By Phyllis Hanlon
Significant cuts in funding, new rules regarding reimbursement, and efforts to streamline delivery impose serious challenges on healthcare facilities today. As these institutions seek to find ways to reduce the strain on the system’s budget, occupational health programs sometimes come under fire. However, programs that are prepared and proactive in explaining their value to internal personnel are more likely to receive the moral and financial support they need.
In years past, occupational health was narrowly defined as a program to deal with workers’ compensation and workplace injuries and was associated predominantly with manufacturing and heavy industry. But pure occupational medicine as practiced in the 1980s has undergone a dramatic metamorphosis. With the passage of the Affordable Care Act (ACA) much attention has been focused on population health management, an area in which occupational health programs theoretically excel.
Today, occupational health should be viewed as a vehicle through which healthcare organizations can reach employers and large clusters of the population with a portfolio of services. Inextricably tied to population health management, an occupational health program can become the hub of the wheel, offering significant benefits to the community and serving as a valuable asset to a healthcare system.
Presenting The Argument
When it comes to presenting a convincing argument for its existence, an occupational health program needs to consider who the decision-makers are where they operate, whether it is the hospital, health system, for-profit clinic network or multispecialty clinic. “In hospitals and health systems, you need buy-in from senior executives who allocate departmental funds. Program directors have to be able to convince leaders there is value in using an occupational health program to cultivate relationships with employers, who are influential group health purchasers,” said Karen O’Hara, Director of Marketing and Communications at WorkCare, Inc. “They also have to be able to present compelling evidence to board members, some of whom represent major business interests and foundation donors.” Depending on the audience though, your message might [should] vary. For instance, if you are speaking with the C.F, you might want to emphasize the amount of money your practice generates, noted Donna Lee Gardner, R.N.,
M.B.A., senior principal at RYAN Associates. “You can validate your program by citing the revenue you are bringing into the health system. Every month, share with the administration your budgetary goals,” she said. “Periodically review those budgetary goals to see if you are meeting them. Consider your market share. Are you constantly building and adding new customers? Look at where you are and where you expect to go.”
Additionally, the occupational health program should examine specific questions that help determine the program’s internal value, said Ms. Gardner. For instance, how does the program meet the institution’s vision and mission?
How many people can the program touch to improve their health? “The connection between the health institution and the employer is extremely important,” she said. Customer and patient satisfaction surveys can also illustrate the value of your program. These tools demonstrate what patients and client companies think of your program and also offer insight into provider and staff performance. By collecting feedback, a program can stay apprised of how it’s doing and use that information as a supporting argument when speaking to decision-makers. “Are you keeping people happy and healthy? If there is a big drop-off in numbers, then you know you have a problem,” Ms. Gardner said. “Monitoring the number of new clients your program has registered may be another influential factor in keeping your program alive and well. A bump in new patients can validate to others that external customers think highly of your program.”
Every occupational health program should have a quality assurance program/process, as well as clearly defined policies, procedures and competencies. For example, by pointing out a low error ratio in drug screens, you can show the administration the competence of your staff.
Ms. Gardner said programs should use best practices because they optimize patient care. “Articulate to administration that ‘this is what the best practice is in occupational health and this is how we are meeting it,’” she said. “For example, physicians have to be certified to do Department of Transportation (DOT) physicals. Are they?
One of the best ways to identify and demonstrate your program is following best practices is to become certified or credentialed.”
Be Proactive
Ms. O’Hara said one frequently overlooked indicator is how an occupational health program that offers services to outside employers can be leveraged to help the parent organization reduce its own workers’ compensation and health management costs.
“Healthcare is one of the nation’s most dangerous professions, so it pays to protect these workers from harm with a strong program and targeted interventions,” she said. “[A good occupational health program] ensures that employees stay healthy and productive.” Roy Gerber,
RYAN Associates’ senior principal and national director of consulting, offered two reasons why hospital-based occupational health programs might be under-appreciated by senior management. “Hospital senior management may not understand the valuable role an occupational health program can play as part of the overall health system,” he said. “Also, some occupational health programs have not been proactive and haven’t always done a good job of proving their value up the line to their constituents. Occupational health programs have to take credit for what they do internally.”
When occupational health serves as the employee health program for the health system and performs pre-placement post-offer physicals, drug screens, injury treatment or other services for the parent company, it often does not get credit for this revenue. “In these cases, occupational health programs should generate invoices and book these services as revenue, even if that revenue is offset in the organization-wide, consolidated financial statement,” Mr. Gerber said. “The program should get credit for these in-kind services either in terms of revenue or expense off-set. It’s also important to track and report ancillary services generated by occupational health programs.”
He suggested creating an ad hoc report that shows ancillary services and downstream revenue that shows up elsewhere in the organization. “Proactively document downstream referrals to other parts of the health system.
For example, if an employee of a client company presents to the occupational health program but is referred to the emergency department, that referral should be logged and reported along with the value of a typical emergency department admission. The same thing for referrals the occupational health program makes to the system’s medical staff specialists, such as orthopedics and neurology. An ad hoc report can capture the overall financial impact that the occupational health program is having system-wide,” Mr. Gerber said.
Certification Counts
Bayhealth Medical Center in Dover, DE, has two hospitals, 30 off-site clinics and the Bayhealth Medical Group physician practice. For the past 25 years the system has provided occupational health services to upwards of 500 client companies, said Deanna Rigby, M.S., FACHE, administrative director for Bayhealth ambulatory care. Most recently, the program assumed responsibility for the occupational health needs of the hospital’s 3,500 employees. The tremendous growth of the program can be attributed to methodically tracking ancillary services, such as labs, physical therapy and diagnostic imaging, and capturing other key data.
The revenue figure impressed the senior administration. “Occupational health generates charge data of approximately $300,000 to $350,000 a year and that doesn’t include referrals to physicians, pain management, ENT, orthopedic, etc.,” Ms. Rigby said. “With healthcare reform, you can justify occupational health. The money will be used to produce and maintain health in the community.”
Jennifer Sutter, BBA-HM, Bay-health’s occupational health consultant, said several occupational health physicians are permanent members of hospital committees like employee safety, infection control and work injury reduction, and that gives the program high visibility. “These experts get on these committees and offer advice and comment to help elevate why we are here,” she said. “Our medical director is on the committee to reduce on-the-job injury. We have reduced worker injuries from nine percent down to three percent. We are good at making sure we tell our story.”
Bayhealth recently acknowledged the value of occupational health by inviting the program to collaborate with the clinical integration department to examine clinical data as part of healthcare reform. “We are working with large companies to get them on board with healthcare reform. We offer a total health package, which helps companies keep costs down,” said Ms. Sutter.
Ms. Rigby said Bayhealth is the only occupational health program in Delaware to be certified by the National Association of Occupational Health Professionals (NAOHP), which publishes this newsletter. Five years ago the program needed a makeover and brought in consultants to help solve some issues, she explained. “We had done training with NAOHP in the past and wanted to clean up our program,” said Ms. Rigby. “Although the process was intense, staff worked together and earned an ‘outstanding,’ which fewer than five percent of programs in the country have. With the certification, the staff got a morale boost,” she said.
Track Data
Janet M. Sheehan, RN BSN, MSN, ANP-BC, manager of the Occupational Health/Travel Clinic at Lawrence General Hospital in Lawrence, MA, doesn’t usually encounter pushback when it comes to keeping her program. What began in 1987 as the brainchild of the medical director in the emergency center has blossomed into a fully staffed program that serves 200 businesses, including trucking, manufacturing and hazmat companies. It also provides occupational health for the hospital’s 1900 employees. This hospital-based program leverages its relationship with the parent organization to increase and retain clients. “It’s a selling point because we have access to the lab, radiology and other services,” Ms. Sheehan said.
Ms. Sheehan attributes the success of the program to the detailed tracking of several statistics, including workers’ compensation-related visits, Department of Transportation (DOT) physicals, drug screens, the number of vaccines administered, asbestos exams and more. Also, the program does its own billing and presents monthly financial reports to the administration. “We are closely monitored and the hospital is well aware of our numbers.”
However, credentialing is more critical to the program’s survival than data capture, Ms. Sheehan said. “All nurse practitioners and registered nurses in the program have a Breath Alcohol Testing (BAT) Certification, which allows them to do federal testing. They are also credentialed urine drug screen collectors.” In addition, providers and staff are certified to conduct pulmonary function and audiometry testing. And all providers passed the test to become federally certified DOT medical examiners well before the May deadline. Sheehan’s program is also heavily involved with the Department of Defense (DOD). “We treat pilot contractors and surveyors who are going to Iraq,” Ms. Sheehan said. She and her staff are well versed in Department of Defense requirements and have a reputation for completing the required, extensive paperwork accurately and on time.
Lawrence Hospital understands the value of its occupational health program. “In February 2013, we moved into a beautiful, renovated building a block away from the hospital. The administration allowed me to weigh in with the architects on how to set up the department. This was a good show of support from the hospital,” she noted. Telling your story can help put your occupational health program in the spotlight––and ensure it remains there.
