By: Greg Moore, MPH & D. Winston Cheshire, MD, QME
Occupational clinics provide front-line care to injured workers who need medical treatment. These services are especially important during the current pandemic, not only for injured workers who might have been infected by COVID-19 but for all others who are receiving care and/or who are sheltering in place with on-the-job injuries. Even companies that have shut down their operations may have employees who are under care for previous accidents. Consequently, all businesses can face the challenge of finding ways to get obtain care for these employees during extraordinary times.
This article describes how occupational clinics are adapting to the current pandemic and what employers and injured workers should know about getting obtaining services through these providers – whether or not the business is operating or closed, and the patient’s condition is new or pre-existing.
Note: Many states have already issued “shelter in place” directives and closed non-essential companies. Organizations operating in any state that is not currently a hot zone should be taking notes on how to respond if and when the situation changes in their state.
Occupational Medicine Clinics are Essential Businesses
In states where COVID-19 is pervasive, occupational medicine clinics are considered an essential business and must keep their clinics open and staff on site. Extra steps must be taken to protect the medical team as well as the patients needing care. Here are the steps Akeso Medical Holdings took in its occupational clinics:
- All clinics have signs posted outside that give important information and tips to visiting patients.
- All patients are offered paper masks and hand sanitizer on entry to the clinic.
- Cleaning protocols and disinfecting procedures are significantly enhanced.
- All visitors, employees, medical providers, allied health care members, contractors, and vendors are screened prior to entry into a clinic. Screening includes questions related to respiratory symptoms such as sore throat, cough or shortness of breath, and temperature taken to ensure the absence of a fever (100.0 or higher).
- Additional training and monitoring of employees is a must. All employees are consistently reminded of the basic hygiene steps (wash hands frequently, do not touch your face, keep social distance, etc.).
- Purchasing agents constantly scour the supply markets for masks. With current supply shortages, face shields and N95 masks are reserved for employees with direct patient contact. Due to wide variations in daily supplies, adherence to this protocol may vary.
These guidelines address what every business should do, particularly a healthcare business that is staying open through the pandemic.
Flunctuations in the Volume of Cases and Claims
There are significant business continuity questions that must be addressed in times like these. On the one hand, with many employers shut down because of state and local orders, there are declines in work-related injuries from sectors like schools and hotels. On the other hand, many first responders and hospital clients are seeing their workforce stretched to its limits and put in situations where they are exposed to infection. It is difficult to predict how declines in cases in one area may be offset by increases in others, so the sooner the clinic can begin analysis of these metrics to plan for staffing and operations, the better.
Another issue occupational medicine clinics must deal with is fear on the part of the patients whose care is still in progress during this shutdown. In the first week of the official pandemic and thereafter, most clinics had a spike in canceled appointments and no shows. Clinics must address these fears so patients can safely receive needed care that may require in-person visits. Here’s a playbook that has proven to be successful at Akeso Medical:
- Protect your environment and let your customers know about these safety measures
To reduce fear that might keep patients away from getting the care they need, take the steps outlined above and make sure your patients know about them – on the website, on your phone message, in communications to patients.
- Adopt remote service solutions
Adopting or increasing the use of telehealth technology increases safe access to medical care. At Akeso, we had just rolled out a new telemedicine platform with Kura as this pandemic hit. As fear and confusion set in that caused patients to want to cancel appointments, we implemented an outbound calling campaign to all scheduled appointments giving them the option to stay at home and connect to our doctors. The response was dramatic – cancelations and no-shows were almost completely eliminated overnight. The patients themselves have been very positive about the experience. Anxiety is a big factor in times like this, and allowing patients to continue their care without having to leave the home provides significant and noticeable relief to them.
- Identify employees at risk and communicate a plan early
Healthcare providers must require people to be in the clinic, limiting work-from-home options. Early on, identify the handful of employees who do not need to be onsite, and set them up to work from home even though the clinics remain open. Having fewer people onsite lowers the risk of employee to employee exposure.
The next step is to take a close look at the resources that needed to be engaged in the clinic from the standpoint of employees who are at-risk and those who have at-risk individuals in their homes. Age risk is easy to identify, but few employees have let their employers know that they or their family members have conditions that make them immunosuppressed. Clinic operations must have that conversation and trust an employee to reveal a concern, without prying into their private situation.
A good approach is to define the risk criteria and then let the employee say whether or not they have a situation in their life that meets that criteria. Each situation is different, and many can be addressed by either moving someone away from typical traffic patterns in the clinic or by cross training roles to cover an at-risk person with another resource.
For physicians who fall into the risk category, telemedicine provided a unique solution. Akeso Medical set up a room in the clinic where the patient could be seen in person by a nurse or physician assistant. Also in the room was a telemedicine system that allowed the at-risk doctor to participate in the encounter while remaining safe at home.
Each situation is going to be different, but the sooner the is completed of people who can work from home, people needed on site who are not in an elevated risk category, and people who are needed on site but are in a risk category, the better equipped everyone is to explore options.
Stay focused on the needs of the customer
COVID-19 presented multiple new needs for occupational medicine customers. First responders and employees in businesses that had to stay open during the pandemic are at risk for exposure. Employers needed a clear plan for addressing workplace exposure to COVID-19. So, Akeso acted proactively and produced a playbook for anyone who thought they may have been exposed.
- First, quarantine at home.
- Second, call a dedicated number where the trained team could set up the necessary processes for a telemedicine encounter.
- Third, go through a screening process with these doctors via telemedicine. Based on that screening, the staff could arrange drive-through screenings or provide qualified advice on next steps.
Lean on the expertise of occupational medicine physicians in determining causation
The current pandemic is uncharted territory. However, at some point the decision must be made about whether the patient was exposed to COVID in public or in the workplace. One of the critical aspects that occupational medicine doctors are trained in is causation, and they are one of the few medical professionals experienced in making a determination of whether an injury or illness is work-related. This ability addresses a client need in a way that protects the employee, their coworkers, and clinic staff by completing the process without any physical contact with the patient.
Occupational medicine clinics are key participants in the health care team for workers’ compensation patients and their employers. The current pandemic is highlighting that role as well as introducing new safety measures and remote treatment options that will become “best practices” even after the current crisis is over.
Akeso develops occupational medicine clinic groups that improve injured worker outcomes through a focus on the patient and a commitment to better partnerships with the payor. The experts at Akeso believe the key to fixing the workers’ compensation system centers around a dedicated group of physicians committed to the right care, without financial incentives for over-treating injured workers. These highly skilled physicians are backed by a clinical organization that works more closely with the insurance carrier and employer to make sure that the right care is delivered in a more timely manner
About the Authors
Greg Moore, MPH is the Chief Executive Officer of Akeso Medical Holdings. Prior to founding Akeso, he started Harbor Health Systems in 2001 as a pioneer in provider benchmarking for workers’ compensation. Harbor grew to be the leading provider of provider benchmarking tools and outcomes based networks for Workers’ Compensation with the core mission to maximize the impact of top doctors to expedite treatment, recovery and return to work for injured employees.
Harbor was bought by One Call Care Management Systems in 2012, where Greg remained as the President of Harbor Health Systems, until he was promoted to the SVP of Innovation for One Call Care Management enterprise. By the time Greg left Harbor provided the outcomes based MPN networks that delivered care to roughly 30% of all injured workers in California, as well as supporting the largest national outcomes-based network solution, with clients like Sedgwick, California State Fund, and Kaiser.
After leaving One Call in 2016, Greg helped form and lead CLARA analytics, a leading AI company based in Silicon Valley that leveraged Machine Learning models to measure Occupational Medicine, Specialty Medicine, and Work Comp Claims performance. These solutions are currently in use at insurance companies like Employers, MEMIC, and Selective Insurance.
Greg holds a Master’s in Public Health from UCLA, and a Bachelor’s of Science from University of Rochester. He was awarded an NIH grant in 2004 related to the National Library of Medicine’s efforts to connect appropriate local resources to taxonomy based searches. He has been published in the areas of quality outcomes application to medical networks, including writing the chapter on practical application of outcomes based networks for the book, Current Perspectives in Clinical Treatment & Management in Workers’ Compensation Cases, edited by Dr. C.E. Stout.
D. Winston Cheshire, MD is the Chief Medical Officer at ProCare Work Injury Center, an Akeso company. After graduation from the University of Miami School of Medicine and several years in Emergency Medicine, Dr. Cheshire discovered Occupational Medicine and found his professional home. He enjoys treating workers as he respects their efforts daily to benefit themselves, their families and society.
After additional post-doctoral studies at the Medical College of Wisconsin, he became board certified by The American Board of Preventive Medicine in Occupational Medicine.
Dr. Cheshire has practiced in outpatient clinic settings, onsite employer clinics and has been on staff at Hoag Hospitals Health system for 28 years. He opened ProCare in Irvine in 2006 as the clinic rapidly expanded. As an integral part of his practice, he has treated employees from and consulted on health and safety issues with private employers, large and small, public agencies and health care facilities.
He is certified as a Qualified Medical Evaluator in California and as ProCare's Chief Medical Officer, he oversees all clinical programs from pre-employment and Department of Transportation drug and alcohol testing programs to adherence to MTUS treatment guidelines for the evaluation and treatment of injured workers in the State of California.
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