A joint International Labor Organization/World Health Organization committee defines occupational health as the “promotion and maintenance of the highest degree of physical, mental, and social well-being of workers in all occupations.”
This article will refine that definition as it applies to urgent care occupational medicine (UCOM) and explore the rationale for incorporating products and services of value to employers within an urgent care clinic.
Scope of Practice
Clinics that offer occupational medicine services are uniquely positioned to help employers manage worker health, injury, illness, and dis- ability in a time of rising medical costs—and increase their own chance for economic survival in an increasingly competitive healthcare marketplace.
It is estimated that only about 1,000 board-certified occupational and environmental physicians are practicing in the United States, which reveals the need for physicians who are skilled in urgent care, emergency medicine, internal medicine, and family practice to step in and work with cost- and quality- conscious local employers who are looking for alternatives.
The path to board certification in occupational medicine is via the American Board of Preventive Medicine. One of 24 medical specialties recognized by the American Board of Specialties, preventive medicine encompasses multiple population-based and clinical approaches to health care, including occupational and environmental health. Another organization, the National Association of Occupational Health Professionals, was created in 1990 to support the advancement of the field of occupational medicine.
Urgent Care Occupational Medicine
The UCOM delivery model requires the clinician to build not only a high level of confidence with patients, but also a rapport with each employer client.
Typical occupational health services that can be readily incorporated into an urgent care clinic include work
related injury treatment and care management; drug and alcohol testing; preplacement and other types of screening exams; and immunizations.
In some markets, expertise in issues as diverse as bioterrorism, ergonomics, toxic exposures, indoor air quality, workplace violence, stress-related complaints, and pain management may also serve the practitioner well.
Wellness-oriented products such as health risk appraisals, smoking cessation, and nutritional counseling/weight loss also may be part of the UCOM product line.
Beyond these core services, urgent care clinicians seeking to offer occupational health services should be well versed in federal and state issues that affect employers, such as workers’ compensation, Occupational Health and Safety Administration and Department of Transportation rules, family and medical leave policies, and patient privacy, to name a few.
Employers the “customer” in the UCOM model— have a wide range of expectations that the urgent care practitioner should bear in mind when deciding whether to offer occupational health services. Among them:
- convenient location, extended hours, comprehen- sive care, and short turnaround times
- return-to-work orientation that helps reduce lost work time
- cost-effective, quality healthcare provided by a multidisciplinary team
- services that can be customized according to a client’s needs
- emphasis on prevention of injury and illness, as well as root causes of workplace incidents
- referrals to appropriate specialists and rehabilitation professionals
- prompt verbal and written communication with employers on patient status and treatment plans
Low Risk, High Potential Return
An occupational health component has the potential to expand an urgent care clinic’s revenue on two funda- mental levels:
- Work-related injury care has the potential to attract new business; satisfied patients and family mem- bers often return for non work-related care at a later date (and tell their friends to do the same).
- Typically, the occupational health payor mix is more lucrative than a traditional payor mix; many times, occupational health programs receive compensation based on employer-paid or workers’ compensation fee
Often, adding an occupational health component equates to the expansion of established services and clinical skills—as opposed to intensive training and the expense of new equipment or construction meaning such a move can be relatively low-cost and low risk. Incremental costs involve additional staff and cross training of existing personnel.
To be successful, a UCOM program must have a designated medical director and dedicated medical personnel who will be available to provide direct patient care, accept patient referrals in a timely fashion, and serve in an advisory capacity, as needed.
Future articles in JUCM will discuss the role of the medical director and various staff members.
Delivery Models
Beyond the workplace itself and growth within the urgent care setting, occupational medicine is well established in hospitals as an outpatient service and/or in emergency departments, usually as part of a “fast track.” Occupational health providers also can be found in multispecialty clinics, freestanding clinic networks, and private, physician-owned practices.
Nonetheless, many urgent care practices have yet to formalize their occupational health offerings. Degrees of integration may vary depending on workers’ compensation reimbursement in the state of practice, employer demographics, and the nature of the competition, among other factors.
Like urgent care, occupational and environmental medicine is an evolving field. The scope of practice has changed dramatically in response to market forces and changing federal and state regulations, as reflected in transitions from the term “industrial medicine” to “oc- cupational medicine” to the current preferred term, “occupational and environmental health.”
Today, emphasis is moving toward “total health management” (i.e., the overall health and well being of the worker both on and off the job), which allows for pro- vision of services to employers, employees, and their families.
The key to success with this model of care is the education, health screening, and referral of employees and their families for appropriate healthcare and disease management, thus reducing both group health and workers’ compensation costs.
Overall, urgent care occupational medicine provides a grassroots delivery model that can offer significant benefits to clinic operators, employers, employees, and their families.