How On-Site Medical Clinics Curb Fast-Rising Costs of Medical Care in Workers Comp

 

On-Site Clinics Decrease Costs

 

Many medium and large employers in their never-ending battle to reduce cost and to provide benefits to their employees are opting for on-site medical clinics.  On-site medical clinics can decrease the cost of general health benefits programs and decrease the cost of medical care associated with workers’ compensation claims.  On-site medical clinics have proven they can curb the fast-rising cost of medical care for both personal and work-related injuries and illnesses.

 

Some employers are hiring clinicians themselves, and others are using contracted providers who also provide software, protocols and other tools to support the clinicians.

 

 

Medical Care Provided at Work Site, Convenient & Effective Treatment

 

With the on-site clinic, the medical care is provided at the work site, which is convenient for employees who otherwise would have to leave work for care.  Injuries and illnesses are evaluated by the clinic staff; many cases can be treated on site.  Employees are referred to off-site medical facilities only if the injury or illness is beyond the scope of the medical professionals in the on-site clinic.

 

On-site clinics often use a variety of staffing models, including RNs, nurse practitioners, and physician assistants – with physician collaboration and direction as needed.  Depending on the employer’s needs, on-site clinics can be staffed with a doctor.  When properly managed, on-site medical practitioners can provide high quality medical care while reducing overall costs.  They can also provide other health services such as wellness, and regulatory exams, etc. On-site clinics can include x-ray machines and pharmacy services, though costs and state regulations affect the feasibility of those services.  Good providers of on-site medical clinics will tailor the services provided to the employer’s needs.

 

 

Benefits to Employees

 

The benefits to the employee injured on the job include:

 

  • Medical services available when the typical doctor’s office is closed – evenings, weekends and holidays

 

  • No appointment is necessary

 

  • Immediate medical care following an injury

 

In addition to the workers’ compensation benefits, the employee also enjoys easy access to medical care, assistance with chronic medical problems and healthy living guidance.

 

 

Benefits to Employers

 

The benefits to the employer of the injured worker include:

 

  • Evaluate and treat employee injuries immediately

 

  • Avoids unnecessary and off-site medical treatment

 

  • Referral to appropriate and screened preferred medical providers when off-site care is needed

 

  • Improved outcomes and faster return to work, increasing productivity

 

  • Assist in keeping all workers healthy and productive

 

  • Reduces absenteeism

 

  • Significantly lower cost for medical services for workers’ compensation claims

 

  • Can provide physicals

 

  • Drug screening

 

  • Improved general health of employees

 

  • Improved employee morale

 

  • Increases employee retention

 

  • Can coordinate pharmacy usage with your Pharmacy Benefits Manager

 

  • Timely reporting of the injury and medical information to relevant parties.

 

  • The First Report of Injury form is completed and filed with both the state and claims office.

 

 

Treat Workers Comp and Health Care

 

On the workers’ compensation side, the on-site clinics can treat lacerations, strains, sprains, other minor orthopedic injuries, abscess drainage, minor skin infections and other routine acute medical conditions.  On the health care side, the on-site clinics can treat the whole gamut of minor medical conditions that causes employees to lose time from work including strep throats, colds, ear and eye infections, skin lesion removal and vaccinations.

 

 

 

Clinics Used For Any Site with 1,000+ Employees

 

On-site clinics are not just for industrial sites like factories, and mines or large office centers.  On-site clinics can be operated for just about any industry where there are 1,000 or more employees in one location.  Mobile and temporary clinics are used  for large construction projects such asskyscrapers, power plants, and highways.  All clinics need to be equipped with the necessary furniture, supplies, equipment, and medications.

 

The cost of drug testing for both employee applicants and existing employees can be significantly reduced by using an on-site clinic.  Drug testing due to reasonable suspicion, random testing and post-accident screening can be completed by the on-site clinic.  In many states the timely completion of a post-accident drug testing can be used to deny workers’ compensation benefits to employees under the influence of a drug at the time of their injury.  A positive drug test result can be sent to a certified lab for further confirmation.

 

 

Be Sure to Select Quality On-Site Medical Provider

 

When an employer is selecting the on-site medical provider, select a medical provider who provides an on-going review of the quality of service they are providing.  The service quality can be evaluated by patient reviews and comments, by clinic audits and by staff performance evaluations.

 

On-site clinics do carry costs and risks as well.  To be successful, the staff needs to be trained for on-site work, and be supported with appropriate software, operating systems, supplies, medical direction, protocols, QA, and other infrastructure.  The medical practice needs to carry malpractice insurance coverings the employer and be compliant with HIPAA, GINA, HITECH and other privacy regulations.  In addition, some on-site providers may introduce conflicts of interest if they are financially tied to the off-site hospitals, clinics and pharmacies that  they refer to.

 

For further information about on-site clinics, please contact us.

 

 

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%Contact: RShafer@ReduceYourWorkersComp.com.

 

Editor Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

 


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What to Tell Employees Who Are Injured On The Job

We are always writing articles to assist the employer in dealing with the complexities of the workers compensation system. We thought for a change of pace we would provide an article to assist the employees in dealing with the tangled web of workers compensation.  

 
The following suggestions will make the workers compensation claim go smoother and alleviate the angst that naturally occurs when an employee is injured on the job. (WCxKit)
 
 
1. Report your workers compensation claim immediately, even if you do not need medical care at the moment. What may feel like a pulled muscle today may be a major problem next week. It is better to have a record of your injury when it occurs rather than trying to explain why you are reporting the injury late.
 
 
2. Ask your supervisor to prepare a written report of the incident. Your supervisor should willingly do so, but if for any reason the supervisor does not act immediately, submit your own written report providing all the details of what you were doing when you got hurt. Be sure the details of your incident are accurate, as the fastest way to lose credibility is to allow inaccurate information to be reported.
 
 
3. Select a medical provider from the list posted. If you do not understand the different specialties, ask for guidance. A medical provider close to work or close to your home is often the easiest one to reach.
 
 
4. All the medical care related to your injury will be provided until you have recovered from the injury.
 
 
5. If you have a pre-existing medical condition, which can be anything from a prior back injury to diabetes, do not try to hide that fact. To get the appropriate medical care you need, all medical conditions or issues should be disclosed to the medical provider.
 
 
6. Keep track of your mileage to and from every medical appointment and to/from the pharmacy. Your mileage can be reimbursed in most states, but only if you have a record of it. Keep a copy of all mileage logs turned into the adjuster.
 
 
7. Obtain a written copy of the report your employer submits to the insurance claims office. If anything is incorrect on the report, now is the time to correct it, not later.
 
 
8. Attend all doctor appointments and all diagnostic testing. If you do not think you are hurt enough to attend the medical appointments, neither will the adjuster.
 
 
9. Provide a copy of all off-work (disability) slips to your employer and to the insurance adjuster, and keep a copy for yourself. Ask your employer if they have a more complete form to use, often called an Injury Treatment Form or Accident Report Form that gathers enough information about your injury so your employer can locate a transitional duty job for you.
 
 
10. Keep in touch with the employer and the insurance adjuster. After each doctor's visit, call both the employer and the insurance adjuster and give them an update on what the doctor said about your medical progress and when you may be able to return to work. If you are on transitional duty and your capability increases (it should) let your employer and insurance adjuster know about this.
 
 
11. Every work place has co-workers that will want to give you unsolicited advice on your workers comp claim. Follow the real doctor's medical guidance not your friends and co-workers.
 
 
12. Every state has a waiting period before lost wage compensation can be paid. Ask the claims adjuster what the waiting period is in your state. If you are out of work longer than the waiting period, you will be paid a percentage (often 66.67%) of your average weekly wage.
 
 
13. Ask about your employer's return to work program while your doctor has you off work with restrictions. Often your employer can modify your current job duties so that you can return to work sooner.
 
 
14. Do not violate the work restrictions placed on you by your doctor while working light duty. You will most likely end up aggravating your prior injury and extending the period of time it will take for you to recover from your injury.
 
 
15. If a nurse case manager is assigned to your claim, keep the nurse informed as to your medical progress and understand he/she is there to make sure you obtain the appropriate medical care. (WCxKit)
 
 
Your employer hopes you will never get hurt, but if you do, keep the workers comp claim suggestions in mind to improve the claim experience and the overall outcome of your claim. 
 
If you are an employer reading this, the above items can be included in an employee brochure.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. Rebecca is the author of Workers Compensation Management Program: Reduce Costs 20-50%. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

 
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Survey Says Consumers Want Employers to Do More with Health Plans

As U.S. companies continue to ask workers to shoulder a greater burden of the cost of health care, a recent survey from Aon Hewitt, The Futures Company and the National Business Group on Health, reveals that consumers want their employers to do more to help them improve their health and get the most from their employer-provided health and wellness plans.


Together with the National Business Group on Health and The Futures Company, Aon Hewitt surveyed more than 3,000 consumers (employees and their dependents) covered by employer health plans to determine their perspectives, behaviors and attitudes towards health and wellness.(WCxKit)


Under continued pressure to mitigate costs and adjust to new regulations, employers are continuing to carefully consider the future of their employer-provided health plans. However, as they adjust their plan design and wellness strategies, the survey finds that many employers are not aligning these strategies with the goals, needs and concerns of their employees.


While a majority of consumers (74 percent) are worried about being able to afford health care now and in the future, they understand that health improvement programs, along with well-designed employer-provided health benefit plans, can help them get healthier while also holding down costs. But, the survey reveals that workers really want four simple things -programs and communication that are easy to use, motivating and meaningful to them, but that also provide personalized information and ideas.


"Employers continue to face countless challenges when it comes to offering health plans that effectively meet the needs of workers and their families, while also managing rising costs," said Helen Darling, president and CEO of the National Business Group on Health. "We hear over and over that the key to ensuring real health improvement is employee engagement, so knowing what employees want and what will motivate them is essential to success. Consumers are telling us that the one-size-fits-all approach to health and wellness is not working for them. In order to help with their challenges and reduce costs, they want health programs that speak to their individual and families' health care needs."


Faced with rising health care costs and new regulations, more employers are introducing health care plans that require workers to take more responsibility for managing their health and the related costs. In fact, a recent Aon Hewitt report shows that 51 percent of employers now offer a Consumer Driven Health Plan (CDHP), up from just 9 percent in 2005.


The good news for employers is that consumers are willing to try CDHPs if the immediate cost savings are apparent. Among those with a choice, most employees (63 percent) select a CDHP because of the lower premium costs.


Additionally, 39 percent choose this plan option because their employer contributes to an associated account-Health Savings Account (HSA) or a Health Reimbursement Account (HRA). In fact, among those enrolled in a CDHP who have a choice, over 90 percent will definitely or probably re-enroll. While CDHPs are, in part, intended to encourage workers to take a more active role in their health, the survey findings indicate that they are having a mixed effect on behaviors.


Encouragingly, 42 percent are getting more preventive care and 40 percent are looking for lower cost health services options since choosing this plan. More troubling, a sizeable number of workers (35 percent) are sacrificing or postponing care (28 percent) to avoid out-of-pocket costs.


"While an eye towards cost is certainly a valid and reasonable reason for consumers to select a certain health care plan, choosing a plan that fits a worker's lifestyle and needs also ensures that people are getting the most appropriate coverage for their needs," said Cathy Tripp, managing principal Health & Benefits at Aon Hewitt and project leader for this study. "However, employers need to make sure workers aren't sacrificing health and the future costs of poor health for lower costs today. Giving employees the tools and advice to decide what is the most appropriate plan for them is critical."


When it comes to tools to help them make health decisions, consumers want information that is tailored to their specific situation. Half of participants (50 percent) want a personalized plan that recommends specific actions they can take to improve their health based on their health status, up 9 percentage points from 2010. Workers are also looking for convenient, one-stop access to information with 40 percent expressing a preference for a wellness website and more than a third (35 percent) want personalized health tips and reminders. Cost is still not far from the minds of consumers though. Fully 44 percent would like cost savings tips and a third (33 percent) want cost estimating tools.


"If companies truly want to move the needle in terms of overall health and cost, they have to stop looking at employees as one group, and start looking at the individual," stressed Joann Hall Swenson, principal and health engagement best practice leader at Aon Hewitt. "Employers can customize health information and related programs to address the specific health conditions and risks of their workers as well as offer specific tips and actionable steps they can take to improve their condition. In addition, offering tools that allow individuals to see and understand the cost of their health care services goes a long way in helping workers make the most of their health care dollars."


In addition to shifting a greater share of the cost to employees, companies are also looking at ways to get employees and their dependents healthier. According to consumers, the best way to motivate them to participate in employer-sponsored health plans is by using rewards. More than half of consumers would prefer either non-cash or cash incentives to encourage them to take part in wellness (60 percent), condition management programs (50 percent) or respond to a health risk questionnaire (58 percent).


For employers, getting workers engaged in their health is critical to health improvement and cost containment. However, the survey finds that there is a disconnect between how healthy people think they are and how healthy they actually are.


The Centers for Disease Control and Prevention reports that approximately one-third (33.8 percent) of U.S. adults are obese, though only 24 percent of survey participants say they are obese. Similarly, the survey found that more than three-quarters (76 percent) of consumers rated their health as "very good" or "good,” while just 15 percent considered their health "fair" or "poor." While employees may think they are healthier than they likely are, they do acknowledge that their health is not perfect. Approximately 60 percent of consumers report having at least one health condition with obesity, high blood pressure and back pain most often mentioned.


"This lack of awareness between real and perceived health is a huge problem since we know that concerns about risk factors can help overcome our natural tendency to put-off making the tough life changes needed to significantly reduce health risks," stressed Darling.


Despite the potential disconnect between real and perceived health status, consumers do understand what it takes to get and stay healthy. When ranking what matters most to their health, many (85 percent) say that good health is a result of making smart health choices each day, over two-thirds (68 percent) say that getting regular preventive care ranks in the top three, while 40 percent rank living and working in a healthy environment in the top three. While people know what it takes to be healthy, there are still often barriers to reaching health goals. Most people cite lack of time (42 percent), cost (40 percent) and unwillingness to sacrifice (35 percent) as the leading obstacles to getting and staying healthy.


Consumers do acknowledge that there are people and things in their lives that may help move the needle when it comes to improving their health. Nearly three-quarters (72 percent) are influenced by advice from a doctor, almost half (47 percent) from friends or family, and 41 percent from general health websites. Just 13 percent consider health information from their employer a trusted source.


To improve health and productivity, employers are increasingly offering programs to both workers and their dependents such as biometric screenings, health risk assessments, onsite clinics/pharmacies and Employee Assistance Programs. However, many employees and their dependents do not seem to be aware of many of these programs. In 2011, more than one-third (36 percent) of consumers did not participate in any health program or service offered by their employer. Among the programs that workers did participate in, blood tests or biometric screenings were the most popular (61 percent participation), followed by health risk assessments (57 percent participation).


Despite low participation, when workers do take part in these programs, satisfaction is extremely high. Almost all (97 percent) of consumers who took part in blood work/biometric screening were satisfied, 97 percent were happy with their on-site clinic or pharmacy, and 92 percent were satisfied with the health risk assessment.


In addition to lack of awareness, and despite the availability of health improvement programs, many consumers do not feel their employers are fully supportive in helping them get and stay healthy. A majority of workers (60 percent) think their company is only moderately-to-not supportive when it comes to their efforts to be healthy.(WCxKit)



"Employers may be missing the mark when it comes to health improvement programs being offered to workers," said Tripp. "Workers need to see that their efforts to become healthy are supported by the company. Developing a culture where leaders care and support healthful living communicates to workers that this matters to the company."
 
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
 
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contactInfo@ReduceYourWorkersComp.com.

Employment Standards Backlog Reduction New Compliance Implemented in Ontario

As the Ontario Ministry of Labour continues to successfully eliminate a backlog of employment standards claims, it is increasingly shifting resources to enhancing compliance. Program changes made in January 2011 included: 
 

1.   A drop in wait time (from 7.1 months to about 3 days) for early resolution and assignment to a claims officer.
2.   Backlog was reduced by more than two-thirds and is slated for elimination by March 2012. (WCxKit)

 
As a result, the ministry is able to increase the number of Employment Standards Officers on its Dedicated Enforcement Team. This means the Employment Standards program now has more officers doing inspections than ever before.
 
 
The ministry continues to help businesses comply with legislation, thus saving them time and money, by heading off employment standards issues before they occur. That includes eliminating the backlog, working with businesses to help them understand employment standards law, thorough education and enforcement, and providing useful tools and resources.
 
 
With the scheduled elimination of the backlog, the ministry will partner and consult with employer and employee groups as it shifts resources to inspections. (WCxKit)
 
 
"Through our enhanced compliance strategy, we will continue reaching out to employers through a mix of education, outreach, and enforcement to help ensure we stem any problems before they arise and enforce the legislation," said Stephen Grier, acting director of the Employment Standards Program.
 
 
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.

Our WORKERS COMP BOOK:  www.WCManual.com
 
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Know the 2 Reasons Employees ELECT NOT to File Work Comp Claims

The question has been asked: Are there any situations where the employee might elect not to pursue a workers compensation claim or might not have a workers comp claim for a work related injury? The answer is yes. While it is not common for the employee to choose not to have a workers compensation claim, or does not have a workers comp claim by statute, it does happen.
1-Excluded People (no coverage)
When an employer does not meet the state's requirements for workers comp insurance, the employee might not have a workers comp claim.   For instance, in the states requiring employers with three or more employees to carry workers comp insurance, and the employer only has two employees, the injured employee would not be able to pursue a workers comp claim.
When the injured employee is the sole proprietor or a partner in the business, s/he will not be covered for a workers comp injury unless s/he buys a workers comp insurance policy on him/herself (which most sole proprietors do not do). (WCxKit)
Another instance where an employee might not be able to pursue a claim is in the states excluding farm laborers, seasonal workers, domestic servants, real estate agents and direct sellers from coverage under the workers comp statutes. When one of these type employees is injured on the job, they still have the right to bring a lawsuit against the employer if they believe the actions of the employer caused their injuries.
2-Pursuing a Tort Claim (want deeper pocket)
In the states where the workers comp insurer has full right to subrogation recovery, the employee will occasionally chose not to pursue the injury claim against the employer. An example of this would be the injury to the traveling salesperson resulting from an automobile accident. The third party was at fault and the accident occurred in a state where the employer controls the selection of the medical provider and the employer/insurer has full subrogation rights. 
An attorney representing the injured employee will often tell the employee they can get a much bigger settlement through the tort system than they can through workers comp. Instead of the employee being treated by the medical provider selected by the employer or the employer's insurance company, the employee is treated by a medical provider selected by the employee's attorney. 
The attorney, of course, is recommending the liberal medical provider who will keep the employee coming back for additional treatment for as long as the employee is willing to go to the doctor. The reasoning for this is simple, the longer the employee is off work and the higher the medical bills are, the greater the settlement the employee's attorney can demand from the insurer of the vehicle at fault in the auto accident. 
Another example of where an injured employee might want to opt out of filing a workers compensation claim is an injury on a construction site. On a large construction project you often find various subcontractors all working at the same time. This will often result in an employee getting injured due to the negligence of a third party. The employee again will have the choice between pursuing the claim for personal injury against the responsible party or filing a workers compensation injury claim. (Of course, in the states where the right of subrogation has been diminished or taken away from the workers comp insurers, the employee's attorney will often pursue both types of claims simultaneously).
A third example of where an employee might choose to pursue a tort claim rather than a workers comp claim is the delivery person who trips and falls on the defective sidewalk belonging to the business where s/he is making a delivery.   While a delivery person has the right to pursue a workers comp claim against the employer, the owner of the property where s/he fell has liability insurance, and the award s/he can collect on the tort claim will surpass what can be collected on a workers comp claim. (WCxKit)
Summary
While it is unusual for the employee to opt out of coverage for a workers comp claim, or for coverage not to apply to the work related injury, it does happen. The wise employer will know when this situation is occurring and keep in close contact with the employee in case the circumstances change.

Author Rebecca Shafer
, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
C
ontact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

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