyour patients with the medicationsthey need at the time of their officevisit. For nearly 20 years, DispensingSolutions has been a trusted supplierof pre-packaged medications to physi-cian offices and clinics throughout theUnited States. Bernie TalleyPhone: (800) 999-9378Fax: (800) 874-3784 btalley@dispensingsolutions.com www.dispensingsolutions.com

Keltman Pharmaceuticals, Inc. Keltman is a medical practice serviceprovider that focuses on bringinginnovative practice solutions toenhance patient care, creating alterna-tive revenue sources for physicians.Keltman’s core service is a customiz-able point of care dispensing system.This program allows physicians to setup an in-office dispensing systembased on a formulary of pre-packagedmedications selected by the physician.Wyatt WaltmanPhone: (601) 936-7533Fax: (601) 936-7787wwaltman@keltman.comwww.keltman.com

Lake Erie Medical & SurgicalSupply, Inc./QCP For 24 years Lake Erie Medical hasserved as a full-line medical supply,medication, orthopedic and equip-ment company. Representing morethan 1,000 manufacturers, includingGeneral Motors, Ford and Daimler-Chrysler, our bio-medical inspectionand repair department allows us tooffer cradle-to-grave service for yourmedical equipment and instruments. Michael HolmesPhone: (734) 847-3847Fax: (734) 847-7921Mikeh@LakeErieMedical.com www.LakeErieMedical.com

PD-Rx PD-Rx offers NAOHP members a com-plete line of prepackaged medicationsfor all Point of Care and Urgent CareCenters. So if it’s Orals Medications,Unit Dose, Unit of Use, Injectables, IV,Creams, and Ointments or SurgicalSupplies that you need, let PD-Rx fillyour orders. 100% Pedigreed. Jack McCallPhone: (800) 299-7379 Fax: (405) 942-5471jlm@pdrx.comwww.pdrx.com

PROVIDERS

Methodist Occupational Health CentersMethodist Occupational HealthCenters (MOHC) is an Indiana basedprovider of clinic based occupationalhealthcare and a national provider ofworkplace health services for employ-ers looking to reduce overall employeehealthcare costs. In addition, MOHCIprovides revenue cycle services nation-ally to other occupational health programs and health systems.Thomas BrinkPhone: (317) 216-2526 Fax: (317) 216-2839tbrink@clarian.orgwww.mohci.com

New England Baptist HospitalOccupational Medicine CenterNew England’s largest hospital based occupational health network offers a full continuum of care. Areas ofexpertise include biotechnology,orthopedics, drug and alcohol testing,immunizations, medical surveillanceand physical examinations.Irene AndersonPhone: (617) 754-6786 Fax: (617) 754-6453Ianderso@caregroup.harvard.edu

PUBLICATIONS

Center for Drug TestInformationWe are here to help you find theanswers to your questions about alcohol and drug testing and the StateLaws that apply. We provide specificstate information and court cases youcan use to protect your organizationand save money by knowing yourstate’s incentives and workers’ compensation rules.Keith DevinePhone: (877) 423-8422Fax: (415) 383-5031info@centerfordrugtestinformation.comwww.centerfordrugtestinformation.com

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VISIONS

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SOFTWARE PROVIDERS

Integritas, Inc. Agility EHR 10 is both CCHITCertified® 2011 Ambulatory EHR, andcertified as an ONC-ATCB 2011/2012Complete EHR, enabling governmentincentives for eligible providers.Designed to meet specific needs ofhigh volume Occ Med/Urgent Careclinics, charting is fast and thorough,coding is automated, customer sup-port is notoriously outstanding. Genevieve MusonPhone: (800) 458-2486www.integritas.com 2011sales@integritas.com

MeditraxMediTrax™ is a user-friendly softwarethat meets real-world information management needs. Features includepoint-and-click appointment schedul-ing, workflow-driven-data entry, “one-minute” patient registration andcheckout, voice-recognition support

for clinical dictation, automated ICD9and CPT4 coding, integrated workers’comp and OSHA reporting, testing-equipment interfaces, and occupation-specific surveillance programs. Joe Fanucchi, MDPhone: (925) 820-7758Fax: (925) 820-7650drjoe@meditrax.com www.meditrax.com

Practice VelocityWith over 600 clinics using our soft-ware solutions, Practice Velocity offersthe VelociDoc™—tablet PC EMR forurgent care and occupational medi-cine. Integrated practice managementsoftware automates the entire rev-enue cycle with corporate protocols,automated code entry, and automatedcorporate invoicing.David Stern, MDPhone: (815) 544-7480Fax: (815) 544-7485info@practicevelocity.comwww.practicevelocity.com

PureSafety’s OccupationalHealth Manager® (OHM®) &SYSTOC®

PureSafety’s powerful, yet easy-to-usesoftware helps you manage all aspectsof occupational health and safety witha full suite of solutions for bothemployers and providers – powered byindustry-leading OHM and SYSTOCsoftware platforms. Now you have thepower of the industry’s best tools formedical surveillance; case manage-ment; billing; flexible reporting andmuch more at your fingertips – from asingle company.Kelley Maier, VP, MarketingPhone: (888) 202-3016Fax: (615) 367-3887marketing@puresafety.comwww.puresafety.com

ALASKA 5 • ARIZONA 3 • ARKANSAS 3 C A L I F O R N I A 9 3 • C O L O R A D O 2 0 CONNECTICUT 13 • DELAWARE 6 • FLORIDA 16G E O R G I A 2 1 • I D A H O 9 • H A W A I I 2 ILLINOIS 62 • INDIANA 23 • IOWA 11 KANSAS 3 • KENTUCKY 21 • LOUISIANA 12MAINE 2 • MARYLAND 7 • MASSACHUSETTS 16MICHIGAN 22 • MINNESOTA 4 • MISSISSIPPI 8MISSOURI 13 • MONTANA 18 • NEBRASKA 1NEVADA 2 • NEW MEXICO 1 • NEW JERSEY 18 N E W H A M P S H I R E 3 • N E W Y O R K 1 4NORTH CAROLINA 10 • NORTH DAKOTA 2 OHIO 53 • OKLAHOMA 5 • OREGON 12 PENNSYLVANIA 34 • RHODE ISLAND 1 SOUTH CAROLINA 8 • SOUTH DAKOTA 6 TENNESSEE 30 • TEXAS 23 • VERMONT 1 V I R G I N I A 1 1 • W A S H I N G T O N 2 0 W E S T V I R G I N I A 1 • W I S C O N S I N 2 7 W Y O M I N G 1

Frank H. LeonePresident and CEO

Since 1985

Karen J. O’HaraSenior Vice President

Since 1990

Roy K. GerberSenior Principal

Since 1998

Donna Lee GardnerSenior Principal

Since 1997

For more information, call Roy Gerber at 1-800-666-7926, x16

EXPERIENCECOUNTS

700 occupational health-specific engagements

in 48 states since 1985

OCCUPATIONAL HEALTH CONSULTING SERVICES

Medical Director/ Staff Physicians• Maryland (Physician) - NEW POSITION• San Francisco (Medical Director, Occupational Health) - NEW POSITION• San Francisco (Medical Director, Employee Health) - NEW POSITION• Boston/Northern New Jersey (Physician)• Boston/Northern New Jersey (Nurse Practitioner)• Southwest Ohio (Medical Director)• South Carolina (Medical Director)• D.C. Area (Medical Director)• Chicagoland (Medical Director)• Florida (Medical Director, Urgent Care)

Non-Physician Openings• San Francisco (Occupational Health Director) - NEW POSITION

For details, visit www.naohp.com/menu/pro-placement.

The NAOHP/RYAN Associates Professional Placement Service is seeking qualified candidates for the following positions:

226 East Canon PerdidoSuite M

Santa Barbara, CA 93101

1-800-666-7926www.naohp.com

PresidentJewels Merckling, Vice President,Enterprise SalesIntegritas, Inc.Kansas City, MO816-399-3951Jewelsm1210@integritas.com

Northeast – DE, MD, New England states, NJ, NY, PA, Washington D.C., WVDr. Steven CrawfordCorporate Medical DirectorMeridian Occupational HealthWest Long Branch, NJ 732-263-7950scrawford@meridianhealth.com

Southeast – AL, FL, GA, MS, NC, SC, TN, VALeonard Bevill, CEOMacon Occupational MedicineMacon, GA478-751-2925; lbevill@maconoccmedicine.org

Great Lakes - KY, MI, OH, WIKaren Kosidowski-Bergen, R.N.,AdministratorEncore UnlimitedStevens Point, WI715-966-5468;kkosidowskibergen@encoreunlimited.com

Midwest - IL, INTom Brink, President and CEOMethodist Occupational Health CentersIndianapolis, IN317-216-2520; tbrink@clarian.org

Heartland – AR, IA, KS, LA, MN, MO, MT, NE, ND, OK, SD, TXMike Schmidt, Director of OperationsSt. Luke’s Occupational Health ServicesSioux City, IA 712-279-3470; schmidMS@stlukes.org

West – AK, AZ, CA, CO, HI, ID, NM, NV, OR, UT, WA, WYDr. John Braddock, CEO & Medical DirectorCascade Occupational MedicineLake Oswego, OR503-635-1960; braddockj@cascadeoccmed.com

AT LARGEMichelle McGuire, Application SpecialistPureSafetyLawrence, KS207-474-8432; michelle.mcguire@puresafety.com

Troy Overholt, DirectorSt. Luke’s Work Well SolutionsSt. Luke’s HospitalCedar Rapids, IA319-369-8749; OverholTL@crstlukes.com

NAOHP Regional BoardRepresentatives and

Territories

Board Roster