On-site clinics save money, time for employers
Therapists concentrate on back-to-work issues
When Stephen Hunter PT, OCS, is working on modified duty for an injured worker, he doesn't have to go far to visit the job site. Hunter, a physical therapist for Intermountain Health Care (IHC) in Salt Lake City, treats his industrial rehab patients on-site at a clinic at a local manufacturing plant. "On-site treatment is so much more functional. I can do a mini job analysis and concentrate on treating the things that will help them get back to work," he says.
The employers are happy having staff treated on site because employees don't have to leave the premises for treatment and because they have some control over the access to care. One employer calculated that having staff go to therapy off-site cut three to four hours off the workday. "If people are getting three therapy visits a week, that can add up to a lot of lost time," Hunter adds.
One employer reported about a 60% reduction in costs due to reduced utilization since the on-site clinic was established. The decrease doesn't include indirect savings from having injured workers off the job site for shorter times.
The on-site program started in 1993 when a manufacturer asked IHC to create a way to make therapy more convenient for patients and more related to what staff would be doing when they returned to work. "We set up a pilot project to provide physical therapy on site and established a joint partnership with the company. We've done well there and have modeled our other on-site facilities after that first one," Hunter says.
The health center has clinics at a jewelry manufacturing plant with 2,500 staff, a bindery with more than 4,000 staff, and a medical equipment manufacturer with 1,000 staff. The employer provides the space and helps with setting appointments, scheduling, and follow-up. IHC provides the equipment and therapists and does the billing. The health center bills at the same rate as if the company were sending a patient to clinic.
Hunter has found he can treat about 95% of all patients referred to the program at the on-site clinic. If a patient needs specialized equipment, he or she is referred to an outside clinic.
Therapists at the on-site clinics see people who are covered by workers' compensation as well as those who are not injured on the job and are covered by private health care plans. "We provide a convenient location for people who were not injured on the job. They can come before work or after work and save driving time," Hunter says.
Employees with work-related injuries can come in during working hours, and some employers allow staff to visit the clinic during working hours even if they were injured outside the job. Thera pists keep the treatment time down to about 30 minutes per visit so employees don't have to be away from work for long.
"We really have to be efficient because we don't have staff to help us," Hunter points out.
Therapists must do everything connected with a treatment visit, from equipment set-up and chart preparation to billing, he adds. Each on-site clinic has about $6,000 in start-up equipment that remains on site. Staff also use some portable equipment they can move from clinic to clinic.
Therapists at the on-site clinics treat patients on Tuesdays and Thursdays to make the most efficient use of staff time. Hunter sees six to 12 patients a day at one site on Tuesdays and Thursdays, then works at a general orthopedic clinic the rest of the week. "It fits in well with our ortho clinic since Tuesdays and Thursdays tend to be slower there," he says. Another therapist covers the other two on-site clinics on Tuesdays and Thursdays, treating patients in the morning at one site and afternoon at the other.
Having clinics on site has helped generate referrals for other services at the hospital, he reports. "In the managed care arena, if you are there on site, you don't have to worry about being on their insurance list. The company will get you on it."
When IHC started its clinic at one plant, the insurance provider was referring patients to a competing health system. "It's opened some doors for us because the physicians have begun referring to us, and we've been able to develop a rapport with them that we wouldn't have had otherwise," he says.
Because Utah laws allow direct access to therapists without a physician's referral, IHC staff often can treat injuries on-site just after they occur. "If they qualify for first aid, we can treat them and follow up before they see a doctor, and if they get well, they don't have to see a doctor," Hunter says.n
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