Occupational health clinics can be an added service in the ED
Occupational health clinics can be an added service in the ED
Many ED directors looking for ways to expand the service lines and marketability of their departments are developing mutually beneficial relationships with occupational health clinics, sites that handle physical exams, substance abuse testing, immunizations, and treatment of work-related injuries.
When occupational health clinics are in the same facility as the ED, the community views the two services as a single care site. "Employers send their patients here nights and weekends, which gives added business to the ED," says Daniel Higgins, MD, FACEP, medical director of emergency services at St. Francis Medical Center in Lynwood, CA, which has an occupational health clinic next door to the ED. Those patients are later referred back to the occupational health clinic for follow-up care and completion of the appropriate paperwork .
The arrangement is proving to be a major selling point to local corporations.
"When we take employers on a tour of the ED, they see the CAT scan and trauma center, and then their own separate area, so they see we have everything here," explains Higgins. "It’s a big selling point, like taking them through the set of ER."
Special skills are required
ED physicians benefit from the expertise of industrial specialists. "It’s a tremendous asset for the emergency physician," emphasizes Higgins. "Often, you’ll get a supervisor who sends a patient over, saying, Test him for drugs.’ You have to know what your obligations are, know patients’ and employers’ rights, and how long to keep a patient off work."
Physicians in the occupational health clinic share that knowledge with ED physicians. "It’s such a unique niche, there is no way an ED physician working nights, days, and weekends can understand the nuances of drug testing, back-to-work status, and interface with all the company supervisors," says Higgins. "That expertise is invaluable."
Issues of patient confidentiality also differ in the ED. "With a workers’ comp injury, information can be distributed to interested parties such as the patient’s company and insurance, whereas with group health insurance, the patient has to sign a release before information is released," notes Phillip Harman, vice president of corporate services at Methodist Occupational Health Centers Inc, in Indianapolis.
The in-house industrial expertise also benefits the hospital. "The hospital loves being able to have the industrial physician available to answer questions about a particular injury or law, or workers’ comp," says Higgins.
The two specialties work together as a cohesive unit. "There is definitely a synergy between occupational health and emergency care," stresses Jatin Bhatt, MD, medical director of the occupational health department and vice chairman of the ED at St. Francis.
An occupational health clinic connected to an ED has a clear advantage over a stand-alone clinic, says Bhatt. "Employers want services relevant to them available 24 hours a day, and most clinics are only open office hours," he notes. "Having the ED side by side with the occupational health clinic gives 24-hour coverage."
If an employee is seriously injured at work, or injured after clinic hours, they go directly to the ED, and the clinic follows up the following day. "The next day we have access to all the information so we can create a report for the employer or insurance company," Bhatt explains.
Extra business for the ED
Marketing the occupational health clinic to local employers benefits the ED as well, Bhatt notes. "You are marketing the ED at the same time," he says. "It can be a big advantage to the ED when you are going out and competing for contracts with employers, because they will immediately send patients to the ED if we aren’t open."
The arrangement also improves continuity of care. "From ingrown toenails to gunshot wounds, we can take care of the problem, which makes the employer feel comfortable sending patients to us," says Bhatt. "If an employee was exposed to chemicals and presented in respiratory distress, instead of calling 911, I just send them to the ED next door."
At Good Samaritan Hospital in Cincinnati, OH, an occupational health clinic is located down the hall from the ED. A staff member acts as a liaison to coordinate care between the ED and the clinic by following up with employers and doing case management.
The occupational health clinic brings business to the ED. "A key customer group is the corporate community, and a key payer is workers’ comp. We’re a referral source for the ED and vice versa, so we very much work together," says Karen Swedersky, director for the occupational medicine centers for TriHealth, which runs seven hospital-based occupational health clinics in the greater Cincinnati area, including Good Samaritan’s.
Employers appreciate the convenience of the hospital-based occupational health clinic, she says. "Client companies are happy to have a point of contact in the ED they are familiar with, so it results in a cross-selling process," says Swedersky. "Many companies have multiple shifts, and generally they prefer one-stop shopping. They don’t want to have to tell the worker to go to one place after 5:00 p.m., another after 8:00 a.m., and another on Saturday, because it gets too complicated."
It’s important to maintain that sense of simplicity when it comes to billing. "At first, the hospital sent separate bills for the lab, radiologists, ED, supplies, on top of a provider’s bill, and employers weren’t happy about that, so we started to consolidate those bill and send only one," says Bhatt.
Keep location, staff separate from the ED
Though they should coordinate care and work in tandem, occupational health clinics should be physically separate from the often-chaotic ED environment, advises David Dann, vice president of Meridian Comprehensive Occupational Medicine Program in Indianapolis. "It’s like mixing oil and water to run it through the ED," he says. "Companies expect to have their employees back within an hour, which is not realistic with the normal patient flow of the ED."
While many occupational health clinics are connected to EDs, others are offsite. Methodist Occupational Health Services has six primary care facilities in greater Indianapolis, the closest one is three blocks from the ED. "Because two of our clinics are [open] 24 hours, to some extent we’re serving the same community as the ED, but we’re geared to take the load off the ED," says Harman. Ideally, occupational health clinics should also not share physicians with the ED. "Many clinics located in the ED just have a different intake person, so the patients are still waiting for the same physicians, and the more seriously injured patients will still get seen first," Harman explains
Successful OHCs work together with EDs. "Every program needs to have an ED they coordinate with for after-hours referral," says Dann. "There has to be a point of access for continuity of care, so a relationship with emergency medicine is important."
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