Financial Management of the Occupational Medicine Practice

In this episode of Fit for Duty, host Dr. Larry Earl, president of the National Association of Occupational Health Professionals, and guest Keith Lavin, Director of Business Operations at Hackensack Meridian Health, delve into the financial hurdles facing occupational medicine practices.

They discuss the increasing costs and shrinking revenues in healthcare, particularly in occupational medicine, studying pre and post-pandemic cost drivers like salaries and turnover rates. The conversation also covers financial management strategies, including cost containment, billing and coding innovations, and the importance of tracking key financial metrics.

The episode highlights the role of technology and AI in enhancing service delivery, examines trends in workplace health services, and offers insights on starting and growing an occupational medicine practice amidst financial and operational challenges.

Key Discussion points:

00:00 Welcome to Fit for Duty: Unraveling Occupational Health

01:07 Deep Dive into Financial Challenges in Occupational Medicine

02:14 Exploring Financial Hurdles and Solutions

06:38 Strategies for Financial Management and Growth

09:44 Innovations in Billing, Coding, and Revenue Optimization

14:14 Cost Effectiveness and Value-Based Care in Occupational Health

25:59 Expanding Services and Embracing Technology for Growth

31:57 Emerging Trends and Opportunities in Occupational Medicine

35:17 Advice for New Practitioners and Conclusion

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[00:00:00] Host: Greetings and welcome to Fit for Duty. I'm Dr. Larry Earl, your host and president of the National Association of Occupational Health Professionals. Today, we'll explore the world of occupational health, unraveling the complexities of [00:00:20] OSHA regulated exams, workers compensation cases, drug testing, and injury care strategies.

[00:00:26] Host: We'll also examine prevention strategies. Total person health analytics and interventions discussing innovative approaches to preventing workplace injuries and illnesses using total person health analytics to [00:00:40] identify underlying factors contributing to workplace health issues. and showcasing successful interventions that have improved employee health and well being.

[00:00:49] Host: Fit for Duty provides a holistic approach to occupational health, empowering organizations to create healthier, more productive workplaces. Join us as we push the [00:01:00] boundaries, break down silos, and bridge theory and practice.

[00:01:07] Host: Hey everyone, and welcome back to this episode of Fit for Duty. I'm Dr. Larry Earl, president of the NAOHP, National Association of Occupational Health Professionals, and your host. Today we're zeroing [00:01:20] in on a topic that's absolutely essential for a successful occupational medicine practice. I'm I have the pleasure of speaking with Keith Lavin, who's the Director of Business Operations at Hackensack Meridian Health.

[00:01:34] Host: With his wealth of experience, Keith is going to share insights on the financial hurdles commonly [00:01:40] encountered in occupational medicine. We'll cover everything from cost containment and those pesky billing and coding issues to new ways of boosting revenue and where a forward thinking practice should be investing its hard earned money.

[00:01:52] Host: Thanks Whether you manage a large operation, own a smaller clinic, or are thinking about starting an occupational medicine practice of your own, [00:02:00] this episode is packed with actionable advice. So let's get right to it. Keith, welcome to the show.

[00:02:11] Host: Okay, Keith. Well, then let's just jump right into the questions. First thing is what are the biggest financial challenges facing occupational [00:02:20] medicine practices today?

[00:02:22] Guest: Well, I think everybody knows this, but it's. increasing costs with not as much revenue coming in. statistic that I came across recently was that, uh, on average over the past couple of years, hospitals, uh, their expenses have gone up like [00:02:40] 17%.

[00:02:40] Guest: But the reimbursement has only gone up 7 percent during the same time period. So definitely creates this really challenging, uh, area for healthcare in general is kind of like, again, the, everybody talks about inflation, but yeah, we're starting to see where some of these numbers really are landing for [00:03:00] healthcare in general and occupational medicine specifically.

[00:03:03] Guest: Last year when we did the survey, those results gave us a really, really good look at a pre and post pandemic cost. And some of the biggest drivers, of course, were salaries. and there were [00:03:20] substantial increases. I mean, some categories we're seeing over a 25% increase in, uh, that difference between the.

[00:03:28] Guest: 2019 survey and the 2023 survey. so that's a lot of, that's a lot of money that's now going out. And yes, these people are worth the investment, but [00:03:40] by that same token, we've got to figure out how to pay for that investment. How do we,

[00:03:44] Host: how do we pay for them? I also saw that the hospital turnover rate last year was something like 23%.

[00:03:52] Host: And you know, when you have a huge increase in turnover, that, uh, that, Typically comes with an increased employee [00:04:00] expense, so not just salaries, but, the turnover with, uh, you know, retraining and all the effort and time and money that goes into that. So how do, how do occupational medicine practices stay afloat?

[00:04:13] Host: in this environment? How has it affected Achmed

[00:04:16] Guest: specifically? So, I mean, there's a lot of [00:04:20] factors that we have to take a look at. the point that you just made in regards to the cost of turnover is seeing what we can do in regards to retention. sometimes that may be saying maybe we need to take a look at our benefits and the possibility of keeping that, uh, or investing a little bit more in regards to [00:04:40] that so that we don't have that cost of the turnover because that is a huge cost and it has a cascading effect through services, which is Can have a cascading effect through revenue.

[00:04:52] Guest: so you got to pay attention to all of those. So it's, it is a big challenge, but it's that dealing with the [00:05:00] employees, keeping the employees, that's kind of your first step in regards to all of this. there's all the issues of burnout. There's all the issues of taking a look. And you have people now that, oh, it's part of their norm.

[00:05:14] Guest: To jump employers every year. we had recently somebody that, [00:05:20] uh, we interviewed and they were proud of the fact that they've had three employers in three different years.

[00:05:27] Host: Whereas in the past, that was always the red flag. Wait

[00:05:30] Guest: a second. Yeah. Yeah. That was always,

[00:05:32] Host: it was the red flag. We wouldn't want to see that.

[00:05:35] Host: And now it's, Oh, well, that's just the way it is because I'm going to, I'm in high demand [00:05:40] and I'm going to go where I get the best deal.

[00:05:41] Guest: That is one of those factors that you have to take a look at because some of these benefits are increasing, where you'll end up a few years ago. It's okay. 21 percent you can figure 21 percent of my annual salary and an additional 21 percent is benefits.

[00:05:58] Guest: Now you got to take a look at it. It's [00:06:00] 26, 27, 28. Sometimes 30%. So again, that's another area that is a big expense that needs to be thought about. because most people just think of salary and they forget to calculate how much that benefit is going to cost. And it's [00:06:20] definitely worth it. but again, it's one of those things that you need to really Understand and delve into to make sure that you're capturing the appropriate costs.

[00:06:28] Guest: And that is part of your calculations as you figure out your financials.

[00:06:33] Host: Well, and you mentioned the benchmark study and calculation. So what are some of the key? financial metrics that [00:06:40] occupational medicine practices should be tracking.

[00:06:43] Guest: So first and foremost, dollars through the door. I always kind of tell everybody it's kind of like, yeah, it's great.

[00:06:51] Guest: Yeah. It's kind of like, it's the dollars that are coming in, and making sure that all of that, but you start to take a look. And as [00:07:00] we were just talking about with the benefits is what are my actual costs and truly understanding Transcribed drilling down into that, so that you can say, it's kind of like, okay, my cost for providing a drug screen is going to be X, and then how do I make sure that I am [00:07:20] capturing everything that goes into that cost and really understanding it, and then having a, you know, profit margin on top of that.

[00:07:28] Guest: And sometimes it doesn't have to be this huge profit margin, but especially in healthcare, I mean, in comparison to a lot of other industries, we have very narrow margins, [00:07:40] but it's still something that we need to be paying attention to. And then the positive side versus sometimes as you walk into situations.

[00:07:49] Guest: Negative margins don't work really well.

[00:07:51] Host: Yeah. Yeah. And I think you're answering the next question pretty, pretty well. If you want to elaborate on this, how can practices use that data to make better [00:08:00] financial decisions? Right. It's not just about the top line, but what does it cost you?

[00:08:04] Guest: Yeah. Yeah. What does it cost you?

[00:08:06] Guest: What are your expenses that go into it? Because it's not just the cost of that test and the base salary for the, the CMA, LPN, nurse, whatever that's performing that [00:08:20] test. It's okay. What's their, the benefits that are going into that also? What are your administrative costs? Uh, What's the cost for keeping the lights on?

[00:08:31] Guest: so you have to start calculating all of those factors that go into that. And generally, as you're, and yes, it becomes very, very [00:08:40] complex. So you want to take a look at saying, okay, where are kind of general areas that I can add on some of these expenses where, okay, I make the calculation with the person's salary.

[00:08:51] Guest: Okay. I know I know somebody's salary. I add 26 percent on top of that for their benefits on an hourly basis and start [00:09:00] drawing through some of that. But then it's kind of like, okay, what do I need to do for some of these other expenses? And you come up with a general number. I mean, it could be as low as 10 percent additional on top of that, and then you put in your profit margin.

[00:09:15] Guest: or if you have the resources to be able [00:09:20] to come up with even stronger numbers than that and delve into that, you can really, uh, bring that down to really saying, okay, this is what I really have to be making to cover my expenses. And this is the. true actual cost of me providing this service.

[00:09:38] Host: So on the topic [00:09:40] of this is what I have to be making, you know, we talked a little bit about the top line.

[00:09:44] Host: Uh, what are some, uh, and, and there have been all these changes in the last couple of years for billing codes. Right. Uh, new codes in 21. what are some of the best practices now for billing and coding? Again, for [00:10:00] occupational medicine services realizing, you know, we've got workers comp, which uses E and M codes and all the typical.

[00:10:06] Host: insurance industry codes that we're used to, but then we've also got EPS, right? Employer paid services that are off the grid as far as insurance companies go. What's the best way to balance a billing and coding for all these different [00:10:20] services?

[00:10:22] Guest: Well, this is going to start with your billing team. I mean, making sure that you have.

[00:10:27] Guest: Certified coders. I mean that again, this is these are some of the investments that you have to make. I think we have section talk. We can talk a little bit later about investments, but that investment in people making sure that you've got the [00:10:40] billing, making sure that your EMR system is really a good quality one.

[00:10:46] Guest: And your. Team understands how to capture everything that you're that you're doing. and that may take some additional education because you have some people that were used to a way of doing it [00:11:00] 5, 6 years ago. Again, we have new codes that are coming out or have come out. and being able to do that, then you've got to start analyzing your market, also in regards to that too, because again, you got to take a look at what you want to do.

[00:11:16] Guest: I mean, being a low cost, the low cost [00:11:20] provider. Has his advantages of you'll grab volume, but revenue, your margins are going to be really, really slim. And if somebody manages to pick something off from you, it can cascade again, uh, making it look bad, but again, be on the flip side, being the high cost provider.

[00:11:38] Guest: Yeah. I

[00:11:38] Host: mean, low cost, [00:11:40] high volume is also very stressful on your staff. Yeah. And that, you know, that has to be, that has to be a consideration. So sometimes, yeah, sometimes you have to pick and choose what services are you going to even provide? What are the decent margin ones that you can afford

[00:11:57] Guest: in the current environment?[00:12:00]

[00:12:00] Guest: Exactly. And it's kind of like, it's that time value of money. Yeah.

[00:12:05] Host: What are the, uh, what sort of things can practices do to optimize the whole revenue cycle? Not just billing, uh, and coding, but are there other revenue cycle, uh, sort of tips and tricks we should be thinking [00:12:20] about? Uh, again, in the context of having kind of a dual practice, right?

[00:12:24] Host: We have some insurance based and we have some direct employer paid services. Is there any innovations there?

[00:12:32] Guest: So you need to understand your basics in regards to that payer mix. I mean, again, you could be Depending [00:12:40] on how you set it up. And again, you have to understand how it's set up You may be in an environment where your reimbursement for workers comp is not necessarily great, but it's solid it's consistent and moves through and you may have your other services, OCMED services that, Hey, I'm making a decent margin [00:13:00] on these.

[00:13:00] Guest: And it's, again, it's that balance of making sure that you don't have too much of one, not enough of another, and taking a look at, again, through that entire cycle of it, because you also have to take a look at your, uh, AR, your accounts receivable. if you're being paid on a, uh, consistent basis, because it's that cashflow, if you [00:13:20] have, payers that are 120 days out, which all of us have, it's kind of like, okay, what percentage is that?

[00:13:28] Guest: and what do you need to do to kind of pull, rein that back in? I've been in situations where it's kind of like, okay, yeah, we've got, Payers that are 360, which is 360 days out. And it's kind of like, [00:13:40] how are we going to get this money? and being able to really kind of rein that back in some of it, setting expectations, sometimes you have to make some hard decisions and say, you know what, I'm just going to have to write this off and, uh, go from there.

[00:13:53] Guest: Um,

[00:13:53] Host: and cancel

[00:13:54] Guest: that client. You provided service and cancel that client. You might have to cancel that client. It's [00:14:00] a hard call. Yeah, it's a hard call. That's always rough. And if you're fortunate enough to have invested in a sales team, they are going to flip out. but sometimes it's necessary.

[00:14:14] Host: Let's switch gears a little bit and talk about cost effectiveness and value based care.

[00:14:19] Host: [00:14:20] We often get this issue coming from our members about how can the occupational medicine practice, particularly in a health system environment, demonstrate the value they provide, not just to employers, but to the health system itself.

[00:14:39] Guest: [00:14:40] So, uh, Again, there's a whole but we're specialists. I mean, we need to act like specialists. it's you go to a cardiologist. If you have heart problem, you need to come. We need to be the specialist and be able to show that value of saying, Hey, we know what a hexavalent chromium physical is. I, I choose that one because [00:15:00] I can say hexavalent chromium physical, which is a fun one.

[00:15:02] Guest: but it's a really important factor because, uh, the hexavalent chromium physicals are a welder physical. It's an industrial thing. Your average. Family medicine or urgent care is not going to know what that is off the top of your head, but that's where we start to show [00:15:20] value to these clients of saying, we know what that is.

[00:15:24] Guest: You don't need to worry. We know what it is. Do it right. we're not having a check. or anything else to make sure that we're got everything covered. That's where we start to differentiate ourselves. and saying, yes, we're able to do this. you're [00:15:40] talking about hospital base and mentioned, hospital base, the med programs and hospitals were pushed straight out into the forefront during the pandemic.

[00:15:50] Guest: because that's where a lot of the systems really started to see the value of kind of like, Oh, wait a second. These people have some very important [00:16:00] information that's critical to the operation of this system. And, oh yeah, let's throw this at them, see if they can figure it out. And yeah, they did. I mean, it was so many cases that I know about.

[00:16:15] Guest: we experienced ourselves in the hospital system I was working in where it was like, nobody knew what to [00:16:20] do. And it's kind of like, so they went to the ACMED doctors and it's kind of like, and they, Within the next day, they had the answer. there's so many of those cases across the country where again, it was just one of these incredible, incredibly tragic, but also incredible opportunities for us to really show again, that specialization and that understanding [00:16:40] of it and the quality, that the teams were able to provide.

[00:16:46] Host: How do we show, uh, cost reductions for employers? What are some of the best strategies?

[00:16:53] Guest: Okay. So cost reductions are always kind of that cost avoidance type thing. It's kind of like, Oh, [00:17:00] you, you didn't have this expense. And it's kind of like, it's hard to show. So you have to create a story around it, uh, really showing, knowing your numbers, not just kind of the basic financial ones, but saying, Hey, what are, uh, standards for like, these type of injuries or return to works.

[00:17:18] Guest: so you [00:17:20] need to be able to really kind of put out a really big net and then create that story for that cost reduction because it's okay. I know what we do for workers comp. I mean, it's not a, we're going to say, Hey, here are the restrictions for this [00:17:40] person to come back to work. You as an employer, if you can.

[00:17:44] Guest: Accommodate that. Great. Otherwise, they'll be out and there's an expense with that, but that's a really critical difference when you start taking a look at things because if you're just putting them out, well, the company may have opportunities for that individual to [00:18:00] continue to, uh, be in the work environment and recover undue stress on them and also maintain that work based support because we spend most of our days at work and it's a part of that structure and they [00:18:20] also deconditioning, yeah, we can have providers talk a whole lot about what's, what happens to an individual if they're just placed out of work versus is actually, again, working with the employer to accommodate.

[00:18:33] Guest: if possible, uh, in this, in a safe way, to get them back to work as soon as possible. Yeah. So, so modified [00:18:40] duty. Certainly. Yeah.

[00:18:42] Host: Modified duty programs have to be in place. And, and we just had, uh, an episode about work conditioning. Perhaps for those who have been off duty for a while or haven't been on their full heavy duty job.

[00:18:55] Host: And as you said, now they're deconditioned, right? So sometimes we're conditioning [00:19:00] strategies that we talked about in the last episode, uh, would, would be helpful to, uh, reduce costs of even further. Time loss,

[00:19:07] Guest: right? Because you're taking, and again, this starts, I look at it from a financial perspective, it's like, Hey, I invest in a little bit on this work conditioning side of things.

[00:19:18] Guest: What's my return on [00:19:20] investment? Preventing an injury.

[00:19:23] Host: Or a re injury in this case. A bounce back. A bounce back. We don't want that. So what are ways that practices can really partner with employers to implement programs on the wellness side of things, uh, you know, [00:19:40] not workers comp, but on other illnesses and diseases that come up in the workplace or just in general.

[00:19:46] Guest: parts of it is again saying, Hey, paying attention to what's going on, but spending a lot of time talking to your clients, talking to them in the workplace saying, what is it that you're seeing? What is it that you're needing? because [00:20:00] HR teams will know saying, Hey, here are some of my trends. But we have to ask those questions.

[00:20:04] Guest: We have to have our providers out in front of our clients, understanding the work, the workplace, understanding what they're doing, but also understanding some of the trends that are currently going on. right now, of course, there's a [00:20:20] major concern in regards to mental health.Our occupational medicine clinics may not be able to provide that directly, but maybe there's a resource that they have that they can access and make that connection for the employer.

[00:20:33] Guest: Yeah, it may not be a direct, uh, financial benefit for us, butcan [00:20:40] create some goodwill, for the future. but also again, puts us forward as kind of like, Hey, if I have an issue, I want to go to the people that have the resources or know the resources as to how to take care of the issues. Yeah. And there's a lot of wellness programs out there.

[00:20:55] Guest: yeah, some of them are better than others. some of them are. Uh, [00:21:00] very simplistic. Others get a lot more complex and really have to have a lot of buy in. and that's a, that's also a really important one. where some of these wellness programs that are out there have been very, very successful. especially some with like fire departments.

[00:21:16] Guest: But what was done was the team worked on the buy [00:21:20] in to get the employees to buy in on this. And it was a whole team approach to get those employees buying in. And they did see some really, uh, substantial results.

[00:21:30] Host: Yeah. Participation, you know, so key, uh, and that's a big draw down with a lot of wellness programs.

[00:21:36] Host: You put the program in place, but there's no champion to sort of rah, [00:21:40] rah, rah, rah. rally the troops and get them to actually participate. You know, one thing you mentioned, uh, huge issue today, mental health. And, that kind of leads to my next question is what is the role of telemedicine in cost effective occupational health?

[00:21:55] Host: And that's certainly an area that has, uh, it's almost [00:22:00] designed for telemedicine, right? Uh, to have, Yeah, it is counseling and support sessions via telehealth. I think is one one good area. Any other, uh, any other, uh, comments or, uh, sort of other not markets, but. [00:22:20]

[00:22:20] Guest: Yeah, there are other areas, because one of the challenges that we've been given is to really start to think outside the four walls of the clinic.

[00:22:30] Guest: How do we do that? How are we going to drive out into the communities? Telehealth is one of those areas where we can kind of expand [00:22:40] our reach, our scope a bit. For Achmed, it needs to be very focused, talking about mental health, that's one area, but there are other areas, partnering with, fire departments, for example, going through annual OSHA questionnaires.

[00:22:55] Guest: you can set some stuff up and have a [00:23:00] telemed visit with an individual if there are additional questions, Without having to drag them into a clinic for a, what could be a very quick, visit, but again, it's again, reaching out, creating that convenience for, for the, for the company, for the patient.

[00:23:19] Guest: so there's definitely a [00:23:20] lot of opportunities. It does need to be kind of taken slow and you have to think out all of the processes for this. there are, of course, uh, in all the issues about reimbursement, how do you do this? Um, but there's codes for that, right?

[00:23:34] Host: You

[00:23:35] Guest: can get paid. Yes, there are. Yes, you can get paid for it.[00:23:40]

[00:23:40] Guest: You just need to understand those codes and what the requirements are and calling it a telehealth visit versus a telemedic visit. I mean, so you've got to understand those. And again, there are people out there that are real experts at it. You need to tap into them.

[00:23:55] Host: What are other ways that practices can adapt to this [00:24:00] growing focus on value based care?

[00:24:02] Host: Uh, you bet sort of an emerging concept, uh, really, right? Uh, fee for service. How do we do that in Achmed?

[00:24:12] Guest: So in Achmed, I mean, what we need to really take a look at is we're kind of going to this much more value based, versus the [00:24:20] kind of really traditional, model that we've had is again, understanding what the needs are.

[00:24:26] Guest: figuring out if there's technologies that you can invest in, that kind of can assist in moving this, and again, being very adaptable, to it. And I know these are very kind of generic kind of, Oh, yeah, these are [00:24:40] the things, but again, it's each market's going to be slightly different. and your customer base is going to be different.

[00:24:46] Guest: So you really need to, again, understand that, having, allowing the providers to be able to get out a little bit, which has, it's, it's a challenge because you have to understand that it's kind of like, okay, if my provider is out [00:25:00] on a site visit, they're not seeing, And that's the billable versus this non billable.

[00:25:08] Host: Yeah, but right. Are you nurturing that relationship with a new client or with an existing client? They want to see them every once in a while.

[00:25:16] Guest: Uh, yeah. And that's, that's an area where the [00:25:20] investment in a sales professional. can be very, very important. going back to, the benchmark survey, we did notice there was a decrease in the number of sales professionals that are out there, uh, in occupational medicine, which can be problematic because they can be out [00:25:40] there, again, understanding the market, understanding that client and being able to bring some really critical information back to the providers, back to leadership.

[00:25:49] Guest: So the, the, Understands again, the changes that are happening in the market and being able to stay on top of that.

[00:25:59] Host: Let's move into, [00:26:00] you talked about investments a couple of times. Let's move into investment and growth a little bit. What do you think are some smart ways for occupational medicine practices to be investing their capital?

[00:26:12] Guest: So, uh, again, uh, and we, we hear a lot of talk about AI, for example, understanding, [00:26:20] How's that going to affect us? can AI eventually move into the future and become, not a replacement? It's definitely not a replacement, but a supplement somehow of an assistant almost, to those providers. I was reading an article recently where, they were talking about That interaction [00:26:40] between, the provider and the patient, where now it's very common that, hey, there's a computer in the room with them and they're typing some notes real quick.

[00:26:50] Guest: They're paying attention, but they're still having to kind of like scroll through some stuff. And as some AI comes on [00:27:00] board to really capture the conversations and can parse all of that out appropriately. Instead, I can be looking directly at the, patient and having that really face to face interaction, which again, a good provider is also going to use that to be able to see any additional cues that [00:27:20] To help dig into some stuff.

[00:27:21] Guest: so again, providing again, that level of service, that level of comfort.

[00:27:25] Host: It's really amazing how, how well the transcription, uh, AI transcription services, uh, work, uh, and

[00:27:33] Guest: why would you not use, yeah, it's, yeah, it's amazing how far they've come over just a few [00:27:40] years and how quickly they're advancing. so, but as you're investing in this, you need to really understand The partnership that you have to create with your technology companies, they've got to share very similar beliefs, and values to you.

[00:27:58] Guest: there's a lot of them out there. [00:28:00] and you got to, you really have to take the time to invest in that because again, this is a big, Big investment in technology. staying on that cutting edge is really important to make sure that you're staying relevant, moving into the future, but you have to have the right partners to be able to do that.

[00:28:16] Guest: so it does take a lot of, it does take time and effort [00:28:20] to really understand them and, and getting beyond the, their sales pitch to you, but saying, Is this really the right connection to them? Am I going to get the support that I need? Because, hey, I'm not technically savvy, or I don't have a huge team that's technically savvy, [00:28:40] or I do have a great, uh, IT department, and they are very tech savvy, and they can really support and help us.

[00:28:49] Guest: Again, it's going to be a whole mix of things, but that technology is one of those areas to really, Invest your time and resources in, as we move into the future, because it [00:29:00] will make things move much quicker, provide the opportunities to, again, get beyond the four walls of the clinic, and drive some of those services out into, our environments where we need to be.

[00:29:14] Guest: Let's talk

[00:29:15] Host: about that growth a little bit then. How can practices expand their services? [00:29:20] Is it all through technology? How do you reach new markets? Are we looking at bricks and mortar anymore? What's the best way to expand our

[00:29:27] Guest: practice? Well again, yes, you're always, you're always going to be looking at brick and mortar, but you really need to be smart about how you're investing in that.

[00:29:36] Guest: And markets are vastly [00:29:40] different. I mean, I'm currently in the Northeast, uh, our markets, I mean, property is very valuable. we're very densely populated here in Jersey. So you've got to make sure that you're in the right place, and that your footprint matches up appropriately. And if you're [00:30:00] looking at going into another market, you need to understand that market and the potential, the competition that's there.

[00:30:08] Guest: and that's where you definitely need to invest in market analysis, which Larry,

[00:30:14] Host: I know you do. So we've done a little work there, haven't we? Yeah.

[00:30:18] Guest: Yes, we have. [00:30:20] Um, so it is an unbiased plug. Um, but it is, but it is important.

[00:30:27] Host: Yeah. You need the market analysis. You need to know how many workers are in your market.

[00:30:32] Host: Who's the competition? Where are they located? Uh, is it accessible? Uh, and how does it drive those revenues? [00:30:40] How do you calculate the expenses? So it's all part of the equation,

[00:30:43] Guest: right? Yeah, I was going to say, it's kind of like, that's just the brick and mortar portion of it. As again, taking a look, saying, okay, how do we use technology?

[00:30:51] Guest: And I'm a big advocate for technology, because you can start to get Get out and do things a little bit non-Traditionally, some stuff that [00:31:00] took like a ton of paperwork and a back and forth and literally guys delivering boxes filled of forms that have been filled out, uh, for a provider to sift through.

[00:31:13] Guest: And it's kinda like, okay, yep, they got all of check marks. Versus using an electronic form where they're filling out [00:31:20] the stuff and they've got, hey, hard stops. If you didn't fill out this section, you can't go beyond that and can't miss it. So and then having that drop into, uh, an Excel spreadsheet or CSV.

[00:31:33] Guest: And so there's a really a lot of those opportunities that just again, That's being creative, [00:31:40] understanding what your market is, what your needs are, and being able to provide some opportunities that, uh, other people necessarily hadn't thought of yet. You

[00:31:50] Host: know, you mentioned some, uh, services, uh, for welders, for firefighters.

[00:31:57] Host: Are these some emerging trends in [00:32:00] occupational medicine that offer some promising opportunities, certainly with firefighters? You know, there's a huge focus now on all the exposures they have and how traditionally we haven't been looking at cancer surveillance as an occupational medicine, uh, service per se.

[00:32:15] Host: But certainly we do with firefighters now and there may be, uh, certainly, uh, [00:32:20] certainly we have other lung exposures that we've looked at, uh, cancers, pneumoconiosis and, asbestos and silicosis and such. What are the trends? We've heard about silicosis with, uh, engineered stone workers has been a huge problem.

[00:32:33] Host: Uh, what are other trends that we should be looking at?

[00:32:37] Guest: So a lot with [00:32:40] first responders, and again, that's a, it's one of those challenging markets because again, municipalities don't necessarily have a whole lot of money to spend, but it's critical to spend on them. Uh, you were talking about firefighters, but.

[00:32:52] Guest: ACOM has come, has come out with, uh, a protocol for law enforcement officers, [00:33:00] uh, for pre employments. again, these are investments in, in some very important people to our communities. and really starting to understand, uh, a little bit more. And that's one of the areas that, We're taking a very serious look at it, saying, how do we best provide services for them?

[00:33:16] Guest: what do we need to take a look at, whether it is [00:33:20] ambulance drivers that, are having to lift and carry and, uh, saying, okay, well, Maybe we've got a growing population, and I'm not talking about numbers, I'm talking about size of the individuals. . Maybe we need to invest in some other, individually growing other things [00:33:40] other than, yeah, individually growing.

[00:33:41] Guest: Individually growing. Um, yeah, I mean, it's kinda like, okay, well the stand, the traditional lift chair for example, that, uh, ambulance, uh, drivers use, that's a very heavy manual thing, and it's kind of like. And we've started to, I've seen a couple where, Hey, their [00:34:00] design is a little bit lighter, it's a little bit better, but there's also the tracks with it and everything.

[00:34:05] Guest: So understanding some of the challenges that they're facing, because again, they're, they're out there. It's kind of like, okay, middle of the night, they go out and they're having to take somebody, uh, to the hospital, [00:34:20] rainy conditions, whatever. So investing in some of that, that's kind of one of the areas that I think, um, is a really good opportunity for us in our communities, to really start to take a look at.

[00:34:32] Guest: And then as you were mentioning, and there's a whole bunch of other areas where again, occupational medicine providers being [00:34:40] on, understand that work environment, understanding the challenges that are in the work environments and the different ones, um, becomes very important. And that gets back to where we started on our conversation about how, what's the value that we're bringing and being able to show.

[00:34:57] Guest: It's kind of like, Hey, these people are specialists. I [00:35:00] mean, an occupational medicine provider is a specialist and. They understand some really unique areas, that parts of health care just don't understand, have never been exposed to, but they're very critical.

[00:35:15] Host: Got a couple minutes left here, Keith. What advice would you give occupational medicine [00:35:20] practitioners who maybe are quite brave and actually just starting out?

[00:35:23] Host: What if they want to open their own clinic? What's the biggest piece of

[00:35:27] Guest: advice you can give them? Yeah, so the biggest piece of advice is Join a bigger practice. No, actually, [00:35:40] join a bigger practice. No, please do it. because there's a lot of, there's a lot of areas. I mean, there's a huge need, um, for this, uh, or for occupational medicine providers and specialists, uh, in this area that really understand workers comp, understand the occupational medicine, can say hexavalent chromium physicals, um, but there's a [00:36:00] really big, there's a huge need for it.

[00:36:02] Guest: Again, you have to be understand kind of before you make this jump. I mean, understand, and there's a little bit of leap of faith in regards to all of it, but you have to understand your market. You have to undertand the expenses that you're gonna be facing. Understand the competition that you are going to face.

[00:36:19] Guest: If you [00:36:20] have the opportunity to do it and you think he can do it, great because there's been some very, very successful. Uh, practices that I am, I know about across the country, uh, where again, they've taken this massive leap of faith being part of a system. I mean, that's always been a trend. Um, [00:36:40] that's a current trend where it's kind of like, okay, that, uh, physician out on his own is, has a lot of challenges.

[00:36:47] Guest: I understand those challenges up front. but there's definitely opportunities if you are In the right location, but you also have to be very nimble, and keeping that, uh, mentality of staying saying, let me be [00:37:00] on the edge of this so that when you're starting to talk, yeah, uh, stay very flexible, because there's a lot of changes that happen.

[00:37:08] Guest: rules, regulations change, end up with another pandemic. I mean, that was like the ultimate inflexibility. but those are very important, uh, factors to consider if you're [00:37:20] wanting to go into this, uh, whether it's on your own or as part of a group. and then there may be an opportunity somewhere down the road to become part of a, another organization.

[00:37:32] Guest: But again, it's making sure you understand who that partner is going to be and that there's a shared value there. [00:37:40]

[00:37:40] Host: So the M& A conversation will have to leave for another session. So thanks very much, Keith Lavin, Director of Business Operations at Hackensack Meridian. Appreciate your insights today and that'll do it for today.

[00:37:57] Host: Thanks all for joining us. This has been Fit for [00:38:00] Duty. I'm your host, Dr. Larry Earl. Thanks. And that wraps up this episode of Fit for Duty. Thanks for joining me today, everyone. I hope you found this conversation as engaging and informative as I did. As always, building healthier, happier workplaces starts with knowledge and collaboration.

[00:38:17] Host: So if you enjoyed this episode, [00:38:20] please consider subscribing to Fit for Duty, wherever you listen to podcasts. That way you'll never miss a beat when it comes to the latest trends, best practices, and inspiring stories in occupational health. Until next time, stay safe, stay well, and keep elevating workplace [00:38:40] excellence.


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