Have you ever had an employer protocol or procedure refused by a patient? Understanding the reasons behind a refusal and how to handle such situations properly is essential to protecting client relationships and maintaining successful business practices.
It’s no secret that employers require their new hires to go through a pre-employment screening process. From physical exams to drug tests, companies need to ensure their employees are fit for the job and do not have any substance abuse issues.
However, in some cases, these employer protocols can be refused by the patient. This was recently seen during a member consultation when a potential new hire was sent to their UrgentCare/OccMed center to complete a new hire exam and drug test.
When the employer received the drug test report, they inquired as to why the physical exam results were missing from the package. It turned out that only the drug test had been completed but not the physical examination.
Here is an email account of what happened next:
Employer
Going forward how can I ensure a physical is completed? I selected on the form to have a physical completed also we do not test for THC how do we ensure the next person I send will receive a physical and also will not be tested for THC?
Clinic
I want to clarify that we have a physical form that can be used when they come in. Regarding THC, this can be omitted from the results. I’ll remind the medical staff to omit it from the documentation. Attached is the authorization form that must be filled out prior to coming in.
Employer
Please see the attachment I sent with <> for clinic visit. (referring to the authorization form already completed where she selected the exam and drug test to be performed)
Clinic
I spoke to the staff member that did the intake for this employee and she stated that the employee wanted a drug test only. The employee will need to return for the physical.
Employer
I do not understand this process at all. How is the patient able to tell your staff what is needed and not follow what was ordered on the form? What is the purpose of the form? This has not been a great experience at all. From the DOT doctor not being available to now my new hires can pick and choose what tests will be performed.
I do not plan to send anyone else there. THANKS!
Could this situation have been avoided, now having lost this client?
Clearly, this interaction did not end well, but could it have been avoided? Yes! By following a simple set of standard procedures, this situation could have been avoided entirely:
- Before the visit, employers should fill out an intake form or authorization of services form – paper or electronic – with the procedures that need to be performed.
- It’s best practice to create a profile in the EHR for each client that includes all their usual exams and components they’ll receive when they come in.
- The front desk staff or MA/nurse doing the intake should review with the patient/examinee what they’re there for and all the procedures that need to be done, such as an exam and drug test.
- After the visit is complete, employers should be notified immediately about who was seen, what procedures were performed, any follow-up plans (if any) and any issues that occurred. This can be done through an employer portal with an email alert or, if necessary, via fax or phone call. Be sure to document who was called and what message was delivered.
- If the examinee refuses a procedure indicated on the form/protocol, it’s best to contact the employer immediately while they’re still there. This gives the employer an opportunity to speak with the individual and clarify what needs to be done.
It’s important for workers to understand that any assessment of their job performance is based solely on their ability to carry out the required tasks and has nothing to do with any medical conditions or diagnoses they may have.
This statement:
“I spoke to the staff member that did the intake for this employee and she stated that the employee wanted a drug test only. The employee will need to return for the physical. ”
Indicates that the staff member did not follow the indicated procedures or was not aware of what should have been performed.
If procedures were missed upon intake, the front desk staff has a chance to review upon discharge what was done and check that against what was supposed to be done.
Once again, an EMR or other electronic tool with an employer exam profile capability would indicate the procedures to be performed and may have prompts or alerts if all procedures are not completed.
Is this client “save-able?”
I believe the best way to rescue a situation where you have messed up with an employer is to:
Review – Revise – Re-train
- Review your procedures that led to the glitch
- Revise the procedures accordingly (perhaps as I have just laid out)
- Re-train the staff on the new procedures and the reason they are needed, share with them the risk of losing/angering a company client because of the failed procedures
- Communicate to the employer:
- Apologize for the misunderstanding/missed procedure
- Comment on the review, procedure revision and re-training of staff so that it does not happen in the future
- Take the opportunity to gather any other protocol info from the client and get it into your system
When should the provider call an employer?
Notice I said when not should the provider call an employer. Physicians and Advanced Practice Providers (APPs) doing occupational medicine work should be in the habit of regularly communicating with employers on a daily basis.
Most routine pre-hire exams and tests don’t necessitate a provider call. This task can typically be managed electronically or by office personnel. It’s usually only injured workers who require a provider phone call.
That said, here are my top 4 reasons the provider should reach out and discuss the matter with the employer:
- After the initial evaluation for a worker’s compensation injury, it’s essential to provide employers with an immediate phone call to update them on the worker’s progress – including their work status, prognosis, and treatment plan. This allows employers to feel more assured of their employee’s well-being.
- If a worker needs to be taken off duty due to their injury, employers must be informed as soon as possible. This will help ensure they are kept in the loop and can make any necessary arrangements quickly.
- Referrals to physical therapy, specialty care or advanced diagnostics may be required if a worker’s condition worsens or fails to progress after initial treatment. Keeping employers updated on this information ensures they can provide for their injured employee’s care in a timely manner.
- Employers must be informed of any changes to the initial plan that was established after the worker’s evaluation. This way they can stay up-to-date with how their employee is being treated and make sure they are receiving the necessary care. Deviations from the initial plan must be explained in order to ensure employers are kept in the loop and comfortable with their employee’s progress.
Providers may complain they just don’t have time for this. It can work when the office functions as a team. The front desk staff can assist in getting those employer contacts on the phone when the provider is in between patients or during specified 10 or 15 blocks once or twice a day for calls.
You can also leave a voicemail in most cases, once you know and have permission to leave messages about injured workers on the correct company contact’s line. Provider phone calls go a long way in differentiating your practice as serving the needs of the employer.
Do you have the right systems?
Having the right systems in place can make all the difference when it comes to avoiding misunderstandings or mistakes with employer clients.
Having an EMR and other electronic tools with an employer exam profile capability will help ensure that procedures are correctly followed, provide alerts for incomplete tasks, and allow for easy communication between patients and employers. Making sure you have these systems in place and are properly trained can save you from losing valuable clients.
