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Back to work: occupational-health centers partner with employers.

Do you hear "carpal tunnel" and think mostly of data entry, clerks? The condition also is common among those who work in retail and on assembly lines. Do you hear "overexertion" and think industrial workers are the only victims? On the contrary, nursing home employees are most commonly afflicted.

But even though workers are subject to countless injuries and cumulative traumas, recent U.S. Department of Labor statistics reflect a steady decline in the number of lost work days. Overexertion, for example, dropped from 86 workers per 10,000 in 1992 to 69 in 1995.

One reason for the decline could be the partnering approach that occupational-health providers are taking with employers, The trend is a growing one in Indiana, where occupational-health providers range from hospital-based centers to stand-alone clinics to on-site services. These businesses are focusing on prevention, general wellness, education, site assessments, ongoing health checks, rehabilitation and single-source occupational-health services.

Helping reduce the number of lost work days is a priority for Methodist Occupational Health Centers in Indianapolis, says Phillip Harman, vice president of corporate services. "We have a whole model of delivery set up to avoid lost time. We look first at preventing injury, then evaluating, diagnosing and treatment."

Rather than saying "no work," Methodist providers identify any work restrictions that may apply, then let employers determine what tasks the employee can handle. Because of the Americans with Disabilities Act, most jobs have been defined by essential functions, so employers can identify appropriate tasks, Harman says.

Your place or mine? That's one of the newest trends in the business - offering on-site services or multisite clinics to give employers a choice of what best meets their needs.

At St. Elizabeth Medical Center in Lafayette, for example, employees can use its Back to Work Center, equipped to replicate a manufacturing site, or services can be provided at the work site. "Employers struggle with employees being off-site, so we are going to customers' sites and offering work hardening there," says Kathy Beaver, director of St. Elizabeth's CorporateCARE program.

Community Hospitals Occupational Health Services in Indianapolis delivers services three ways, says Dr. Steven Smith, director of occupational and environmental health and medicine. "People can come to us at our clinics. We can go to them with our mobile van service. Or we can become part of them, on-site, where our nurses and physicians are in their facility."

Employers especially appreciate the van service, he says. "We have two vans that travel to the workplace. They may go once a month or once a year for screening kinds of evaluations." Those include x-rays, hearing tests and breathing tests. "Employees can work up until they come to us. We see them, do whatever needs to be done, and they go right back to work. It reduces the time they are away and is very convenient."

Methodist offers a similar range of options. Besides eight primary-care occupational-health clinics in Marion County two of which are open 24 hours a day, 365 days a year - it's just added a mobile unit and provides full- and part-time on-site physicians and occupational-health nurses.

U.S. HealthWorks, a two-year-old national occupational-health company with sites in Fort Wayne, Huntington, Warsaw and Elkhart, operates stand-alone clinics. "We can go on-site. We have the capabilities," says its administrator, Howard Drenth.

"However, what we want is to have strategically located centers in the community to provide a vertically integrated delivery system. We put providers in one center, and employees go to one place for physical exams, drug screens, specialty care and acute care, all under one roof," he says. "That gives the employer tighter control and a consolidated bill."

Prevention of illness and injury and promotion of general health are two areas occupational-health businesses are focusing on.

"We do walk-throughs of clients businesses, assisting with general concepts and thoughts related to safety and prevention. And if we see patterns of injuries, we talk to the company about why and what can be done," says Maureen O'Connor, director of sales at St. Mary's Health Care Services in Evansville. "Another key is screenings and physical examinations at hiring or the return-to-work point."

"Industries are starting to focus more on prevention," says Laura Fudacz, director of the St. Catherine Occupational Health Program in East Chicago. "They are investing in programs from smoking cessation to weight loss to stress reduction to fitness."

Floyd Memorial Hospital Occupational Health Network markets a Life Club Program that promotes wellness, says Louetta Combs, supervisor for occupational health. "We plan monthly activities for employees, offer incentive rewards, screenings and educational talks." Another benefit: giving flu shots on the job. This winter Floyd Memorial personnel gave more than 2,800 flu vaccines at work sites.

Site assessments are one way Arnett Clinic Occupational Health Services, based in Lafayette, serves its clients, says Scott Lerew, program manager. "We have a certified ergonomist on staff who can evaluate the workplace."

St. Mary's, too, offers ergonomic profiles. "We observe the work station, go through ambient environment issues, review accident summaries and report back to the company on what's being done correctly and what could be changed," O'Connor says. "We've developed a poster of stretches for pre- or mid-shift, from hands for people on computers to the whole body. A lot of injuries are too much of the same thing, without rotating or breaking."

"Cumulative traumas are always a concern," she says. "They include backs, shoulders, knees and carpal tunnel and are often more lingering cases. In the long run, these can be totally disabling. Our goal is to avoid anything that will lose productivity, and that's where ergonomics comes in."

At St. Elizabeth, Beaver says assessment recommendations are often simple suggestions. "It may be giving your foot a rest, shifting your weight or adding a rubber mat to stand on. These save backs, legs and feet." Most companies recognize the importance of prevention, she says. "Some of it is practical and pragmatic. Site assessments are a big help in reducing injury, and they reduce the off-site time. It keeps production moving," Beaver says.

At Community Hospitals, an industrial hygienist can diagnose a workplace and monitor it for noise or chemical exposure.

Smith at Community Hospitals suggests that one can view the whole practice of occupational medicine as a subspecialty of preventive medicine. "There is now a thrust for prevention," he says. "We predicate our whole program on prevention."

Community Hospital's approach is three-pronged, Smith says. "First, we try to protect the individual from even getting the disease. That includes physical exams to make sure they are not susceptible to something they will be exposed to in the workplace. It includes immunization programs and education, from material handling to diet and lifestyle."

The hospital's second level of care covers screening to detect diseases before symptoms appear. By using x-rays, blood tests and breathing tests, Community Hospitals can screen for exposure to lead, asbestos and other hazardous substances.

The third approach is intervening with rehabilitation or medical treatment to prevent disability or death, Smith says. This approach covers everything from lowering cholesterol to treating back injuries.

"We function at all three levels, but our intent is to push it to the lowest level, to have a person not be injured or ill."

That goal of eliminating illness and injury has prompted Indiana's occupational-health businesses to offer an array of services, such as Arnett Clinic's functional capacity assessment. It determines an applicant's ability to meet a job's demands safely before the applicant is placed in the job.

St. Elizabeth's portable work-capacity system evaluates an applicant's ability and capacity to perform tasks, measuring such factors as grip; arm, shoulder and torso strength; and flexibility. The system's dexterity and body-composition tests help determine an applicant's physical capacity.

Another program is where employers let employees build up to the level a task may require. "Some of the most proactive programs spend a lot of time with new employees, training them up front," says Combs at Floyd Memorial. "Some larger and more progressive employers have begun work conditioning for new employees before they go to work."

Work hardening is a valuable service because of the money it can save, Harman at Methodist says. "Those are the non-surgical injuries, where there's definite pain and disability, but it's not resolving itself. We use a multidisciplinary approach that involves learning how to live and work with pain, learning to do things, and getting the maximum improvement to manage their physical situation."

Another trend is investigating near-misses, what was almost an accident, says O'Connor at St. Mary's.

Education, too, is a major focus. "Education on the front end reduces and controls costs on the back end," she says. "We do a lot of back education and upper extremity education. One of our biggest clients is a white collar industry that wants to control its worker-compensation costs. We did on-site supervisor education and safety education."

St. Catherine's offers a breakfast and lunch speakers' series on educational topics of interest to employers. Speakers available for site visits range from occupational therapists to safety specialists.

Despite these efforts, though, injuries can occur. And Indiana's occupational-health businesses are there to rehabilitate workers when they do.

"We can never prevent everything, so we have good, professional people to treat workplace injuries and illness," says Smith at Community Hospitals. "Our emphasis is on functional restoration."

At St. Catherine's, workplace injuries are treated much the same way athletic injuries are, Fudacz says. "When athletes are injured, they get significant treatment. They're not in bed for two weeks. They're working out, keeping those muscles flexible. We use the term 'industrial athletes,' and try to keep them in the workplace, even if they are filing or doing a different task. We like them to keep active. If they are in bed, their muscles would become stiffer and weaker."

A common term these occupational-health providers use to describe their relationship to Indiana's businesses and industries is "partner."

"Occupational medicine is a relationship business," says Drenth at U.S. HealthWorks. "We have to have trust and a positive relationship. We partner with our customer."

"We listen," says Lerew at Arnett Clinic. "Then we tailor our program to meet the needs of the employer."

"We like to think of ourselves as an off-site health and safety program for our employers," says Smith. "We are the corporate medical department for small and medium-sized companies, and we also provide services to companies that do have a corporate medical department."

Occupational-health services pay in financial returns and other benefits. these providers say. "Many programs have an extremely high return on investment. For $1 spent, some programs return $4 to $10," Smith says. "Smoking cessation, injury prevention and industrial hygiene all bring an excellent return on investment. And there are warm and fuzzy reasons for prevention, too."

St. Catherine's is now looking into outcomes software, so it can show employers actual bottom-line results, Fudacz says. "Employers are getting more sophisticated, so we want to be able to provide this before they ask. It's like a report card, a way to check ourselves."

U.S. HealthWorks promises even more. "In two years, we want to be able to share financial risk with an employer," Drenth says. "We want to share in the responsibility for medical indemnity costs by being effective in preventing injury and illness, by moving it further upstream and keeping workers from getting injured."

Data will be key in achieving this, Drenth says. "With more data we can have better management. We can start looking at trends, looking at cost per case, and sit down with employers and help them manage better. We feed our customers back consolidated data."

These efforts and the business/occupational-health partnering trend suggest that even greater drops are ahead for U.S. Department of Labor reports on lost work days. As Smith says, "It is not only humanitarian, but economical."
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Title Annotation:Indiana
Author:Mayer, Kathy
Publication:Indiana Business Magazine
Date:Jan 1, 1998
Previous Article:Indiana's largest hospitals.
Next Article:Hammond.

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