Setting up a Remote Occupational Clinic Has Challenges

Peru – Medcor CEO Philip Seeger testing Medcor’s telemedicine software with an Imarsat/BGAN satellite system on the bank of the Elto Madre river in the Amazon jungle. Seeger and his team also tested their telemedicine system with Iridium sat phones.
Working in the creature-infested and disease-prone Amazon jungle is not all just fun and games – no indeed – someone might get hurt (just as they might at a less remote worksite).
And that is what companies such as Medcor are for.
Founded in 1984, Medcor operates more than 170 non-traditional clinics located on-site in client locations around the United States. Medcor’s staff, systems, and software in these clinics help employers control costs, improve outcomes, provide rapid access to medical care when necessary and avoid claims when they are not necessary.  This means planning ahead, even when the worksite is very different from the typical office.
Privately held with 400 full-time and 400 part-time employees, Medcor does $54 million in business per year, and claims to save its clients several hundred million in workers compensation and general health care costs every year. In addition to its on-site clinics, the company provides telephonic injury triage to more than 80,000 triage worksites from a wide variety of industries across the US.
Although its core business is focused on providing on-site medical clinics to large worksites and providing injury triage to small worksites across the country, Medcor has a great deal of expertise in the fascinating field of wilderness medicine.
The company provides on-site medical services at Yellowstone National Park, supports a clinic at the base camp of Mount Everest, and has provides medical services to remote projects such as oil pipelines, windfarms, and highway construction. The company has provided medical support to government projects on Kwajalein and Midway Island in the pacific ocean. Medcor has also has served those affected by hurricanes Katrina and Rita, and provided on-site medical services at the World Trade Center after 9-11. Medcor is currently deployed helping the flood relief efforts in Minot, ND.
Currently, Medcor is working for the Zoological Society of San Diego. The society hired Medcor, to establish a wilderness medical program to support a research station in the jungle, at Cocha Chashu in the Amazon jungle of Peru. Zoo officials asked Medcor to help assess the medical needs and response options for people at the station as it is very remote, requiring four days travel from the U.S., the last two being by small boats 10 hours a day.
The zoo is assessing the risks to the participants — zoo employees or visitors — and planning to provide for the safety of everyone there. These goals include providing medical services to the program.
Executive Vice President Curtis Smith says there are many challenges to such a remote project.
First, he says, most medical providers are trained and experienced to work within a broader system. Here, there is a 911 system to call in emergencies, there are specialists to refer to or to consult with by phone. In the US, X-ray, lab, and other diagnostic tools are readily available, and well-stocked pharmacies exist nearby. If on-site clinic staff in the US rely on those off-site resources too much, they negate many of the benefits of resolving cases on site, avoiding unnecessary claims, and reducing costs, Smith says.
If they rely on those systems in remote locations, they are really in trouble, Smith says. Clinics operating in remote locations cannot rely on traditional off-site resources, forcing the on-site staff to be self-reliant. Those efficiencies help Medcor’s on-site clinics perform better back in the U.S.
13 common challenges to setting up a remote medical clinic include:
  1. Recognizing the hazards and limitations of the area.
  2. Determining a scope of care that minimizes risks and costs – then writing standards and protocols to match.
  3. Figuring out the logistics of getting there and back routinely, and during medical emergencies..
  4. Determining the equipment and supplies that are truly needed and what is extraneous.
  5. Developing practical reliable emergency plans based on the logistics, staff, and supplies that are available.
  6. Establishing the method, reliability, security, and cost of various communication methods.
  7. Selecting the right staff – not only in terms of medical skill and experience, but with the personality to get along with the client team at the remote site, and the character to function independently.
  8. Training the staff in advance of deployment so they are not learning the basics, such as equipment, software and procedures, on the job. The on-site staff will have to learn the specifics of each site once there, which will be tough enough.
  9. Handling turnover – in the event that the medical staff leaves, for whatever reason.
  10. Finding valuable and rewarding work for the medical staff to do when not treating patients so the staff stays engaged and motivated to remain on the project.
  11. Establishing clear goals with clients – often they, too, do not understand everything about the remote site.
  12. Language barriers between the employees and local medical providers, if not English speaking, need to be addressed.
Another common challenge to setting up remote clinics is being underbid by people who grossly under estimate the work involved and resources needed.
Each site and project can be very different from others. Long-term assignments are very difficult to staff because the medical personnel miss their families, friends, and “professional life,” Smith says. Short term assignments are difficult because they interrupt or prevent long term work elsewhere.

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. See for more information. Contact:

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

Benefits of a Nurse Providing Immediate Medical Attention to Injured Workers

Benefits of the Nurse Triage Approach to Workplace Injuries
Employees obtain  immediate medical attention from a trained occupational health professional. They love the new benefit that helps them deal with their pain. Extensive data shows that costs are much less than a visit to a hospital or clinic. Supervisors no longer need to be solely responsible for making the medical assessments of injured employees with all the awkwardness of the work relationship. Employees are soft-channeled to a designated medical facility, usually an occupation health clinic, identified in advance by the employer location.

The initial triage  report from the nurse is faxed to the designated medical facility before the employee arrives – reducing the time an employee waits to be treated while shortening the time away from work. The paperwork is begun and emailed at the conclusion of the call.

All calls are recorded  and the nurse is well-trained and personable when asking a series of questions to get at the cause of the injury. This locks an employee to a story at the time of the workplace injury. It may make all the difference in avoiding a runaway case. Employers can identify specific loss control oriented questions for certain types of injuries, use of personal protective equipment for example.

The results  of the triage process can be measured and the ROI is compelling. It reduces the actual number of claims handled because as many as 50% of the calls result in a non-referral to an outside metical provider. Good triage has been shown to lower the ultimate cost of a claim by driving more accountability. It cuts the number of instances where the ‘story’ or nature of the injury or body part changes. Soft-channeling by the nurse increases utilization of discounted network providers typically saving 25% per bill. The return on investment is often $3 – $5 for every dollar invested.

Author: Brian Cullen  ARM, CLIC, Executive Director with Medcor has joined our list of guest bloggers. He can be contacted at 630-240-6741 or

Click on these links to try it for yourself.
WC Calculator
TD Calculator
WC 101
Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel before implementing any cost containment programs.
©2008 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

Key Considerations When Selecting A Clinic To Treat Your Injured Employees

Amaxx: Is there anything else employers should look for during a visit to the prospective clinic?
Dr. Dubin: When everything is done on site it is sometimes a double-edged sword because although it is more convenient for the worker and fewer logistical issues for the company workers’ compensation coordinator, there is a greater possibility of over treatment. This is especially true with physical therapy is done at the same location.

Several other questions to consider:  

1-Are blood draws done on site?
2-Are X-rays done on site?
3-Are spirometry tests done on site?
4-Are stress tests done on site?
5-Is physical therapy done on site?
6-Are drug and alcohol screen done on site?
7-Do they do pre-employment tests performed?
8-Do the nurses/doctor call the injured worker to check on their condition the day following the visit?
9-How workplace-friendly is the office. For example, how do they coordinate with the workplace before placing a worker on lost time?
10-Are they open to visiting the work site?

David Dubin, MD. is an emergency room physician who serves as a medical advisor for several companies. Formerly president of Aon Medical Consultants, he has been helping employers and insurance companies develop innovative cost containment programs and reduce workers comp costs for over 20 years. He can be reached at: or 860-553-6604.

WC Calculator
TD Calculator
WC 101

Do not use this information without independent verification. All state laws are different. Consult with your corporate legal counsel or other professionals before implementing any cost containment program.

©2009 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

Working with Occupational Clinics: Before the Injury

Establishing a cooperative relationship with an occupational clinic convenient to your worksite is very important. Even though not many of your injured workers will ultimately visit the clinic, you as the employer are often in a good “bargaining” position to get the most attention and the best service possible. If the clinic is doing pre-employment physicals, drug testing, etc. your company is a valuable source of revenue.

Next, involve your Medical Director. If your Medical Director is local, he or she should attend the initial meeting to set up the relationship. Establishing a doctor-to-doctor relationship will be an important component of getting injured workers back on the job. A treating physician is more comfortable sending an employee back to the workplace knowing that another physician is also concerned with the worker’s safety. If your Medical Director is not local, he or she should have a phone conversation with the clinic’s Medical Director to establish a good rapport.

In your meeting with the Clinic Manager and Medical Director ahead of time, make sure that the clinic is aware of whom to contact at your company whenever an employee is treated. It is essential that the employer contact be made before anyone is taken off work. This should be part of a clear, stated policy with regard to return to work (RTW). Ideally, the work status should be determined by the employer and not by the treating doctor. This is a key point that is often missed. While the treating physician determines the physical restrictions, as long as the workplace can accommodate a worker’s restrictions, it should be up to the company whether or not to bring the worker back. Always involve your legal department in setting up return to work parameters. For more ideas of how to coordinate medical care click here:

One way to reemphasize these key points is to use a Brochure to the Physician like the one in Workers’ Comp Kit — a “leave behind” communication reminding the doctor and clinic employees about the employer’s transitional duty program. Dr. Dave is happy to answer questions from the comments box below or thorugh his email at

For more cost savings tips go to WC Cost Reduction Tips.

Professional Development Resource

Learn How to Reduce Workers Comp Costs 20% to 50%"Workers Compensation Management Program: Reduce Costs 20% to 50%"
Lower your workers compensation expense by using the
guidebook from Advisen and the Workers Comp Resource Center.
Perfect for promotional distribution by brokers and agents!
Learn More

Please don't print this Website

Unnecessary printing not only means unnecessary cost of paper and inks, but also avoidable environmental impact on producing and shipping these supplies. Reducing printing can make a small but a significant impact.

Instead use the PDF download option, provided on the page you tried to print.

Powered by "Unprintable Blog" for Wordpress -