In the future, everyone will be world-famous for 15 minutes

—Andy Warhol

By Karen O’Hara


Unfortunately for the citizens of Wilmington, Ohio, their minutes of fame have passed – at least for the time being.

 On Jan. 25, Wilmington had the dubious distinction of being featured on CBS’ perennially popular news show, 60 Minutes, as the quintessential all-American town devastated by massive layoffs.

 According to news reports, one of every three Wilmington households is hurt by the departure of the package-delivery company, DHL, and the associated job losses at its local partner, ABX Air. Wilmington itself has less than 13,000 residents, and the population of its home county, Clinton, is around 40,000. About 8,000 people in the region were employed by DHL, and several thousand more served the company via ABX.

It is a sad chapter in the history of a hard-working community with Quaker roots dating back 200 years. But the venture started out with a lot of promise.

 In 1980, Airborne Express turned Wilmington’s abandoned Air Force base into an “Air Park” to serve as a hub for overnight shipping, bringing in thousands of jobs. In 2003, a German company, Deutsche Post World Net, bought Airborne in what turned out to be an unsuccessful attempt to compete with FedEx and UPS. By last fall, with the global financial crisis unfolding, DHL was losing $6 million a day in the U.S.; layoffs started occurring in droves, USA Today reported.


 Cheryl Fisher, manager of Corporate Health Services for the CMH Regional Health System, and her colleagues at Clinton Memorial Hospital in Wilmington have watched the unwinding of DHL with considerable consternation. However, the program is hanging in there, primarily thanks to a can-do attitude on the part of its staff and support from the organization.

“Of course, our biggest struggle is how to gauge the future effects of the loss of DHL and ABX,” said Ms. Fisher, who noted that the health system workforce hasn’t escaped the impact, either.

In 2007, Clinton Memorial Hospital re-positioned itself and announced a reduction in force (RIF). Corporate Health staff was affected by attrition and the combining of some positions. For example, Ms. Fisher, who was the program’s account executive, is now also the manager and a hospital safety team member. Meanwhile, the program’s financial management/ billing staff divides its time among multiple departments.

Despite the economic hardships suffered in the community, the program has continued to offer essential services to employers. Corporate Health operates as a hospital department out of a freestanding location in close proximity to local industry. It uses the emergency department for after-hours backup. The program entered into a contract with a physician group (including a board-certified occupational medicine doctor), about six months ago as part of an effort to improve consistency in patient care.

“We have been fortunate. Flexibility is something we really believe in,” Ms. Fisher said. “We are all very creative and teamwork-oriented.

 “Our staff ‘gets it’ as far as being willing to take on more to survive and is glad to be able to have the opportunity to do that. We are all experienced at working with the public and patients. Our success comes from years of being customer-service focused, and we look for people who are like that when we are hiring.”

Program Fundamentals

 From her perspective, the recession calls for a renewed focus on program fundamentals.

“With the population declining here and the unknowns with the Air Park, our goal is to stay in business and be viable,” she said. “So, what we do we have to do very well: drug screening, DOT physicals, injury care, etc. We are aggressive with returning to work, and we try to keep prescription drugs to a minimum.

“The local businesses are aware of our capabilities and they know we are the local experts in occupational health. They really do depend on us to answer their questions.”

In addition to focusing on core service capabilities, Ms. Fisher recommends lavishing attention on key clients. In her case, it’s a group of about 25 companies with whom the program has close working relationships. In addition, she strives to maintain visibility in the business community by frequently sending out e-mail blasts and newsletters containing items of interest to employers and sponsoring periodic breakfast seminars for employers.

While hiring freezes impact the demand for pre-placement screening services, Ms. Fisher has observed an increase in the number of companies conducting random drug testing to weed out employees who are violating drug-free workplace policies. The program has stepped in to assist.

“For instance, we just went onsite and took turns doing 12-hour shifts to provide random drug tests at a local facility,” she explained. “We are willing to consider the employers’ needs and meet them.

”The program manages hospital employee health and workers’ compensation case management functions, as well. One cost-cutting strategy the self-insured organization has implemented is the use of a health questionnaire for all job applicants, with physical exams reserved for those with identified risks. The hospital has also changed some policies so it is positioned under Ohio workers’ compensation rules as the preferred provider for an employee.

Although it is too soon to measure the impact of these changes, Ms. Fisher said compliance with post-accident drug screening has improved, and the majority of employee-patients are now seen by a Corporate Health physician and returned to work either on full or transitional duty.

Lemons to Lemonade

Ms. Merckling

Corporate Health Services in Wilmington is just one example of the many hospital-affiliated occupational health programs and independently owned clinics that are paying particularly close attention to business practices as they hunker down to weather the economic crisis.

At times like these, paralysis by analysis isn’t an option, says Jewels Merckling, NAOHP Board president and vice president of provider development for P2P Link, a company specializing in electronic connectivity between workers’ compensation payers and medical providers. Rather, this is a time to thoroughly delve into operations and correct inefficiencies – no matter how insignificant they may seem.

 “My recommendation is to perform an analysis at the most intricate levels, evaluating every process in the facility,”

Ms. Merckling said. “If it takes a doctor six steps to dispense medication in the clinic, can that be reduced to three steps? Does the organization of the front desk allow for optimal efficiency, etc.?” Prior to joining P2P Link, Ms. Merckling directed WorkHealth Solutions, the occupational health program at Liberty Hospital, Liberty, Mo. During her tenure there, she developed a method to measure the financial impact of a new electronic billing system (See Impact Analysis on page 8).

“Through this type of analysis, a program may find justification to make the transition to an electronic health record and come out of the economic downturn ahead of the curve,” she said. “This in-depth analysis can be applied to any process or procedure in the facility.

“The information equips the manager with information he or she may need in the event that supervisory approval is required to move forward with a new initiative that will ultimately save the facility time and money. It can be used to demonstrate a proactive push toward sustained viability in the marketplace. The applications are endless from the base format.”

Attention to Detail


Leonard Bevill, CEO of Macon Occupational Medicine (MOM), a freestanding practice in Georgia, also advocates paying careful attention to the details. Anticipating that things will get worse before they get better, he started his own business analysis in mid-2008.

“My best advice is to make sure you are doing absolutely everything you can right now to be the best you can possibly be,” he said. “Rather than sit around and wring our hands, we decided to take a proactive approach – really sharpening our pencils.

“We dove in and looked at every single thing that goes on here. As people get busy, sometimes they don’t pay attention to things they should pay attention to. We analyzed every single job, every single person and their role here,” and made some adjustments accordingly.

“Secondly, we consider any product line we provide to reach out and help our customers. On the other hand, we don’t want to overextend. We can expand and maybe make more money, but I want to be sure we can do it cost-effectively before branching out into new ventures.”

Most importantly, he said, the practice has thoroughly analyzed every single client’s activity by revenue generation: which companies are using or not using the clinic, what are the volume increases and decreases, what types of injuries are occurring and what are the hiring trends?

“We are engaging in more direct conversation on a more frequent basis with our customers,” said Mr. Bevill, who noted that MOM’s top 200 clients represent about 80 percent of its business.

“We started a methodical campaign to meet our clients to say, ‘How can we help you be more safety conscious and manage occupational health more effectively at your facility?’ It requires going out to visit each client on a one-to-one basis. I did a good portion of the visits myself or with my sales staff.”

He found that employers were receptive, and the time spent was worthwhile in terms of both public relations and product line insights. One of the themes that emerged during the site visits was an interest in the provision of more services at the workplace – a trend in keeping with NAOHP findings. As a result, MOM has lowered its threshold for onsite outreach.

“We come onsite more than what we have in the past,” Mr. Bevill said. For example, “instead of having the employer send five or six employees to the clinic for random drug tests, we will do it for them at the worksite. As more and more companies are working with fewer people, they are really stretched thin. Lost productivity is a major issue. Going onsite helps keep employees on the job.”

MOM charges its standard fees plus a minimal onsite service fee to cover staff travel to and from the facility. Another area in which the practice has been successful is the development of an Americans with Disabilities Act-compliant post-offer placement evaluation utilizing job simulation techniques. For example, a local ambulance company with a higher-than-average injury incidence rate determined that it was hiring individuals who were physically incapable of doing the job without putting themselves at risk. Since implementing the job simulation program to screen out at-risk candidates, it has experienced a significant reduction in injuries.

Re-visiting vendor contracts and attempting to negotiate better prices or find more cost-effective alternatives is another strategy being employed by Mr. Bevill and his group. He has also changed the company’s benefits plan to get the best possible rates and pass some savings along to his employees.

As a business owner, Mr. Bevill can easily relate to the stress his clients are under. He deals with it on a personal level by spending time with friends and family and being honest with his employees about it.

“I find that being as open about the situation as possible and leading by example is the best approach,” he said. ”I tell my staff, ‘I am asking you to work harder than you did before. I don’t know what is going to happen, but I am too, and here is my commitment.’ I have a transparent policy on expenses and revenues, so the staff know what we are doing and where we are going at all times.”

Value-Added Services


Rick Rankin, an occupational health program director at Adventist Medical Center, Portland, Ore., says his team looks at the recession as an opportunity to market new products that can easily be recognized by employers as “value added.”

For example, the program is currently developing a pre-placement medical screening product as an alternative to full physicals for employers who do not use them or are considering discontinuing their use. When the medical screen is combined with a drug screen, the employer will receive a discount on both.

The program also is preparing to launch a new risk management product that features software designed to assist employers with regulatory compliance. The product, available through an outside vendor, will be branded with the Adventist name.

“We believe we can market this product with some success to assist employers with their risk management requirements, and it will come across as one of our own products,” Mr. Rankin said. “We are also doing a campaign on injury management and how bringing the injury to us rather than the emergency department saves the employer money. Many times the employer forgets we can treat most injuries, including suturing of lacerations.”

According to Mr. Rankin, the products being developed by Adventist Occupational Health will show an immediate impact on the bottom line for employers. In addition, the risk management piece is expected to produce long-term savings through efficiencies gained by using the software and “taking the ‘risk’ out of risk management compliance.”

The following are some additional suggestions from NAOHP Board members for coping with the recession:

“We are focusing our marketing efforts more on industries less affected by economic downturns, such as agriculture and governmental clients. We are customizing products to meet their particular needs. Usually, the service involves ancillary services related to physicals, requested tracking, and reporting channels.”

—Dr. David Durand, Company Care, Lincoln, Neb.

 “This is a good time to diligently follow up on missed appointments. We have also been working on internal marketing to the Emergency Department.” 

—Gloria L. Bamforth, CorpOHS, Frederick, Md.

 “We have raised our prices on some services (drug/alcohol testing, hearing, respiratory exams). We have also implemented a “Lab Link” function with our software (iSYSTOC) so customers can go online to retrieve test results, which results in more efficient use of staff time and materials.”

—Mike Schmidt, St. Luke’s Occupational Health Services, Sioux City, Iowa

“We are carefully monitoring supply levels and ordering on an as-needed, just-in-time basis. To maximize efficiency, one of our occupational health departments is now sharing space with an urgent care clinic.”

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