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Back to work; Indiana's occupational health centers cut worker's compensation costs and get employees back on the job.

Back to Work

About $56 billion.

That's the estimate of what it cost U.S. companies in 1989 for worker's compensation and lost productivity as a result of medical problems. Employers obviously are concerned about their workers' on-the-job safety and the rising cost of worker's compensation insurance. Add in the costs of meeting madates from the U.S. Occupational Health and Safety Administration, and it's not surprising that a growing number of companies are taking advantage of the myriad of services that Indiana's occupational health center offer.

"Occupational health care is no longer just a 'trend' in the health-care industry," notes Jack Jeffries, president of Occupational Health and Hygience Corp., which is affiliated with Westview Hospital in Indianapolis. Indeed, what was a trend is sprouting into a new industry. Occupational health centers--many of which are affiliated with hospitals--are flourishing around the state, rehabilitating injured workers so they may return to their jobs as soon as possible. The centers also conduct wellness programs, provide drug-testing services, perform physical examinations and evaluate and control employee exposure to hazardous substances, among other services.

Getting injured workers back on their feet is one of the key services occupational health centers provide. It is important to business and industry, because every day that an injured worker is out means lost productivity and greater worker's compensation costs. "Use of occupational health centers is growing mainly because the cost of worker's compensation continues to increase greatly in Indiana. Much of the cost in worker's compensation is in time off, not the medical costs," notes Maureen F. O'Connor, a manager at St. Mary's Medical Center's Programs for Industry in Evansville. Revenues at St. Mary's Occu-Med and Occupational Medicine Clinic have doubled each year since the centers were opened in 1988, she says.

O'Connor says the per diem worker's compensation payment in Indiana is lower than it is in neighboring states, but that it is on the rise. In the past, low worker's comp payments provided an incentive for an injured employee to return to work quickly, but as it becomes more lucrative to be off work, some workers will take advantage of the system. Meanwhile, some general practitioners in the medical profession with concerns about avoiding malpractice litigation will allow an injured worker to stay off the job longer than he or she needs to be, or will send an injured worker to a specialist when it's not necessary.

That's where occupational medicine centers come in. Their doctors strive to get injured workers back on the job as quickly as possible without comprising employee health, O'Connor says. That helps foil the small percentage of workers intent on beating the system, and empowers the more motivated employees to return as soon as they can. "Most injured workers are extremely motivated to return to work," notes David B. Dann, CEO of Methodist Hospital of Indianan Inc.'s Occupational Medicine Centers in Indianapolis.

Needless to say, most employers are extremely motivated to get those injured workers back on the job. Their absence is expensive. O'Connor points to a study of work-related back injuries, of which the Hoosier state saw 14,000 in 1988. A typical back injury costs an Indiana employer $1,700> 58 percent of that is medical fees, while 42 percent is payment for time off. The worker's comp component may seem steep here, but it's even higher elsewhere. In Illinois, for instance, worker's comp payments make up 69 percent of what an employer pays for a back injury. The higher worker's comp per diem makes the average back injury cost $6,300 in Illinois.

How do occupational health centers help fight costs by getting workers back on the job more quickly? A process called work hardening is one of the solutions. "Work hardening is a custom-tailored program that helps an injured worker return to his job after he participates in work simulation tasks that duplicate the movements he makes while on the job," Jeffries explains. The process is important because in many jobs, repetitive movement itself can lead to problems.

"For example, an employee who works for an RV manufacturer putting a specific part together on an assembly line will be bending his hands the same way repeatedly during his entire shift," notes Vickie M. Notzel, director of the Center for Occupational Health at Memorial Hospital of South Bend.

"Our program includes teaching the injured worker how to use proper body mechanics and proper lifting techniques when he does his job.c Jeffries adds. "Physical and occupational therapists do the teaching."

Assembly line workers are not the only employees at risk for health problems related to repetitive movement. Phyllis Stewart Hope, director of the occupational health department at the Occupational Health Center of St. Vincent Hospital and Health Care Center Inc. in Indianapolis, cites U.S. Department of Labor statistics that identify manufacturing, construction, transportation, distribution and public utilities as the job fields with the greatest number of injuries and the greatest potential health risks. She adds that people in clerical jobs also suffer from repetitive stress injuries because they often sit at computer terminals all day

In general, jobs most likely to have injury are those that require a joint to leave its neutral position repetitively and those that require the natural arch of the back to be inverted, or curved out instead of in, according to Charles Wolf, director of physical therapay and part owner of Associated Rehabilitation Services, which provides occupational health service for the Comprehensive Out-patient Rehabilitation Center at Memorial Hospital of Michigan City.

Some injuries are seasonal because some jobs are seasonal, notes Dr. Jeffrey Jones, medical director of the St. Francis Occupational Health Center of Beech Grove's St. Francis Hospital Center. "In the summer we treat a lot of workers who suffer acute injuries from working in some type of building trade."

The work-hardening program at Methodist Hospital's Occupational Medicine Centers in Indianapolis lasts four to eight weeks. Participants are asked to wear their normal work clothing, and are given work tasks that simulate those at the workplace. They also are given the same work breaks and lunch periods that they would get on the job. At the end of weeks four and eight, they are given thorough evaluations, and they either are returned to work of given a permanent partial-impairment rating.

Rehabilitation is aided by technology that, among other things, helps in accurate diagnosis. An isometric strength testing unit at Methodist, for example, can evaluate the extent of an injury, measure rehabilitation progress and determine whether an injured worker is malingering.

Work hardening is a relatively new approach to an old problem, according to Bill Hitchcock of Muncie's work Performance Center. Hitchcock, who worked for a number of years as a physical therapist before opening the center in 1983, says work hardening now is used much more widely than the old-school methods, which prescribed immobilization for work-related injuries. "It used to be thought that lengthy bed rest was the best medicine," he says. "Now it's accepted that aggressive treatment is the best treatment for these injuries." The aggressive treatment at Work Performance Center is conducted by occupational and physical therapists, who guide patients as they use machines that test and improve eye-hand coordination, lifting strength and other work-related factors. Work simulation devices assist patients whose jobs involve lots of climbing or require a sustained posture.

Occupational health centers often don't need to turn to the simulation devices and other specialized equipment, even in the case of back injuries. Treatment of work-related back injuries varies depending upon the circumstances, says Dr. Jerome Schubert, a vice president and physician at Fort Wayne Occupational Health Center, which has three locations in Fort Wayne and branches in Warsaw, Huntington and Elkhart. If the back was injured in a fall, for instance, one of the first thing a doctor will do is order an X-ray, some type of support for the back and some medication. For a strain, an X-ray might not be taken at all, unless symptoms don't disappear after a couple days of treatment with ice packs.

If there is no bone injury but symptons remain, Schubert says daily heat and ultrasound therapy could be provided, followed by back exercises. The specialized equipment and work-hardening routines often come into play only if patients aren't responding to the other treatments.

While the initial purpose of occupational medicine is to get a patient back on the job, it also is geared toward keeping that worker from having to return to the occupational health center. The goal of occupational medicine is the eventual prevention of injury, says Wolf. "Education is the key," he says. "It doesn't matter what we do if the worker doesn't recognize or understand his contribution to his own care." The worker, he sys, must understand what part of his body he injured, why the injury occurred and what he can do to help himself.

The largest occupational health operation in the state is Methodist Hospital's Occupational Medicine Centers, according to Phillip M. Harman, director of marketing. Methodist has four occupational health center locations around Indianapolis. Its downtown branch stays open 24 hours a day. "Our goal is to meet everyone's needs--the injured worker and his employer, the union that's involved and the worker's compensation insurance carrier," he says.

Meeting everyone's needs under one roof is one of the basic tenets of the growing occupational medicine industry. The concept, says Dann of Methodist, is to provide services that run the gamut from the prevention of work injuries to rehabilitation when injuries do happen.

Southeastern Medical Center, which operates an occupational health center in Hammond, also subscribes to the philosophy of offering as mny useful services as possible. "Whatever they need, we provide for them. We are full-service," says Kishor Shah, the center's administrator. Southeastern, he says, has such preventive services as physical examinations and drug screenings to emergency care to post-injury therapy.

Such "one-stop shopping" also is offered by WorkWell, a cooperative occupational health-care service operated by Welborn Clinic and Welborn Baptist Hospital in Evansville. Besides treating work-related injuries and rehabilitating injured workers, the WorkWell program's six Evansville-area locations provide emotional counseling through its Employee Assistance Program, which is a confidential service that helps employees and their families solve personal problems through counseling and therapy.

Such services can help promote the image of the benevolent employer, which is one of the goals of occupational medicine, according to Wolf of Associated Rehabilitation Services. "We are about networking," keeping in touch with employees, he says.

Performing physical examinations is a major service provided by occupational health-care centers, says Nancy George, regional director for ambulatory care development and physician practice enhancement for Lakeshore Health System. Her organization offers occupational health services through its hospital, St. Catherine in East Chicago and St. Mary Medical Centers in Gary and Hobart.

Among other things, employers call upon George's organization to do pre-employment physicals, periodical physicals on current employees, and the more involved executive physicals for those higher up on the corporate ladder. Occupational Health Industrial Medicine, which is the name Lakeshore uses to identify its occupational services department, leads some to believe that such services are mainly for industrial clients, says George, but in truth she sees many clients form office settings as well.

There are other services that also are available to employers at occupational health-care centers. Drug screening and audiometric testing are among the more popular services, says Barry A. Gemmer, administrator of the Fort Wayne Occupational Health Center. Gemmer's center also brings a range of services directly to the workplace. It has, for instance, a mobile audiometric testing unit. "This type of testing accounts for a big chunk of the center's business." Fort Wayne Occupational Health center also travels to businesses to conduct specialized physicals and health screens and to administer annual flu shots, all of which stem from the center's goal of reducing lost work time.

Drug screenings and audiometric testing also are among the business and industrial health services on the menu at Kosciusko Community Hospital in Warsaw. Through the hospital's Synergy program, businesses also can arrange for pulmonary assessments, physical examinations and screenings for high cholesterol, among other services. Veisa Staton, wellness program coordinator, says her hospital set up the program upon learning that area businesses were having to look in other cities to meet some of their occupational health needs. The program has been in business for less than a year, and Staton says more services will be added in the future.

Though spiraling worker's comp costs are one reason for the boom in the occupational medicine industry, legislation has had a role as well. Shah of Southeastern Medical Center says the industry has probably doubled in size in the past few years, "mainly because of federal and corporate regulations."

The OSHA, for example, requires logs and records of injuries, and occupational health centers are familiar with the necessary paperwork. OSHA regulations require, among other things, medical surveillance for workers who have on-the-job exposure to hazardous substances. Occupational health centers typically provide such services. "There's a whole new area of occupational medicine that is trying to reduce exposure to hazardous materials," notes O'Connor of St. Mary's.

New U.S. Department of Transportation regulations, in addition, require truck drivers, locomotive engineers and other transporation workers to undergo drug screenings that meet specific requirements. Occupational health centers are poised to help businesses meet those regulations, which O'Connor says can be quite complicated. "If you don't conduct the DOT drug screen properly, it's thrown out."

Medical schools also are recognizing the increasing emphasis on occupational medicine. Doctors are able to get training specifically in the kinds of injuries and treatments that are common in the workplace. Dr. Scott Edwards, for instance, has a fellowship in occupational medicine. He heads a staff of 12 at St. Joseph Medical Center's Center for Business Health in South Bend and Mishawaka. Jones of St. Francis Occupational Health Center is one of only about 1,000 U.S. doctors who are board-certified in preventive medicine, specializing in occupational medicine.

Who uses occupational health centers? The client employers are both large and small. Patients are teachers, delivery-truck drivers and utility workers. The Fort Wayne Occupational Health Center, for instance, has clients ranging from Conrail to Creation Windows. Occupational Health and Hygiene as well as Methodist Occupational Medicine Centers provide services for employees of United Parcel Service and Indianapolis Public Schools. Ace Battery and Alpine Electronics Manufacturing workers get their occupational health care from St. Francis, while WorkWell in Evansville takes care of the military meal-makers of Shelf Stable Foods and the advertising creators of Keller-Crescent Co.

Many companies recognize the need to provide occupational health care but would rather take care of what they can in-house. Many set up their own nurse-directed occupational health programs, often with advice from the Indiana Association of Occupational Health Nurses.

"Two or three cases, depending on what's involved, could pay a nurse's salary over a year," says Mary Baumgart, president of the occupational nursing association.

"A large part of what we do is health and wellness education and case management, following people who are off on work-related injuries, making sure they are getting the appropriate care."

Baumgart is a nurse for PPG Industries in Evansville. She says nurses are employed by medium to large businesses of all types, and while they can't do everything an occupational health center can, there are some cost and convenience benefits. "We do cholesterol testing here for our employees. It cost $4,000 initially for the equipment, but in the first year we found several young people who needed immediate care. We may have saved some strokes or heart attacks down the road," she says. If that is so. the $4,000 investment could end up saving lives as well as substantial medical costs.

Baumgart adds that services such as hearing tests often can be done more cost-effectively by a staff nurse. "Most companies that have any noise exposure need annual hearing tests. If you have several hundred employees that need this done, it can be a lot cheaper to buy the equipment and pay a nurse. And the nurse is there for follow-up."

Having an occupational nurse on staff can help in other, less obvious ways as well. Carolyn Webb, president of the nursing organization's central Indiana chapter, is an occupational nurse for Farm Bureau Insurance in Indianapolis. Her employer is building a new headquarters facility, and Webb has been involved in selecting equipment that among other things will help minimize the repetitive stress injuries common to people who work on computer terminals. "I've been working with people who are ordering workstations so we can prevent these injuries."

A company that has an occupational nurse on staff may need fewer occupational health center services, but, the nurses point out, they're really not competing. Nurses handle some testing, wellness education and treatment of minor injuries, but they also work with occupational health centers when employees need specialized services, treatment and equipment that the nurses can't provide. "We work together," Baumgart says of on-site nurses and occupational health centers. "It's a cooperative venture."

The organization advises employers who are considering establishing their own programs to identify their corporate philosophy toward the health of their workers. From that philosophy, the companies can determine the scope of the nursing practice and the components of the program. The organization recommends that a company hire at least one nurse for every 300 industrial employees or 750 non-industrial workers.

The nation currently is facing a shortage of nurses, but Baumgart says companies looking for occupational health nurses generally don't have any trouble. Any openings that there have been for occupational health nurses have been snapped up fast." The companies, of course, will need to offer pay and benefits similar to those that hospitals offer, but occupational health nursing has some attributes that make it more attractive to many nurses.

"Part of it in many cases is the hours," Baumgart explains. "Many companies work with just one nurse who typically works Monday through Friday. And it's interesting work because you are working with people on an ongoing basis."

Whether it's through their own nursing programs or through occupational health centers, employers are likely to find an increasing need for such services in the future, says George of Lakeshore Health System.

"I definitely see it more," she says, "and see the need for hospitals to be more proactive in making sure their programs stay abreast of the standards of industry."
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Author:McKinley, Sara; Kaelble, Steve
Publication:Indiana Business Magazine
Date:Jan 1, 1991
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