During a recent online educational program sponsored by RYAN Associates, four speakers representing three health system-affiliated occupational health programs discussed the development of revenue-producing product lines designed to complement core service offerings, including:
- Jim Carroll, Director, Health Connections, and Eric Waters, COO, Pen Bay Healthcare, Rockland, Maine;
- Rick Rankin, Director, Adventist Health Job Care, Portland, Ore.
- Tim Ross, Regional Administrative Director, WorkingWell, Sisters of St. Francis Health Services, Inc., Northern Indiana Region.
Q: What basic approach has your program taken to enhance revenue through the introduction or integration of adjunct service offerings?
Mr. Waters emphasized the importance of leveraging economies of scale and acknowledged the need to plant the seed before expecting staff to embrace or understand a new idea.
Mr. Ross highlighted the necessity of thorough information gathering from reliable sources before introducing new services, emphasizing the involvement of front-end staff in managing the paperwork. In response to economic changes,
Mr. Rankin discussed the shift in the value discipline of their program from operational excellence to product innovation, viewing the downturn as an opportunity to introduce value-added products with a direct impact on the bottom line and minimal overhead expense.
Q: What are some specific examples of adjunct services that you recommend other occupational health programs investigate and/or introduce in their markets?
Mr. Ross introduced three services—travel medicine, Social Security disability physicals, and immigration physicals—at selected clinic locations, with potential plans for Federal Aviation Administration physicals.
Mr. Waters described the infrastructure built for primary care within their occupational health program, enabling resource sharing to address bottlenecks in Health Connections/occupational health, the emergency department, employee health, and physician practices. This setup allows for resource allocation to equalize variations in demand.
Mr. Rankin outlined the development of a low-cost pre-employment medical screen and a partnership with a vendor for a proactive, web-based risk management product, aiming to save employers time and money while aiding in regulatory compliance.
Q: Complete this sentence: With regard to developing adjunct products and services, if we knew then what we know now, we would have…
Mr. Carroll has been better prepared to bill group health insurers. I would have had that all set up in advance, because each provider had to be credentialed with Aetna, Blue Cross, Prudential, whoever the payer was, and that significantly delayed primary care implementation.
Mr. Rankin spent more time thinking about and developing services that had a direct impact on the bottom line and a better profit margin.
Mr. Ross handled travel medicine marketing a little differently upfront. There is a broad range of opportunities out there and you can’t use a blanket approach. Each segment and travel locale has specific requirements; services should be marketed accordingly.
WorkingWell Adds Selective Products to Increase Revenue
WorkingWell, an occupational health program based at Saint Anthony Memorial Hospital, Michigan City, Ind., with affiliated clinics in Crown Point, Valparaiso, Hammond, and Munster, operates under the Sisters of Saint Francis Health Services, Inc., Northern Indiana Region. As part of its efforts to meet client needs and build its business, the program has introduced several adjunct product lines, including travel medicine, Social Security disability physicals, and immigration physicals.
Travel Medicine:
The program provides travel medicine services at two of its five locations. Services include:
• pre-travel consultation to international travelers on vaccination requirements and safety precautions, e.g., food, water, destination-specific information, disease prevention; and
• Vaccinations, educational materials and prescriptions (e.g., malaria prophylaxis mediation); The potential market for travel medicine is more
broad-based than one might initially imagine. In addition to business travelers, target market segments include leisure and adventure travelers, scientists/researchers, church groups and missionaries, and philanthropic organizations. Registration with the U.S. Department of Health as a designated yellow fever vaccine supplier is necessary to become a full-service travel clinic. (Yellow fever vaccination is required prior to admission to certain
countries.) Other issues to consider include:
• Knowledge of CPT and ICD-9 codes specific to travel medicine.
• Access to specialized reference materials and software that can be obtained from the Centers for Disease Control and Prevention (www.cdc.gov/travel) or purchased by subscription.
• Reimbursement issues. For example, at WorkingWell, reimbursement ranges from $60 to $120 per visit, plus vaccination charges. The patient may choose to submit charges for payment under their private insurance plan.
Social Security Disability Physicals:
The determination of disability benefits involves independent physicians performing exams under contract. Upon review and approval of an application submitted by the physician, the Social Security Administration designates the occupational health program as a preferred provider. When a claimant files for Social Security income due to a disability, a case evaluator determines if a consultative exam is needed, typically required when the claimant’s medical record lacks certain information or they haven’t recently seen a doctor. A Social Security representative schedules the exam, and the clinic sends the evaluee a packet of medical history forms before their visit. WorkingWell has designated times for evaluations, lasting about 20 to 30 minutes. Completed exam and medical history forms are sent to the Social Security office, which pays WorkingWell $110 per physical plus a set rate for additional diagnostic work. Extra tests are performed only at the request of the Social Security Administration. Due to the paperwork-intensive nature of disability exams, the process must be handled exceptionally efficiently and cost-effectively for the service to be profitable.
Immigration Physicals:
Individuals applying for citizenship, seeking permanent residency, or a green card must obtain an immigration physical as part of their adjustment of status application. WorkingWell conducts immigration physicals at two locations, assessing health conditions like sexually transmitted diseases, TB, and psychological disorders. The physical, performed by a civil surgeon designated through the U.S. Department of Homeland Security’s Citizen and Immigration Service, requires physicians to be board-certified with a full and unrestricted license, four years of professional experience, and no current disciplinary actions. The civil surgeon follows CDC guidelines for the examination, reporting results on Form I-693. Completed forms are retained for at least two years. The examining physician may refer the applicant for follow-up, and compliance is necessary for status adjustment. WorkingWell charges a base fee of approximately $300, plus additional diagnostic tests, with applicants covering the cost out of pocket.
Value-Added Services Improve Bottom Line for Adventist Program
Adventist Health Job Care operates four occupational medicine clinics in greater Portland, Ore. As part of a head-to-toe examination of its operations, management introduced a number of new policies and procedures and eliminated activities perceived as “non-value-added.” A medical screening questionnaire offered as a low-cost alternative to a standard pre-placement exam and a web-based safety and risk management system for employers is among its most recent innovations.
Medical Screen:
The medical screen is a questionnaire that legally provides employers and their insurers with baseline health information on job applicants; it is being marketed as a deterrent to fraudulent workers’ compensation claims. The questionnaire is not designed to take the place of a physical exam; it is an alternative for jobs that don’t require a full physical. The target market includes companies that have not previously performed any pre-placement screening exams. A physician reviews the job applicant’s completed questionnaire and recommends either approval, approval with limitations, or denial of hire to the prospective employer based on the findings and essential functions of the job. If medical treatment appears to be warranted, the screening physician recommends a follow-up physical examination and/or diagnostic tests. The job applicant is advised that the employer or hiring official will not receive any confidential information, only the results of the physician’s review. For less than the price of a drug screen, the program is able to offer the employer a detailed medical history of each employee that is kept in a medical record on file in the Job Care clinic. When the medical screen is combined with a drug screen, the employer receives a discount on both, and the package has been exceptionally well received.
Risk Management:
Job Care has entered into a partnership with an external vendor, Succeed Management Solutions, to offer employers low-cost access to web-based, risk management, safety, and regulatory compliance applications. The product positions Adventist as a “solutions provider.” Each module features the Job Care brand and is accessible to client companies only through the Job Care website. There is a one-time fee of $500 to access the entire platform (less for individual modules), plus a nominal annual maintenance fee. Job Care receives 50 percent of the revenue. The content includes a safety library of more than 1,300 bilingual safety documents and materials; certification of insurance tracking; a comprehensive incident and claim management program, including OSHA log maintenance, incident reports, first reports of injury, and losses; material safety data sheet functions; and a variety of training components. “Succeed Management Solutions also has an effective marketing mechanism in place,” said Job Care Director Rick Rankin. “We select six to 10 employers and they give them a password to do a free trial. They also sponsor webinars (on the product) and invite 20 to 25 companies at a time to participate in that. It’s a win-win.”
