Loss control as a line of business is manageable, all you need is the right tools. As Charles Haanel (1916) reminds us, "You don't have to laboriously shove out the darkness, all you have to do is turn on the light."
So, let's talk about the 'company doc'. This option for controlling workers' compensation expenses is an interesting one. But the question as to whether or not it is cost effective for you to employ an occupational health physician or use your local health care provider is not easy to answer. Lots of factors need consideration.
The size of your organization, the amount of funding you have, your pre-employment and mandatory testing needs, and the number of injuries and illnesses your organization experiences will all influence your decision.
Additionally, how responsive to your needs is your medical provider? For instance, how far away are they and how much time are employees taking when going there for evaluation? How efficient are they? Do they comply with return to work restrictions? Are follow-up appointments timely? Do they offer pre-employment and mandatory testing for your industry? If the answers to these questions are not satisfactory, then you may want to take the next step and contract with a physician to work with you on-site.
So, bottom line? If you have enough work for an on-site company doc, and your medical provider is less than satisfactory, you should think about hiring a physician.
You will need to discuss with him or her as to the types of duties expected. These may include general oversight of your workers’ compensation program (policy and procedure), pre-employment physicals, health and safety exams specific to your industry (tuberculosis, hearing, pulmonary, etc.), evaluation and treatment of employee injuries and illnesses, follow-up to those injury and illnesses, return to work exams, and the substance abuse program if you have one. Also, your company doc should always evaluate any employee who is placed out of work by a medical provider off hours.
A quick note on substance abuse programs. They can be problematic and I advise that you have a third party provide this service. Having your company physician also be your Medical Review Officer (MRO), which a drug screening program requires, can create animosity and distrust of your physician in your employee base as well as put your company physician at risk, physical harm actually should a pre-employment candidate or one of your employees tests positive.
Additionally, how responsive to your needs is your medical provider? For instance, how far away are they and how much time are employees taking when going there for evaluation? How efficient are they? Do they comply with return to work restrictions? Are follow-up appointments timely? Do they offer pre-employment and mandatory testing for your industry? If the answers to these questions are not satisfactory, then you may want to take the next step and contract with a physician to work with you on-site.
So, bottom line? If you have enough work for an on-site company doc, and your medical provider is less than satisfactory, you should think about hiring a physician.
You will need to discuss with him or her as to the types of duties expected. These may include general oversight of your workers’ compensation program (policy and procedure), pre-employment physicals, health and safety exams specific to your industry (tuberculosis, hearing, pulmonary, etc.), evaluation and treatment of employee injuries and illnesses, follow-up to those injury and illnesses, return to work exams, and the substance abuse program if you have one. Also, your company doc should always evaluate any employee who is placed out of work by a medical provider off hours.
A quick note on substance abuse programs. They can be problematic and I advise that you have a third party provide this service. Having your company physician also be your Medical Review Officer (MRO), which a drug screening program requires, can create animosity and distrust of your physician in your employee base as well as put your company physician at risk, physical harm actually should a pre-employment candidate or one of your employees tests positive.
There are national organizations that provide testing and MRO services whereby you or your medical provider become the collection site only. There are very rigid collection standards and many different methods and substances to test for. Please visit http://www.drugfreeworkplace.gov for more information. You will need to decide what you want to test for, and if you wish to conduct pre-employment testing only or random as well.
Okay, back to the company doc. There are several types of specialists you can choose from: physicians certified in occupational medicine, osteopathic physicians, orthopedic physicians, physiatrists, or chiropractors. Sometimes employers partner with generral medicine physicians such as internal medicine and family practice and/or nurse practitioners or physician assistants. Each specialty offers its own expertise, however each brings its own limitations as well.
Your first best choice is a physician certified in occupational medicine. You can find resources by going to http://www.acoem.org. The American College
The traditional specialties usually have some experience in occupational medicine, and can easily be advised of your policies and procedures and your needs as an organization. However, sometimes follow-up care can be longer, especially with chiropractors and orthopedic physicians. Many organizations have had success with physiatrists, who specialize in soft tissue problems.
It may be wise to set up access to a second opinion resource. For example, you employ a physiatrist as your company physician, but have an orthopedist as backup. Both specialists must understand your organization, and can offer different skills for particular injuries and cover for one another during vacations. Regardless of the physician specialty, you have the option of hiring your on-site doc full or part time.
You also have the option of contracting 'off-site' with hospital walk-ins (which are usually the slowest ), free standing clinics, or physician offices for your injuries and mandatory exam needs, however although this may be cheaper you lose control over availability as well as timeliness of appointments.
If you do hire a company doc, you will have to provide a secured area where he or she can privately conduct business that has all the necessary equipment; including a sink, refrigerator, a dry storage area, and an exam table. It should also be somewhat close to a bathroom and near a reception/registration area, as you will have to provide some type of clerical support as well.
A word of caution: a company’s worker’s compensation ‘doc’ can be expensive and may be abused by employees who try to utilize him/her for other non-employment needs such as prescription filling and health checks. I have seen employers fall into the trap of running a primary care practice with their workers’ compensation dollars, while also paying for health insurance through their benefits program. Clear guidelines need to be communicated to both your employees and your company doc.
It may be wise to set up access to a second opinion resource. For example, you employ a physiatrist as your company physician, but have an orthopedist as backup. Both specialists must understand your organization, and can offer different skills for particular injuries and cover for one another during vacations. Regardless of the physician specialty, you have the option of hiring your on-site doc full or part time.
You also have the option of contracting 'off-site' with hospital walk-ins (which are usually the slowest ), free standing clinics, or physician offices for your injuries and mandatory exam needs, however although this may be cheaper you lose control over availability as well as timeliness of appointments.
If you do hire a company doc, you will have to provide a secured area where he or she can privately conduct business that has all the necessary equipment; including a sink, refrigerator, a dry storage area, and an exam table. It should also be somewhat close to a bathroom and near a reception/registration area, as you will have to provide some type of clerical support as well.
A word of caution: a company’s worker’s compensation ‘doc’ can be expensive and may be abused by employees who try to utilize him/her for other non-employment needs such as prescription filling and health checks. I have seen employers fall into the trap of running a primary care practice with their workers’ compensation dollars, while also paying for health insurance through their benefits program. Clear guidelines need to be communicated to both your employees and your company doc.
A final thought: In some instances you will be required to facilitate an Independent Medical Exam (IME) for a workers' comp claim. An IME can be required by state mandate at any point during an employee’s recovery in order to provide a disinterested third party opinion of an employee’s ability to return to work, or whether the medical end point has been reached.
Physicians who are also IMEs may or may not contract with an organization as a company doc. They are, most likely, not in your immediate geographic area. They are few and far between as they must be knowledgeable of specific disability guidelines. Your injured/ill worker may have to travel for an hour or more for the appointment, depending on your location.
So, good luck with all of that. If there is anything that you would like me to discuss, or if you have questions please let me know otherwise I will continue with what I believe are important to your workers' compensation loss control efforts.
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