By Curtis Smith, Executive Vice President, Medcor
On-site health services can deliver significant savings in workers’ compensation costs (as well as other valuable benefits), but these savings don’t happen automatically. Poorly run on-site services can actually add to costs and bureaucracy. Average programs can generate enough savings to be deemed successful – preventing employers from extracting the full potential from their on-site programs. Maximizing the value of on-site health services requires following a few core best practices, relevant experience, and ongoing oversight – principles common to maximizing the value from most professional services. These efforts are well worth the investment, whether or not the services are delivered in-house or outsourced.
The scope of on-site health services varies substantially. Clinical staff ranges from first responders to nurses, mid-level practitioners, and physicians. Coverage ranges from a single shift to 24/7. Services range from first aid to complex medical care and everything in between. Worksite populations using on-site services range from a few hundred employees to sites with many thousands of employees. Regardless of the scope of services, the core concept is similar: placing a medical professional on-site with appropriate equipment to assess injuries, treat on-site where appropriate, and refer off-site when necessary.
Summary of Benefits
The benefits of top-performing on-site health services are so compelling that thousands of worksites use on-site health services already. The focus is usually on cost savings, but there are other benefits, too.
Reducing Workers’ Compensation Costs
- Treating minor cases on-site, rather than referring to off-site providers avoids unnecessary claims and their associated costs. (Without on-site services, many cases are sent for medical care simply to find out if they need medical care.)
- When off-site care is required, on-site medical staff can guide the referral in three ways, all of which reduce costs: selecting the right level of care (e.g., doctor vs. ER), recommending in-network providers (e.g., based on preferred pricing, service levels, and outcomes); and determining the urgency (e.g., right now vs. appointment tomorrow). Even in states where employees have the option to select their provider, the on-site medical professional can successfully guide good decisions much of the time.
- The benefits of early intervention are well established; being on-site enables intervention to begin literally within minutes of an incident.
Supporting Claims Management
- By interacting directly with injured employees in the worksite, the on-site professional can become the eyes and ears of the case manager and claims adjuster, providing real-time information to help them do their work.
- The on-site provider can relay information back to the injured employee. Being dedicated to one worksite, the medical professional can become very familiar with the employer’s workers’ compensation policies and providers (such as the TPA), becoming a trusted advisor for the employees.
Supporting Return to Work
The on-site professional can serve as a return to work liaison, answering questions and clarifying restrictions for employees and supervisors alike, as well as off-site providers. Being on-site, able to visit the worksite and personally interact daily with the affected employee is simply not feasible for off-site medical providers. Improvements in return to work drive down indemnity payments, improve productivity, and speed recovery when proper restrictions are followed.
Supporting Safety
In the course of assessing and treating injuries, the on-site health staff can collect valuable information about the incidents – when they happened and where, the mechanism of injury, affected body parts, etc. Sharing this data appropriately with safety professionals frees them to focus on causation and prevention. The on-site staff can also reinforce prevention and compliance issues in their interactions with employees. Ultimately, supporting safety reduces frequency which is the best outcome for employees as well as the payor!
Regulatory Compliance
Onsite medical staff are ideally positioned to help manage PHI and comply with HIPAA, GINA, HITECH, OSHA, and other applicable regulatory restrictions on the health information employers can collect and how they use it.
Controlling Occupational Health Costs
Separate from workers’ compensation, many employers incur substantial costs associated with new hire exams, mandatory surveillance programs (such as hearing conservation and respiratory protection), drug tests, and a host of other occupational health services. These services often fall into many different budgets and their total size is not recognized by employers; an on-site health program may be able to consolidate these services at lower cost and with far less time away from work.
Best Practices
Achieving the full potential of the benefits described above and others requires following a few best practices.
- Standards & Protocols
The on-site program must set written standards and follow them. The standards must be matched to the clinical level of the staff, ensuring staff can function to their fullest ability. The standards must also set limits; the infrequency of some kinds of interventions means staff will likely not stay proficient over time; in other cases, the human risks and costs risks associated with certain interventions (e.g., treating eye injuries) make them ill-advised for most on-site services. The standards must follow evidence-based medicine: using only treatments that have been shown scientifically to work and avoiding treatments that are unproven. This requires keeping up with current, published, authoritative sources – more than just reading a couple medical journals. The standards should be optimized for on-site services, which is different than practicing in clinic or hospital settings. The value of good protocols is hard to overstate: the best systems enable RNs to handle over 80% of the cases on-site, while the worst systems handle only 20%! - Training
On-site health services have become a true subspecialty, but it is not part of regular medical training. Learning the nuances and best practices can take years for even good practitioners, at a high cost to employers and injured employees who have to wait for the benefit of best practices. The best programs include intensive training at the onset, supported by ongoing training. Training not only transfers knowledge from experienced practitioners, but provides opportunity for assessing capabilities and service levels. - Medical Oversight
On-site health services need physician medical direction. In most cases, state laws regarding medical practice and the corporate practice of medicine require it. The physician should be actively engaged in supporting on-site staff, consulting on complex cases, mentoring, and quality assurance. If the medical director is not familiar with on-site services or doesn’t believe in the staff’s capabilities, the outcomes will be limited. - Electronic Health Record
State-of-the-art software is no longer an option; it is key to operating efficiently, standardizing documentation, data collection and reporting, QA, regulatory compliance, and implementing standards. The last point is often overlooked – if the software the clinician is using with every patient doesn’t have the standards and protocols programmed into it, the chances are good that the protocols will sit on the shelf in a binder unused. Good health data systems enable analyses of cost drivers, injury drivers, ROI, benchmarking between sites, productivity, and other valuable assistance to workers’ compensation stakeholders. Secure data connections can efficiently transfer injury information to TPAs and other providers. When combined with claims data, the analyses become even more valuable. - Avoiding Conflicts of Interest
The on-site world is fraught with potential conflicts of interest that can prevent maximizing the value of an on-site health program. Some vendors gain revenue from referring patients to their off-site clinics or hospitals; others sell and mark-up the medications or physical therapy they prescribe. Still others sell group health insurance and retirement plans, and use on-site occupational health clinics as a path to selling those programs. In-house programs aren’t immune, either – budgets, staff and turf are vigorously defended, even if underperforming. Fixed fees may incentivize vendors to cut corners; cost-plus models underestimate costs in bids and shift risks of escalating prices to the employer. Consultants have their favorite vendors and derive fees from running RFPs. TPAs (and in-house claims departments) may fear a reduction in claims that on-site programs can achieve. No model is perfect; to maximize value, the employer must be engaged in the on-site program, understand the potential conflicts, and monitor performance carefully.
While most organizations are looking for ways to control the rate of increase in their comp costs, a best-in-class on-site program can actually reduce hard-dollar costs – and generate additional benefits from productivity; presenteeism; reduced turnover, IBNR, and litigation; improved frequency mods; and other “soft costs.” Maximizing results is well worth the investment.
(p.s. Many companies and vendors are, understandably, focused on general health costs, which are often much larger than comp costs, and the effect of healthcare reform; on-site health services can help there, too. The benefits of wellness, chronic disease management and group health savings may take years to achieve, and can be challenging in industries with high turnover. Even in these cases, solid savings from workers’ compensation may be an effective way to fund the long-term investments necessary to control general health costs.)
About Curtis Smith
Curtis has nearly 30 years of experience in delivering heath care services, including emergency service, on-site services, and telemedicine in public and private sectors. As EVP at Medcor, Curtis is responsible for business development, including implementation of new services, and helping customers develop cost saving strategies. Curtis helps Medcor and its clients integrate data and services from multiple vendors within healthcare, including brokers, TPAs & ASOs, provider networks, and case managers. Since joining Medcor in 1995, Curtis has gained first-hand experience in many aspects of healthcare operations, from recruiting to training staff, to start-ups and vendor transitions, IT systems, supply chain, legal structures, and matching scope of service to client needs. He has worked with large and small clients, in rural and urban settings, with union and non-union labor, and with government agencies.
About Medcor
Medcor provides worksite health services to help employers reduce their workers’ compensation and general healthcare costs and improve health outcomes. Medcor provides its services with staff and systems located on-site in large client locations or via telemedicine for smaller locations. When injuries or illness occur, Medcor intervenes immediately. Following evidence-based medicine, Medcor can determine the severity of each case as well as the best course of action for its immediate treatment. With this approach, unnecessary treatments, claims, and costs are avoided, while required treatments are obtained right away.