VISIONSVolume 21, Number 2

September/October 2010

The Periodical of the

National Association

o f O c c u p a t i o n a l

Health Professionals

“The person whoremoves a mountainbegins by carryingaway small stones.”— Chinese proverb

By Karen O’Hara

Research suggests employ-ers need occupational health professionals to help themdesign targeted workforcewellness interventions,encourage healthy behaviorand develop meaningfulrewards.

Whether financialincentives willimprove workforce

health and cut medical andbenefits costs in the long runis a subject of academicdebate.

Meanwhile, employers fac-ing the immediate prospect ofhealth reform impacts and ris-ing health insurance premiumcosts in 2011 seem disinclinedto sit on the sidelines waitingfor proof. Instead, a growingnumber are experimentingwith incentives to encouragehealthy behavior.

For example, in a recentstudy of 450 U.S. companies,the Integrated BenefitsInstitute (IBI) found a signifi-

cant number of employers areconnecting rewards with well-ness, health and productivitymanagement (HPM) inter-ventions “despite a generallack of empirical data on theoutcomes of these efforts,”said Thomas Parry, Ph.D.,president of the SanFrancisco-based researchorganization.

Employers also seem tohave an increasing appetitefor penalizing employees forunhealthy behaviors, reportsAON Hewitt, a global con-sulting and outsourcing com-pany.1 In Hewitt’s 2010health care trends survey ofnearly 600 large U.S. compa-nies representing more than10 million workers, 47 per-cent of respondents said theyalready use or plan to usefinancial penalties over thenext three to five years foremployees who do not partici-pate in certain healthimprovement programs. (See Table 1 on page 5.)

Of those companies usingor planning to use penalties,81 percent said they would doso through higher benefit pre-miums. Other strategiesinclude increasing deductiblesand/or out-of-pocketexpenses. When asked whatthey would penalize, 64 per-cent of employers cited smok-

ing, half indicated not partici-pating in disease manage-ment/lifestyle behavior programs and 45 percentidentified not participating in biometric screenings.

The apparent interest in“sticks” rather than “carrots”suggests that employers areincreasingly challengingemployees and their depend-ents to be accountable for thedecisions they make regarding

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Employers Trying Incentives to Encourage Healthy Behavior

INSIDE2 NAOHP News

3 Editorial

9 In the Numbers

10 TrendsettersWorkplace StretchingPrograms

12 OutcomesState Comparisons Reveal Differences

14 Legal AdvisoryDistracted Driving

16 RegulatoryAgenda

18 Recommended Resourcess

19 Calendar

20 Vendor Program

24 Job Bank

2

Outreach, Benchmarking on Board Agenda

Executive EditorFrank H. Leone

Editor in ChiefKaren O’Hara

Graphic DesignErin Strother • Studio E Design

PrintingOjai Printing

VISIONS is published bi-monthly by the National Association of

Occupational Health Professionals,226 East Canon Perdido, Suite M

Santa Barbara, CA 93101(800) 666-7926 • Fax: (805) 512-9534

Email: info@naohp.com • www.naohp.com

NAOHP and RYAN Associates are divisions of Santa Barbara Health Care, Inc. © pending VISIONS may not be copied in whole or in

part without written permission from NAOHP.

Volume 21, Number 2Sept/Oct 2010

The NAOHP Board held its quar-terly meeting via conference callon Aug. 18. Executive Director

Frank Leone and NAOHP staff memberKaren O’Hara were also in attendance.The following Board members partici-pated: Jewels Merckling, Tom Brink,Mike Schmidt, Dr. Steve Crawford,Michelle McGuire, Leonard Bevill andKaren Kosidowski-Bergen. Denia Lashand Rick Rankin were unable to attend.

Member Recruitment: Mr. Schmidtreminded the Board to send out e-mailblasts to members reminding them torenew their association membership.

National Conference Update: Ms.O’Hara reported that faculty recruit-ment for the Natural Conference wasfinalized and that efforts were nowfocused on promoting the conference.Board members were invited to offersuggestions for boosting conference registration.

Mr. Bevill advised fellow Board mem-bers to send out personal e-mail invita-tion to members in their regions. Dr.Crawford proposed using AmericanCollege of Occupational andEnvironmental Medicine pre-confer-ence courses as a way to attract physi-cians to RYAN Associates’ conference.Dr. Crawford expressed enthusiasmabout the NAOHP’s collegial relation-ship with ACOEM. He also said hebelieves NAOHP publications are aneffective way to reach out to physicians.

Staff and Clinician Relationships:Ms. Merckling reiterated that team-building is a major focus. She reportedthat she and Dr. Crawford would lead asession at the National Conference onstaff and physician relationships, themedical director’s role and responsibili-ties, and how to address conflicts in theworkplace. Ms. Merckling said shewould use a worksheet with team-build-ing exercises during the conferenceworkshop.

Member Education and Services:

Ms. O’Hara reported the NAOHP hasbeen promoting individual re-certifica-tion (Certificate of Competency inOccupational Health ProgramManagement) in conjunction with theNational Conference curriculum. Inaddition, she said several sites that werecertified three years ago are coming upfor renewal.

Benchmarking: Ms. O’Hara remindedBoard members to complete theNAOHP’s bi-annual national survey ofprovider-based occupational health pro-grams if they haven’t already done so.She said the survey produces a consider-able amount of useful information forindustry benchmarking.

Mr. Brink reported that he recentlysent out a request for proposals and thatPress Ganey had responded with a pro-posal to help the NAOHP develop a setof questions to assess patient satisfactionspecific to occupational health pro-grams. Mr. Brink said one of the objec-tives is to create a vehicle for theNAOHP to engage in benchmarkingwhile also generating revenue to supportassociation activities. The next stepwould be program-to-program bench-marking.

Information Management: Ms.McGuire said she is developing a codingspreadsheet for various levels of officevisits. She explained that she perceivesthe practice of medicine more as a sci-ence and coding more as an art and thatit is important to break down the ele-ments that are required for appropriatecoding.

Ms. Merckling reiterated plans toreach out to companies offering codingand billing expertise to help develop amore coordinated approach for provider-based programs.

Promoting National Visibility: Mr.Leone reported progress with efforts toreach out to occupational health nurses.

Ms. Kosidowski-Bergen mentionedthat her organization has been engagedin discussions with Reed Group, an

NAOHP Vendor Member and publisherof the Medical Disability Advisor, oneffective disability management throughthe use of guidelines and electronicmedical records. She suggested present-ing a session on the model at the 2011National Conference.

Elections: Ms. O’Hara remindedBoard members that some terms willexpire at the end of the year and thatelections will be held before then.

Additional Comments: Mr. Leoneasked the Board for input on issues andchallenges they have observed in theindustry. Ms. Kosidowski-Bergen said akey issue is teaching consumers how touse health care wisely and cost effec-tively. Mr. Brink said his focus has beenon developing occupational health’s rolein population health management ini-tiatives and blending occupational med-icine with urgent care and primary careservices at the worksite.

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A Letter from the Executive Director

By Frank H. LeoneNAOHP Executive Director

As I write this piece – 25 years tothe day since I establishedRYAN Associates in September

1985 – a myriad of clichés fill my mind:To name a few: “Where did the time

go?” “It has been quite a run.” “It is the people, not the program.” “Regrets,I have a few, but then again too few to mention.” “Who would o’ havethunk it?”

There is something about a silveranniversary that propels even the mostunsentimental mind to action. When Ithink of these past 25 years, a lighten-ing-fast retrospective runs through mymind like a film reel as I think aboutthe thousands of wonderful people Ihave met, worked with (both withinand beyond RYAN Associates) andbefriended over these past 9,131 days.

I have waxed nostalgically about ournational occupational health family inprevious anniversary missives, so I’llease up on that now and focus on moretangible results.

My first exposure to occupationalhealth occurred when I read a journalpiece toward the end of my master’s inpublic health studies in 1981. I realizedthat if public health is all aboutenhancing the health of large popula-tions, then the workplace, with its largecaptive audience, would be a logicalvenue for such outreach. Acting on thisbelief, I helped start an occupationalhealth program in Massachusetts shortlythereafter and launched RYANAssociates three years later.

Beyond striving to make the company

financially viable and well respected,my over-arching goal has consistentlybeen to encourage hospitals, health sys-tems and clinics to define occupationalhealth in a broad manner by using theirworkplace connections as an opportu-nity to educate and screen patients, pre-vent injury and illness, and reach out toworkers and their employers in a noble,progressive manner.

Like anything else worthwhile,progress toward this end has been slowat times. Old habits, such as segmentingservice lines and positioning them asstand-alone entities rather than as partof an integrated whole, seem to diehard. But when evaluating progress overa quarter of a century, one sees thingsmore clearly. The concept of what con-stitutes an effective occupational healthprogram has changed markedly duringmy time in the industry – and it willcontinue to evolve.

Dedicating my career to the nation’spublic health using occupational healthas the vehicle for outreach is one of thebest decisions I have made in my life. Ilook forward to many more years in theindustry.

RYAN Associates’ National Conference Highlights

Dr. Peter Amato discusses the role of the medical director.

Participants at RYAN Associates' National Conferenceenjoy a standing ovation.

Keynote speaker Dr. John Howard, director ofthe National Institute for Occupational Safetyand Health, engages in a discussion with conference attendees.

Mary Alice Ehrlich, R.N., B.S.N., M.S.A.,Executive Vice President of First Medical,LLC, Grand Rapids, MI, accepts theNAOHP's Professional AchievementAward, which recognizes longevity in anddedication to the field of occupationalhealth. Her 30-plus years of progressiveexperience include 25 years in hospitalnursing and senior administration.

their own health, AON Hewitt analysts said.

Two Faces of IncentivesPopulation health management is a

complex matter, Robert H. Haveman,Ph.D., University of Wisconsin-Madison, Department of Economics andLa Follette School of Public Affairs,observes in a September 2010 article.2

While both are available to encourageefficient behaviors and discourage costlyand unproductive ones, evidence oftheir beneficial effects is slow to emerge,in part because the evidence mustdemonstrate how behaviors havechanged in response.

“Nevertheless, the potential forincentive programs in health care seemslarge, and research should support theirdesign and assess their effect,” Dr.Haveman said.

“There is some evidence that finan-cial incentives can affect simple behav-ior changes such as medical compli-ance,” concedes Adam Oliveris, a senioracademic fellow in health economicsand policy at the London School ofEconomics and Political Science in acommentary – Do Wellness IncentivesWork?3 “For example, in a systematicreview of 11 randomized controlled tri-als that used financial incentives, 10demonstrated a positive effect.”

However, he goes on to note: “Forcomplex behavior change of the typeoften included in wellness programs,such as smoking cessation and weightloss, there is almost no good evidencefor a sustained, positive effect. Forexample, in a systematic review of 17studies on financial incentives for smoking cessation, none of the studiesfound significantly higher quit ratesafter six months among people who hadfinancial rewards compared to thosewho did not.”

The economist concludes that giventhe current lack of supporting evidence,“governments should be cautious inendorsing financial incentives as ameans to encourage complex behaviorchange.”

In an article in the New EnglandJournal of Medicine, researchers from theHarvard School of Public Health andthe Harvard University Program inEthics and Health offer a perspective onwellness incentives in relation tonational health reforms.4

“Incentives for healthy behavior maybe part of an effective national responseto risk factors for chronic disease,” theysaid. “Wrongly implemented, however,they can introduce substantial inequityinto the health insurance system. It is aproblem if the people who are less likelyto benefit from the programs are thosewho may need them more.”

For instance, in some cases “incen-tives are really sticks dressed up as carrots,” the Journal authors said. Whileproponents emphasize that wellness programs are voluntary, “voluntarinesscan become dubious for lower-incomeemployees, if the only way to obtainaffordable insurance is to meet the targets” that may not be feasible forthem attain.

Insurance DriversMedica, a regional health insurance

company with 1.6 million covered lives,provides an illustration of how rewardsare being integrated with wellness pro-grams. While employees stand to bene-fit, so do their employers, who have theopportunity for healthier, more produc-tive employees, rate guarantees andreduced premiums, the company says inan October press release.

As part of the Minneapolis-basedcompany’s fall open enrollment period,it is making an effort to engage its mem-bers (i.e., consumers) in their ownhealth care decision-making. Medica’sofferings include biometric screening inthe workplace, customized health infor-mation and rewards such as gift cards,lower premium contributions and richerbenefits for healthy behaviors.

However, while studies show manyemployers are on board with such strate-gies, the majority are not yet effectively

measuring their impact. In interviewswith 1,503 employers conductedrecently by GfK Custom ResearchNorth America on behalf of MetLife, aninternational insurance and benefitscompany, 69 percent of respondents saidthey recognize the return on investmentassociated with wellness programs, butthey are not necessarily measuring it. Inthat survey, participation in wellness-oriented strategies ranged from 10 percent with financial penalties to 38percent with employee assistance/counseling programs.

By comparison, according to a recentNational Business Group on Health(NBGH) survey, 41 percent of respon-dents representing large companies saidthey offer premium discounts for com-pleting health assessments while 22 per-cent offer premium discounts for partici-pating in tobacco cessation programs.5

In Working Well: A Global Survey ofHealth Promotion and WorkplaceStrategies, a 2009 study conducted byBuck Consultants, 64 percent of compa-nies surveyed said they have a wellnessstrategy that incorporates a variety offinancial and non-financial incentivesto encourage positive behavior andreward achievements.6 The survey fea-tures responses from 1,103 employersfrom 45 countries representing morethan 10 million employees. BuckConsultants is an international humanresource and benefits consulting firmowned by Xerox Co.

According to the global survey, themajority of incentives reward participa-tion in or completion of certain activi-ties or screenings. In many instances, toreceive a reward an individual mustattain specific health-related goals, suchas not smoking or maintaining choles-

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terol levels or body weight withinhealthy ranges.

“In this way, employers seek to tie therewards back to actual reduction inrisk,” Barry Hall, an actuary and princi-pal with Buck Consultants, reports inthe January/February 2010 edition ofContingencies, a publication of theAmerican Academy of Actuaries.

Gifts cards or merchandise, raffles andcash payments are among the most pop-ular rewards worldwide. Discounts andsubsidies for preventive health services,such as annual physicals and screenings,and membership fees for fitness facili-tiess or wellness classes are prevalent.Reduced health care premiums and cashcontributions toward health care-relatedspending accounts also are gaining pop-ularity, especially in the United States.

“These practices help employersemphasize to employees a strong con-nection between healthy living andtheir ultimate objective of reducing thecost of health care,” Mr. Hall said.

“These practices help employersemphasize to employees a strongconnection between healthy living and their ultimate objective of reducing the cost of health care.”

Benefits TrendsBuoyed by the expectation that well-

ness programs will help reduce risk andcontrol costs over time, “educated”employers, in general, appear to be morewilling to invest in a comprehensiveapproach to the management of work-place exposure hazards, health risks such

as obesity and tobacco use, and chronicconditions such as diabetes, asthma,hypertension and depression – all contributors to higher health care costsand recurring absences.

Collectively, employers of all typesconstitute a promising target market foroccupational health programs with asolutions-driven portfolio. An occupa-tional health program or medical prac-tice capable of providing work-relatedand group health care to employers iswell positioned to reduce client costs,improve workforce productivity andgenerate direct and indirect benefits forits parent organization, industryobservers say.

Benefits trends serve as a barometerfor the gradual shift from a reactive,episodic orientation to one thatembraces prevention and populationhealth management. For example, 53percent of large U.S. employers plan tochange their 2011 health care benefitprograms in response to national healthreforms and expected health benefitcost increases next year, reports theNBGH, a non-profit association of largeemployers. The NBGH’s 2010 survey onbenefits trends features responses from72 of the nation’s largest corporationsrepresenting more than 3.7 millionemployees.

“While the health reform law hasforced employers to evaluate theirhealth care benefit strategies, theyhaven’t lost sight of the fact that con-trolling rising costs remains one of, ifnot their highest, priority. They have tofoot the bill,” said Helen Darling,NBGH president. “In fact, with costincreases expected to accelerate nextyear, many of the plan design changes

employers are making are being done tohelp curb those increases, as they haveto do every year.”

According to the NBGH survey:• 70 percent will remove lifetime

dollar limits on overall benefits;• 64 percent will offer a high-

deductible plan combined with ahealth savings account;

• 63 percent will increase the percentage employees contribute to the premium;

• 61 percent will offer a consumer-directed health plan;

• 46 percent will raise out-of-pocketmaximums; and

• 25 percent plan to raise the co-payor co-insurance for retail pharmacyprescription drug benefits.

Productivity EnhancedOne of the Integrated Benefits

Institute’s primary objectives is to followemployer adoption of prevention, well-ness, disease management and disabil-ity-management/return-to-work (RTW)programs. In a study conducted earlierthis year, IBI researchers found:• Health and productivity manage-

ment practices have a particularlystrong, positive impact on employeesatisfaction. While employee satis-faction is not a traditional outcomemeasure, this finding indicates that aHPM program is an important invest-ment for employers interested inattracting and retaining workers bybuilding a culture of health.

• Certain practices have high impactacross several outcomes. Six practices – nurse case management, transitional RTW, health risk coach-ing, on-site providers, participationincentives and weight management– have positive impacts on at leasttwo important health and productiv-ity outcomes and should be consid-ered an essential part of an effectiveHPM program.

• No single HPM program area has alock on high-impact practices.Among the top 10 high-impact practices, four are associated withdisability management/RTW, fourare related to health promotion andtwo are associated with diseasemanagement.7

“Results show that employers votewith their pocketbooks to sustain HPMprograms,” even though financial vali-dation is lacking, IBI researchers said.“For organizations that have not yet

Table 1: Health Care Penalties

Use of Health Care Penalties % Companies That Impose or Plan to Impose Penalties

Smoker surcharge 64%

Require participation with disease management/lifestyle behavior programs or pay a penalty 50%

Require biometric screening or pay a penalty 45%

Require participation with a health coach or pay a penalty 25%

Require biometric improvements or pay a penalty (e.g., lower blood pressure, lower BMI) 17%

Source: AON Hewitt 2010 Health Care Trends Survey. N= 600 large companies.

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implemented an HPM strategy, the experiencesof our sample employers can provide a startingpoint for evaluation.”

The 8th Annual MetLife Study of EmployeeBenefits Trends8 corroborates the IBI results.While employers and employees may notalways see eye to eye, they agree that wellnessprograms help improve productivity. The studyalso suggests wellness programs can reducemedical costs, and that participating employeesare more likely to benefit from prolonged goodhealth and financial security.

“It is noteworthy that most employersand employees are on the same pagewhen it comes to seeing value inhealth and wellness programs forimproving employee productivity.”

“It is noteworthy that most employers andemployees are on the same page when it comesto seeing value in health and wellness programsfor improving employee productivity,” MetLifereports. “It stands to reason that a healthierworkforce can not only help control medicaland disability costs, but also decrease absencesand presenteeism.”

According to MetLife researchers, going forward, benefits strategies may be shaped byan increased focus on health and wellness aswell as financial security; research shows a correlation between physical well being andbeing in control of one’s financial situation.

MetlLife advises employers to use incentivessuch as health insurance credits and gift certificates to encourage employee participa-tion in wellness programs as opposed to penalties for non-participation. Other recommendations include:

• Focus on wellness programs with provensuccess rates such as weight loss andincreasing exercise.

• Seek “off-the-shelf” wellness programsfrom local health organizations.

• Incorporate oral health initiatives as a wayto reduce medical costs.

• Provide access to onsite or offsite healthscreenings (blood pressure, cholesterolchecks and health education). Give employees time to access screenings duringbusiness hours.

• Check with health care providers to see if there are discounts available for implementing a wellness program to helpoffset costs.

“There is still ample opportunity for employ-ers to leverage health and wellness programs asthey strive to improve cost control and produc-

According to Dr. Robert H. Haveman of the University ofWisconsin-Madison, the following basic principles should guidethe development of any incentive arrangement: 1. Identify the desired outcome.2. Identify the behavior change that will lead to the outcome.3. Determine the potential effectiveness of the incentive in

achieving the behavior change.4. Link a financial incentive directly to this outcome or behavior.5. Identify the possible adverse effects of the incentive.6. Evaluate and report changes in the behavior or outcome in

response to the incentive.

Similar steps are recommended by theWellness Councils of America: 1. Determine what actions or behaviors you want to increase

or decrease.2. Research the values that would hinder adoption of the

desired actions or behaviors.3. Research and select formal and informal rewards that are

feasible for inclusion in the incentive design while producingthe largest behavioral change effect.

4. Develop incentive rules and examine them for unintendedconsequences.

5. Use focus groups of randomly selected employees picked totest the incentive system.

6. Develop a communications plan for the incentive program.7. Field-test the incentive system.8. Evaluate the field test, modify the design and implement

organization-wide.9. Follow-through as planned in implementation of the

incentive program.10. Periodically, at least annually, evaluate the effects of the

incentive system and revise it.

Popular RewardsIn terms of the most commonly used incentives, the types

of wellness programs or activities being offered plays an influential role:1. Completion of a health risk assessment (HRA): The trend is

moving away from a voluntary, non-rewarded approach toHRA completion and toward continued health benefit eligibil-ity or use of a differential premium contribution for healthplan coverage and modest cash rewards for completion.

2. On-site Activities: Participation in on-site wellness activitiestypically features rewards involving material goods or mer-chandise coupons.

3. Long-term Involvement: Overall program participation, completion of biometric and/or preventive screening tests,attainment of particular health goals, seat belt use and otherpersonal health and safety measures are related to satisfyingcertain criteria. In turn, these criteria are associated with apoint system linked to reduced health plan premiums and/ordeposits in health savings accounts.

Methods for Designing aWellness Incentive Program

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Do RewardsPromote WorkerWellness?

Workers who experience little connec-tion between their effort and theirrewards have worse health habits thanthose who work hard and see rewards,reports Wendy Lynch, Ph.D., executivedirector of the Health as Human CapitalFoundation.

Studies suggest that when efforts donot result in anticipated rewards, work-ers have a greater tendency not to careabout practicing healthy habits.Conversely, employees who arerewarded for their efforts on the jobhave a corresponding tendency toimprove other aspects of their life, suchas their health, she said.

“Work and health come down tomore than offering wellness programs,”Dr. Lynch says. “If you are like most people, you work because you want orneed what you get in return,” such assense of accomplishment, pay, recogni-tion and opportunities for advancement.

She invites employers to answer thefollowing questions: 1. Is your workplace supporting personal

control by giving people appropriatediscretion over their work tasks?

2. Are the people who get better resultsreceiving better rewards?

3. Is there a clear pathway for thosewho are NOT doing well to improveand succeed?

“If you cannot answer ‘yes’ to thesequestions, your workplace may be detri-mental to worker health, regardless ofprograms and messages encouraginghealthy habits,” she advises. “The work-place has a powerful influence onbehavior at and away from work. Byfocusing on positive aspects of work,employers have a direct opportunity toimprove individual health.”

Source: hhcf.blogspot.com

tivity,” MetLife researchers said. “Wellness programs with reported high success rates, such as smoking cessation and weight loss, can beinexpensive to implement.”

References1. Employers Continuing to Invest in Health of Workers Despite

Uncertainty of Future Health Care Landscape, March 2010;www.hewittassociates.com.

2. Principles to Guide the Development of Population HealthIncentives; RH Haveman; Prev Chronic Dis 2010;7(5).

3. Do Wellness Incentives Work? Health Care Cost Monitor, TheHastings Center, Feb. 18, 2010.

4. Carrots, Sticks, and Health Care Reform – Problems WithWellness Incentives; H Schmidt, K Voigt, D Wikler; NEJM, Dec. 30,2009.

5. Large Employers’ 2011 Health Plan Design Changes, August 2010;www.businessgrouphealth.org.

6. Workplace Wellness: Calculated Risk Reduction; Barry Hall;Contingencies, Jan/Feb 2010; American Academy of Actuaries;www.contingencies.org.

7. The Impact of Employer Health and Productivity ManagementPractices; July 2010; Integrated Benefits Institute; www.ibi.org.

8. 8th Annual MetLife Study of Employee Benefits Trends;www.metlife.com/trends2010.

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Employees believe they are incontrol when it comes to their ownhealth, but they do not take con-sistent action to stay healthy andneed encouragement, according toa study, The Employee Mindset:Views, Behaviors and Solutions,2010.

The study features findings froman online survey of 3,026 employ-ees working at large companiesand their dependents. Sponsoredby the National Business Group onHealth, which represents Fortune500 companies, and AON Hewitt, aglobal human resource manage-ment firm, the study provides valu-able insights by zeroing in onemployee attitudes and character-istics including gender, age, educa-tion, job title, industry, income,ethnicity and health status.

“The research helps us identifyhow to help employees betterunderstand their role as healthcare consumers and what employ-ers can do to facilitate thatprocess,” said Cathy Tripp, a princi-pal in AON Hewitt’s health man-agement consulting practice.

Research HighlightsRespondents ranged in age from

23 to 69; about 25 percent weredependents – primarily spouses ofemployees. Among the key find-ings:

1. Skepticism about health infor-mation sources, confusion aboutbenefits and questions aboutcosts are obstacles to participa-tion in wellness and health man-agement programs.

2. Participation rates are relativelylow, but when employees partici-pate in wellness/health manage-ment programs, satisfaction withthem is generally high.

3. Internal motivators such as“wanting to do the right thing”can be just as meaningful asexternal ones, such as financialincentives.

4. Among various outreach meth-ods, targeted and personalizedcommunication is the best way

to encourage participation inwellness programs.

5. In the future, employees will bemore concerned about afford-ability than access when evaluat-ing health care coverage options. The majority of respondents (65

percent) said they are great/goodat obtaining “appropriate preven-tive screenings,” compared to 47percent who said they aregreat/good at “getting exercise atleast three times a week.”Biometric screening had the high-est participation rate (61 percent),followed by online health manage-ment tools (53 percent) and healthrisk assessment (HRAs) (41 percent)– services frequently provided byexternal occupational health programs.

The lowest participation rateswere health coach (15 percent),claim help (14 percent), stress management and employee assistance programs (9 percenteach). Respondents were most satisfied with biometric screening,onsite clinics and physical fitnessprograms.

Forty-eight percent said theywould complete an HRA for intrin-

sic reasons; 29 percent for anincentive; 28 percent if there is apenalty. Wellness programs: 44 percent/32 percent/30 percent.Disease management: 33 percent/17 percent/25 percent.

“You need to look for a combi-nation of the intrinsic and extrinsicmotivators that drive behaviorsand figure out what is going towork in your workforce,” Ms. Trippsaid. “I guess this does give us aglimmer of hope.”

To review the report, visitwww.businessgrouphealth.org.

Workers With ‘Health Smarts’ May Still Need a Push

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Employers can expect 2011 healthcare cost increases to be at theirhighest levels in five years,

according to a study by AON Hewitt(formerly Hewitt Associates), a globalhuman resources consulting and out-sourcing company. Next year, Hewittprojects an 8.8 percent average pre-mium increase for employers, comparedto 6.9 percent in 2010 and 6.0 percentin 2009.

According to Hewitt’s analysis:1. The average total health care pre-

mium per employee for large com-panies will be $9,821 in 2011, upfrom $9,028 in 2010. The amountemployees will be asked to con-tribute toward this cost is $2,209, or22.5 percent of the total health carepremium. This is up 12.4 percentfrom 2010, when employees con-tributed $1,966, or 21.8 percent ofthe total health care premium.

2. Average employee out-of-pocketcosts, such as co-payments, co-insur-ance and deductibles, are expected

to be $2,177 in 2011, a 12.5 percentincrease from 2010 ($1,934). Theseprojections mean that in a decade,total health care premiums will havemore than doubled, from $4,083 in2001 to $9,821 in 2011. Employees’share of medical costs, includingemployee contributions and out-of-pocket costs, will have more thantripled, from $1,229 in 2001 to$4,386 in 2011.

The increases are primarily attributedto higher medical claim costs, an agingpopulation and health care reform. Forexample, Hewitt reports an increase incostly catastrophic claims, particularlyamong older workers. Meanwhile, themost immediate applications of healthcare reform—including coveringdependents to age 26 and the elimina-tion of certain lifetime and annual lim-its—contributed approximately 1 to 2percent of the 8.8 percent projectedincrease for 2011.

“After 18 months of waiting for

health care reform to play out, employ-ers find themselves in a very challeng-ing cost position for 2011,” said KenSperling, Hewitt’s health care practiceleader. “Reform creates opportunities formeaningful change in how health careis delivered in the U.S., but most ofthese positive effects won’t be felt for afew years. In the meantime, employerscontinue to struggle to balance the sig-nificant health care needs of an agingworkforce with the economic realities ofa difficult business environment. Whilehealth care reform cannot be blamedentirely for increasing costs, the incre-mental expense of complying with thenew law adds fuel to the fire, at least forthe short term.”

Source: Hewitt Health Value Initiative™database, which contains detailed census,cost and plan design information for 350large U.S. employers representing 14.4 million participants and $51.9 billion in2010 health care spending. Visit www.hewittassociates.com.

Employers Brace for Heath Care Cost Increases

The American College ofOccupational and EnvironmentalMedicine (ACOEM), in partner-

ship with the International Associationof Industrial Accident Boards andCommissions (IAIABC), has released AGuide to High-Value Physician Services inWorkers’ Compensation: How to Find theBest Available Care for Your InjuredWorkers.

The guide provides practical advice,checklists, and other resources and toolsto help employers, insurers and otherstakeholders identify physicians whohave certain characteristics thatincrease the likelihood of positive medical outcomes in workers’ compen-sation cases. According to the guide,physicians who provide high-value services in workers’ compensation:

1. Meet a basic set of requirements:2. Are accessible when needed3. Have appropriate credentials4. Have relevant professional experi-

ence and necessary proficiencies5. Practice medicine in a high-quality

manner by employing evidence-based treatment methods; utilizingtests, procedures and specialist serv-ices wisely; and coordinating care.

6. Focus on functional recovery andminimize needless life disruptionand work disability for the workersthey treat.

7. Produce good overall medical andfunctional outcomes in a timelymanner.

8. Satisfy the needs of key parties in workers’ compensation cases(worker, employer, payers and others

who may become involved) to betreated with courtesy and receiveinformation and guidance providedwithout bias and with good commu-nication skills.

Free copies are available online atwww.acoem.org and www.iaiabc.org.

Guide Identifies Qualities of High-Value Physicians

10

By Scott Ege,P.T., M.S.

Tenniselbow.Tendonitis.

Carpal tunnelsyndrome.Shoulderimpingement.Back pain.

Employers and occupational healthand safety professionals are certainlyfamiliar with these conditions. In gen-eral, work-related musculoskeletal disor-ders (MSDs) continue to create signifi-cant care management challenges foremployers, health care professionals,insurers and patients.

Studies show MSD-related medicaltreatment and productivity loss costsemployers billions of dollars a year.1

When combined with factors such as anaging workforce, obesity and poorworker fitness levels, one can see whyMSDs continue to significantly impactthe bottom line and the overall healthand safety of the workforce.

Meanwhile, the Occupational Safetyand Health Administration (OSHA)and the National Institute forOccupational Safety and Health(NIOSH) have identified factors thatcontribute to these disorders, includingawkward or static postures, excessiveforce, repetition, vibration, direct con-tact stress and poor worker fitness.NIOSH further recommends employersimplement certain controls to reduce oreliminate exposure to MSD hazards.2

Stretching as a Preventive Measure

Employers often look to the expertiseof occupational health and safety profes-sionals to help address MSDs, and work-

place stretching is often proposed as apreventive measure. From a wellnessperspective, stretching has long beenrecognized for its positive health bene-fits. It promotes good posture, improvesflexibility and energizes the body. It justfeels good to stretch!

However, while stretching helpsreduce injuries, many stretching pro-grams fail to achieve desired outcomesover the long term. The root cause ofdisappointing results is typically notincorrect technique or lack of frequency,it is the lack of a process for developing,implementing and monitoring the pro-gram. Experience shows that successfulprevention strategies feature processesthat focus on continuous and sustainableimprovement – and that many programslack necessary attributes.

Three cornerstone elements are cru-cial for an effective workplace stretch-ing program. When these elements arecombined, employers see a markedimprovement in injury reduction andsafety performance. For the occupa-tional health provider, an appropriatelystructured workplace stretching programcreates a natural platform to sustain anonsite presence that can lead to otherinjury management and preventionservices.

Cornerstone ElementsOrganizational Structure

The stretching program must be fullysupported by top management and organ-ized by levels of responsibility. An effec-tive program needs an internal championwho is responsible for organizing, man-aging and monitoring the program.

Senior management, especially thechampion, must sustain a highly visiblerole throughout the course of the pro-gram. Supervisors must be encouragedto embrace, actively support and con-

tribute to the stretching initiative.Research demonstrates there is a directcorrelation between the presence andactive participation of the supervisorduring the stretching sessions and theoverall success of the program.

Obtaining outside expertise shouldalso be part of the organizational struc-ture. While the vast majority of employ-ees will have no pain or physical diffi-culty performing the stretches, situationsrequiring exercise modifications willarise. Medical history, current/activesymptoms, work restrictions and/or otherphysical disabilities should be addressedin a non-confrontational manner.

An on-going relationship with alicensed local rehabilitation specialist,such as a physical or occupational thera-pist, to help manage these situations ishighly advisable. Otherwise, theemployer risks losing the participationof less-able employees who could benefitthe most from the stretching program.The rehabilitation professional can alsoprovide added value by training employ-ees to lead their own stretch groups.

Employee Participation Stretch groups, or teams, should be

limited to 10 employees to allow foradequate supervision of all participantsand optimal participation. Fellowemployees who have completed trainingand demonstrated competency with all

Use Workplace Stretching Programsto Gain a Competitive Edge Onsite

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of the stretches should initially lead anewly formed team. (These individualsare identified as “stretch coaches” inthe Stretch It Out!© program. Seerelated article). Stretch coaches eithervolunteer or are nominated by theirsupervisor to lead their team. Thecoach’s primary responsibility is to pro-vide guidance on proper stretching andserve as a communication liaisonbetween the supervisor and the inter-nal champion.

Once the group is familiar with thestretches, it is recommended that arotation schedule be developed toallow each member to lead stretchingsessions. Variety and an element of funhelp ensure long-term success.

MonitoringThe employer’s ability to measure

and monitor progress is critical to asuccessful injury prevention initiative.The process includes: identifying goals,developing a plan, implementing solu-tions and establishing measures thatwill be used to assess progress towardthe goal(s).

The employer’s OSHA-300 injuryand illness recordkeeping log is com-monly used for benchmarking andmaking past-to-present comparisons.The employer also may track leadingindicators to identify conditions thatrequire intervention to sustain theeffectiveness of the stretching program.Random employee surveys and coachand stretch group observations also areeffective information-gathering mecha-nisms. In addition, feedback fromsupervisors and top stakeholders isimportant when program modificationsare proposed.

In SummaryWorkplace stretching can be an

effective prevention measure for work-ers who are exposed to factors that leadto MSDs. Employers often look tooccupational health experts to helpthem develop a regimen of appropriatestretches for their workforce. By pro-viding these services onsite, the occu-pational health provider is strategicallypositioned to forge a lasting relation-ship with their employer clients.

Successful stretching programs mustfeature a structure that is supported bytop management, encourages employeeleadership and participation, and pro-vides clearly defined roles and responsi-bilities. Long-term success will only berealized when a monitoring componentis in place.

About the author: Scott Ege isPresident of Ege WorkSmart SolutionsPC, Rockton, Ill., and the developer ofStretch It Out!©, a comprehensivesafety resource designed to assistemployers and occupational healthproviders in developing, implementingand sustaining an effective workplacestretching program. He is a graduate ofthe University of Iowa and received hismaster’s degree in physical therapyfrom Des Moines University.

References1. United States Bone and Joint

Decade: The Burden of MusculoskeletalDiseases in the United States.Rosemont, IL; American Academy ofOrthopaedic Surgeons, 2008.

2. Musculoskeletal Disorders andWorkplace Factors, A Critical Reviewof Epidemiologic Evidence for Work-Related Musculoskeletal Disorders ofthe Neck, Upper Extremity, and LowBack; NIOSH Publication 97-141.

Case Study:Stretch ProgramCuts Injury Rates,Lost Work Days

In 2006, Schneider ElectricBuilding Systems, Loves Park, Ill.,implemented a comprehensiveworkplace stretching program(Stretch It Out!©) to help reducethe frequency and severity ofmusculoskeletal disorders (MSDs)or soft tissue injuries. Schneiderhealth and safety officials alsoincorporated an ergonomics program the same year.

Senior management demon-strated its commitment to thecompany’s prevention efforts byproviding the necessary resourcesand capital to support the overallMSD prevention initiative. Thestretching program involved allof the firm’s production employ-ees, including machining, assem-bly and shipping/receiving.

Several key elements wereintegrated into the process tohelp guide the company whiledeveloping, implementing andmonitoring the stretching initia-tive. Participation was manda-tory. More than 400 employeeswere involved, 42 “stretchcoaches” were trained by alicensed physical therapist andeach group was comprised of sixto 12 employees.

Combined results from safety,ergonomics and stretching interventions were analyzed. To measure employee commitmentand satisfaction, the employeescompleted surveys at six, 12, 18and 24 months. The average ageof the participants was 40 yearsand the average years of servicewas 12.5.

The company’s OSHA-300 log showed the followingimprovements:• 67 percent reduction in lost

workday cases • 70 percent reduction in

MSD-related cases • 1.06 average total recordable

incident rate For information on the Stretch

It Out!© program, visitwww.egesolutions.com.

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In state workers’ compensation sys-tems, it is essential to follow theflow of payments in order to iden-

tify cost drivers and evaluate theeffectiveness of medical managementinterventions, according to the inde-pendent Workers’ CompensationResearch Institute (WCRI).

CompScope™ Medical Benchmarks,10th Edition, a new report from theWCRI, is a comprehensive resourcethat examines and compares workers’compensation experience in 15 states:California, Florida, Illinois, Indiana,Iowa, Louisiana, Maryland,Massachusetts, Michigan, Minnesota,North Carolina, Pennsylvania,Tennessee, Texas and Wisconsin.

The report features detailed meas-ures of medical prices, payments andutilization by provider type and serv-ice group in each state. For example,the July 2010 edition identifieschanges in treatment patterns, atypi-cal medical payments per claim,where under- or over-utilization ofservices may be occurring and conse-quences associated with restrictionson access to care.

Researchers asked two key questions:

1. How do medical prices, pay-ments and utilization per claim differacross states for similar injuries andtypes of workers?

2. How have medical prices, pay-ments and utilization per claimchanged over time within each state,and what are the major drivers ofthose changes?

Illustrative FindingsIllinois: After a medical fee sched-

ule was adopted in 2006, growth inmedical payments per claim slowed to5 percent for 2007 claims with more

than seven days of lost time and 12months of experience. This slowergrowth was in contrast to 12 percentaverage annual growth in the threeyears prior to implementation of thefee schedule in Illinois, whereemployees choose their own workers’compensation medical provider. Thedecrease in rate of growth likelyreflected the impact of regulations onnon-hospital and hospital providers,WCRI reported.

Louisiana: Medical costs per claimin Louisiana were among the highestof the 15 study states, largely becauseof higher utilization and higher pricespaid for services that are delivered inthe majority of claims, such as officevisits, diagnostic tests and physicalmedicine. In addition, injured work-ers in Louisiana received medicaltreatment for a longer time than inother study states. The average dura-tion of medical treatment was 45weeks in Louisiana, about six weekslonger than in the typical study state,WCRI reported.

Wisconsin: Medical payments perclaim (for claims with more thanseven days of lost time and 36months’ maturity) were fairly typicalof the 15 study states, a result ofhigher prices paid offset by muchlower utilization of medical services.However, over the five-year studyperiod, medical payments per claimgrew faster than in other studystates—64 percent compared to 40 to50 percent in most study states.

Reasons cited for the rapid growthin medical costs per claim inWisconsin include reimbursementpaid to non-hospital providers such asphysicians, physical/occupationaltherapists and chiropractors, and pay-ments-per-hospital outpatient service.

State Comparisons Reveal Differencesin Workers’ Compensation Experience

Three TrendsDriving Up Costs

Three trends – obesity, the agingworkforce and antibiotic-resistantinfections – are commanding theattention of workers’ compensationcase managers and payers, accordingto Kevin Glennon, vice president ofclinical services for Total MedicalSolutions.

These trends are relevant in thecontext of National Council onCompensation Insurance statisticsthat show claim frequency is declin-ing while indemnity and medicalseverity rates and the cost of perma-nent total claims are rising.

According to Mr. Glennon, claimsinvolving obese workers are 2.8times more expensive than non-obese claims at 12-month maturity.In addition, the cost differenceclimbs to 4.5 at three-year maturityand 5.3 at five-year maturity.

Meanwhile, compared to youngeremployees, older workers are atincreased risk for fatal work injuries,are more likely to need extra timeoff to recover from an injury or ill-ness and have a greater potentialfor permanent disability.

Antibiotic-resistant infections arewidespread concern affecting allmedical care, including workers’compensation case outcomes. Forexample, Mr. Glennon noted thatthe Institute of Medicine estimatesthe annual cost of treating antibi-otic-resistant infections in the U.S.exceeds $90 billion.

Total Medical Solutions specializesin home health care and complexcare products and services for theworkers’ compensation industry.Source:www.totalmedicalsolutions.com

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These rates rose faster inWisconsin than in manystudy states.

Massachusetts:Medical costs per claimin Massachusetts in 2007were 45 percent lowerthan the norm for claimswith an average of 12months of experienceand more than sevendays of lost time. WCRIreports several relatedfactors: hospital inpa-tient and outpatient pay-ments per claim amongthe lowest of the studystates, lower prices paidfor non-hospital services(except surgeries) andlower utilization of mostnon-hospital services.

Fee ScheduleImpacts

In a related study, Benchmarks for Designing Workers’ Compensation MedicalFee Schedules: 2009, published June 2010, the WCRI reports that a medicalfee schedule was used as a cost-containment tool in 43 states last year.

“The designing or updating of fee schedules is often subject to politicalpressure from payers and providers and involves a delicate balance,” WCRIresearchers said. “If fee schedule rates are set too high, their effectiveness asa cost-savings tool is limited; if fee schedule rates are set too low, treatinginjured workers may be uneconomical for providers and may jeopardizeworkers’ access to quality care.”

To help clarify these issues, the report compares workers’ compensationand state Medicare fee schedules as of December 2009, focusing exclusivelyon non-hospital and non-facility charges.

Among the findings: • Substantial differences in workers’ compensation fee schedule rates

exist among states in comparison to Medicare. The premium variedfrom 8 percent above Medicare in Massachusetts to 215 percent aboveMedicare in Alaska.

• Interstate variation in fee schedules was not necessarily related tointerstate variation in expenses incurred by medical providers, e.g.,malpractice insurance and office practice costs.

• Many state fee schedules may create financial incentives to overuseinvasive and specialty care. Nine states, however, set rates that resultedin the premium over Medicare being relatively the same (within 45percentage points) for each of eight major service groups, which WCRIsaid may help neutralize some utilization incentives.

• Some states may have set fee schedule rates for certain service groupsthat may be below an optimal level, raising concerns about access toquality care. The most likely candidates are states with fee schedulesthat are near or below the state’s Medicare rates.

Reference:Individual reports for all states in CompScope™ Medical Benchmarks, 10th

Edition, with the exception of Indiana and Iowa, are available for purchase.Visit www.wcrinet.org.

Steps to AvoidLitigation in Work-related Cases

In a report on Avoiding Litigation:What Can Employers, Insurers andState Workers’ CompensationAgencies Do? the Workers’Compensation Research Institute(WCRI) examines two factors thatlead injured workers to seek repre-sentation by an attorney:

1. They feared they would be firedas a result of their injury, and/or theyperceived their supervisor did notthink their injury was legitimate.

2. They presumed their claim wasdenied, although it was later paid.This perception may stem from a formal denial, delays in payment orcommunications that the worker misinterpreted as a denial.

According to the WCRI, attorneyinvolvement can be decreased ifemployers, claims organizations, stateagencies and other parties in theworkers’ compensation system“reduce or eliminate unnecessaryactions that workers interpret asthreats.”

WCRI suggests the following preventive actions:• Help supervisors create timely com-

munications that focus on trust, jobsecurity, and entitlement to medicalcare and income benefits.

• Create state agency resources featuring educational materials andhelp call lines to answer workers’questions and ease feelings of vulnerability and uncertainty.

• Communicate in a clear and timelyfashion about the status of theworker’s claim so the worker doesnot mistakenly conclude that theclaim has been denied.

• Eliminate system features that leadto denials or payment delays.WCRI cited numerous benefits

associated with these litigation-avoidance techniques: workers wouldreceive benefits in a more timelymanner; employers and insurerswould save on legal defense costs;and state workers’ compensationagencies with funding pressureswould have smaller caseloads to man-age and could save on resources allo-cated for dispute resolution services.

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Officials, Employers Act to Curb Distracted Driving

Occupational health and safetyprofessionals who encourage safedriving practices are likely to gar-ner appreciation from their clientsand management in their ownorganizations.

Motor vehicle accidents are aleading cause of work-relatedinjuries and fatalities.

Given the ubiquitous use of cellphones and other hand-held electronicdevices, reducing distractions such astext-messaging while driving hasbecome a cause célèbre for law enforce-ment, government agencies, safety

organizations and employers.For example, as part of a national

campaign, the Occupational Safety andHealth Administration (OSHA) hasintroduced an initiative that includes aneducational component to preventoccupationally related distracted driving- with a focus on prohibiting text-mes-saging while driving - and enforcementaction when there is evidence a com-pany requires employees to send textmessages while driving.

“There is no question that new com-munications technologies are helpingbusinesses work smarter and faster,” saidOSHA Director David Michaels, Ph.D.“But getting work done faster does notjustify the dramatically increased risk ofinjury and death that comes with tex-ting while driving.”

OSHA is encouraging employers toexamine their driving policies and prac-tices while reminding them that theyhave a legal obligation to prohibit work-place hazards. In a letter posted on itsnew distracted driving website, theagency advises employers to immedi-ately remove any incentives that maymotivate employees to text whilebehind the wheel.

“OSHA’s message to all companieswhose employees drive on the job isstraightforward: It is your responsibilityand legal obligation to have a clear,unequivocal and enforced policy againsttexting while driving,” Dr. Michaelssaid. “Companies are in violation of theOccupational Safety and Health Act if,by policy or practice, they require tex-ting while driving, or create incentivesthat encourage or condone it, or theystructure work so that texting is a prac-tical necessity for workers to carry outtheir jobs. OSHA will investigateworker complaints, and employers whoviolate the law will be subject to cita-tions and penalties.”

In a related initiative, the U.S.Department of Transportation (DOT)

held its second annual DistractedDriving Summit in September. At thesummit, Transportation Secretary RayLaHood kicked off the event byannouncing anti-distracted driving regu-lations for drivers transporting haz-ardous materials, commercial truck andbus drivers, and rail operators.

New Rules AdoptedThree DOT agencies have published

final or proposed rules to prohibitaffected employees from sending textmessages while operating a commercialmotor vehicle (CMV) or being engagedin rail operations.

The Federal Motor Carrier SafetyAdministration’s rule, effective Oct. 27,says any violation by a CMV driver canbe punished with a fine up to $2,750and any employer violation with a fineof up to $11,000. The Federal RailroadAdministration’s final rule, effectiveMarch 28, 2011, codifies most require-ments of its Emergency Order No. 26barring texting by rail employees.

The Pipeline and Hazardous MaterialsSafety Administration’s proposed rulewould prohibit texting by drivers duringthe operation of a motor vehicle con-taining hazardous materials requiringplacards under 49 CFR part 172 or any

Distracted Driving Defined

There are three main types ofdistraction:1. Visual: taking eyes off the road.2. Manual: taking hands off the

wheel.3. Cognitive: thinking about

something other than driving.Text messaging while driving is

considered particularly dangerousbecause it involves all three distractions, but it is not the onlyculprit. Other commonly observeddistracting activities include:• Talking on the phone, either

hand-held or hands-free• Eating and drinking• Talking to passengers• Grooming• Reading, including maps• Using a PDA or navigation

system• Watching a video• Changing the radio station,

CD, or Mp3 playerSource: National Safety Council

VISIONS

quantity of selected agents or toxins listedin 42 CFR part 73.

In addition, in light of two recent mar-itime accidents involving U.S. CoastGuard patrol boats, the NTSB has proposed prohibiting the use of cellulartelephones and other wireless devices forpersonal communication or activity unrelated to operations while engaged invessel operations.

Thirty states, the District of Columbiaand Guam have banned text messagingfor all drivers; 12 of these laws wereenacted this year. Eight states, the Districtof Columbia and the Virgin Islands prohibit all drivers from using handheldcell phones while driving.

Other InitiativesLast year, President Obama issued an

executive order prohibiting some 4 mil-lion federal workers from sending textmessages while driving.

Meanwhile, last spring, the DOTlaunched a Phone in One Hand, Ticket inthe Other pilot campaign in Hartford,Conn., and Syracuse, NY, to test whetherincreased law enforcement efforts com-bined with public service announcementscompel drivers to put down their cellphones. During two week-long periods ofincreased enforcement, police in Hartfordwrote approximately 4,956 tickets andSyracuse police issued 4,446 tickets forviolations involving drivers talking ortexting on cell phones.

Before and after each enforcementwave, the National Highway TrafficSafety Administration (NHTSA) con-ducted observations of driver cell phoneuse and collected public awareness surveysat driver licensing offices in each test andcomparison site. Based on these observa-tions and surveys, NHTSA determinedthat hand-held cell phone use dropped 56percent in Hartford and 38 percent inSyracuse during the study period. Textingwhile driving declined 68 percent inHartford and 42 percent in Syracuse.

“Good laws are important, but we knowfrom past efforts to curb drunken drivingand promote seatbelts that enforcement isthe key,” Secretary LaHood said at theDistracted Driving Summit.

The DOT also has been working withthe Network of Employers for TrafficSafety (NETS) to engage the private sec-tor in the promotion of anti -distracteddriving policies in the workplace. NETS,which was created by NHTSA, is an

employer-led public-private partnershipdedicated to improving the safety andhealth of employees by preventing trafficcrashes. The DOT and NETS reportedthat nearly 1,600 U.S. companies andorganizations have already adopted dis-tracted driving policies that apply toapproximately 10.5 million workersnationwide. An additional 550 organiza-tions have committed to adopting policiesthat will cover another 1.5 millionemployees within the next 12 months.

Earlier this year, the National SafetyCouncil issued a white paper describingthe risks of talking on a cell phone whiledriving. The paper, Understanding the dis-tracted brain: Why driving while usinghands-free cell phones is risky behavior,describes how drivers who use cell phoneshave a tendency to “look at” but not “see”up to 50 percent of the information intheir driving environment. A form ofinattention blindness occurs, whichresults in drivers having difficulty moni-toring their surroundings, seeking andidentifying potential hazards, andresponding to unexpected situations,researchers said.

Interestingly, a study on passenger andcell phone conversations in simulateddriving environments (Psychol Appl.2008 Dec;14(4):392-400) found that the number of driving errors was higher when using a cell phone. In passengerconversations, more references were madeto traffic, and the production rate of thedriver and the complexity of speechdropped in response to increased traffic.

To learn more: www.distraction.govwww.osha.gov/distracted-drivingwww.nsc.org/safety_road/Distracted_Driving

Driving ResearchFindings

• In 2009, nearly 5,500 peopledied and half a million wereinjured in crashes involving adistracted driver. (NationalHighway Transportation SafetyAdministration)

• Teen-age drivers have the highest proportion of distrac-tion-related fatal crashes.

• Drivers who use hand-helddevices are four times as likelyto get into crashes seriousenough to injure themselves.(Insurance Institute for HighwaySafety)

• Using a cell phone while driv-ing, whether it is hand-held orhands-free, delays a driver’sreactions as much as having ablood alcohol concentration atthe legal limit of .08 percent.(University of Utah)

• The overall estimated cost oftransportation crashes in theU.S. each year is $170 billion forrepairing the road, fences,lights and other infrastructure;emergency assistance; healthcare; rehabilitation; loss of pro-duction if it involves a worker;workers’ compensation andother insurance costs; vehiclerepair; and court costs. (NHTSA)

• Motor vehicle crashes arethe leading cause of occupa-tional fatalities and the leadingcause of death for ages 2-39and ages 50-72. In 2009, 40 per-cent of all U.S. workplace fatalities were transportation-related. (U.S. LaborDepartment)

• Vehicular accidents cost U.S.employers an estimated $60 billion a year in medical care,legal intervention, propertydamage, lost productivity, andworkers’ compensation, SocialSecurity, private health and disability insurance. (NationalSafety Council)

• On average, a vehicle crashcosts an employer $16,500.When a worker is involved in anon-the-job crash with injuries,the cost to the employer aver-ages $74,000. Costs can exceed$500,000 when a fatality isinvolved. (National Institute ofOccupational Safety and Health)

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16

Accountable Care RaisesAnti-Trust Questions

At a recent meeting, Federal TradeCommission Chairman Jon Leibowitzsaid his agency would explore an “expe-dited review process” for hospitals andphysicians seeking to determinewhether partnerships they form underan Accountable Care Organization(ACO) structure would violate antitrustlaws, Kaiser Health News reported.Donald Berwick, administrator of theCenters for Medicare and MedicaidServices, said government agencies thatoversee doctors and hospitals will worktogether to give unified guidance onhow to form ACOs. “We will need aregulatory framework that nurturescooperation, while it guards against thelingering threat of inappropriate prac-tices,” he said at CMS headquarters, thesite of the meeting. Health and HumanServices Inspector General DanielLevinson promised “fresh thinking” onhow his agency enforces anti-fraud lawsthat prohibit hospitals from giving doc-tors any financial inducement for refer-ring patients. “We want to make sureACOs are not unduly inhibited byexisting fraud and abuse laws…Ourrules should not stand in the way ofimproving quality and reducing coststhrough ACOs,” he said.

Climate Change AdvisoryIn a joint letter, 120 leading public

health organizations and experts –including the American Public HealthAssociation, the American NursesAssociation and the American Medical

Association – urge Congress to protectthe public’s health by allowing the U.S.Environmental Protection Agency(EPA) to move forward with new rulesto reduce pollution that contributes toglobal climate change. Refer towww.apha.org.

DOT RevisesDrug Testing Rules

The Department of Transportationrevised parts of 49 CFR, Part 40,Procedures for TransportationWorkplace Drug and Alcohol TestingPrograms, effective Oct. 1. Most of thechanges and additions involve labora-tory procedures, drugs for which testingis conducted and cut-off levels.Significant changes include: • MDMA (Ecstasy) will be a target ana-

lyte in the amphetamines screeningassay, with confirmation testing forMDMA, MDA and MDEA.

• Lower cut-off levels for cocaine andamphetamines.

• Mandatory initial testing for heroin:The target analyte 6-acetylmorphine (6-AM) will be added to the opiatesscreening test.

The changes also affect MedicalReview Officers (MROs). Under therevised rules, MROs must be re-quali-fied, including passing an examinationgiven by an MRO training organizationevery five years. The final rule elimi-nates a requirement for MROs to take12 hours of continuing education everythree years. In addition, several otherreview requirements are clarified in therevised regulation. Refer to the Aug. 16,2010 Federal Register orhttp://edocket.access.gpo.gov/2010/pdf/2010-20095.pdf.

Drug Exposure HazardsThe National Institute for

Occupational Safety and Health hasadded 21 drugs to a notice on precau-tions for handling drugs that may posecarcinogenic, reproductive or other seri-ous occupational risks. Refer towww.cdc.gov/niosh/docs/2010-167.

Equal EmploymentLawsuit Filed

The federal Equal EmploymentOpportunity Commission (EEOC) issuing to stop United States Steel Corp.from randomly testing probationaryemployees for alcohol use. The lawsuit,filed in a Pittsburgh federal court,alleges a diabetic employee was fired forviolating the company’s alcohol policyafter two breath tests given 15 minutesapart showed positive results. Doctorshave determined that people with dia-betes can sometimes falsely test positivefor alcohol because the disease alterstheir body chemistry. The EEOC wantsthe judge to order U.S. Steel to end“random, suspicion-less alcohol testing”at all facilities because it deprivesaffected probationary employees ofequal employment opportunities.

Health Care Industry Trends

Cleveland is one of 12 communitiesin the country subject to periodicCommunity Tracking Study site visits,which are jointly funded by the RobertWood Johnson Foundation and theNational Institute for Health CareReform. The Center for StudyingHealth System Change has been track-ing these communities since 1996. Anew report, Cleveland Hospital SystemsExpand Despite Weak Economy, shows:• Ongoing capacity expansions as

Cleveland Clinic and UniversityHospitals compete for well-insuredpatients and physician loyalty, partic-ularly in suburban areas, even as thelocal economy falters and the popu-lation declines.

• The continued shifting of health carecosts from employers to employees,including greater use of high-deductible health insurance plans.

• A safety net system protected in theshort run by federal stimulus fundsbut threatened in the longer run byongoing state budget woes and theweak local economy.

Refer to www.hschange.org/CONTENT/1154.

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Health Centers FundedThe Department of Health and

Human Services awarded more than$727 million in grants from theAffordable Care Act to help upgrade143 community health centers. Thefunds will support construction and ren-ovation of community health centers,and it extends access to another745,000 underserved patients, accordingto an HHS press release.

Lead Exposure PrecautionThe Environmental Protection

Agency’s Lead RRP (40 CFR, Part 745,Subpart E) now requires contractorsperforming renovation, repair andpainting projects that disturb lead-basedpaint in homes, child care facilities andschools built before 1978 to be certifiedand follow specific work practices toprevent lead contamination.

‘Popcorn Lung’ AwardA factory worker suffering from

“popcorn lung” was awarded $30.4 million in a lawsuit filed against thesupplier of diacetyl, a chemical found in butter-flavored microwave popcorn. The award is believed to be the largestyet in a lawsuit involving that condi-tion, attorneys for the plaintiff said. Anappeal is anticipated.

Reforms FoundConstitutional

In the first ruling on the multi-statelawsuit against health reform, a U.S.District Judge in Detroit sided with theObama administration in rejecting aclaim that requiring Americans to buyhealth insurance is unconstitutional.“The economic burden due to the indi-vidual mandate is felt by plaintiffsregardless of their specific financialbehavior,” Judge George Steeh said inhis ruling. “The [Affordable Care] Actdoes not make insurance more costly,

[and] in fact the contrary is expected;rather the Act requires plaintiffs to pur-chase insurance when they otherwisewould not have done so.”

Sick Plane DebunkedAn aircraft cabin poses no more of a

health threat to passengers than if theywere sitting in a movie theater or sub-way, according to the National ResearchCouncil. On most trans-Atlantic jets,for example, air is filtered through hos-pital-grade filters that are designed toremove 99.97 percent of bacteria andtiny particles that carry viruses.

Cabins are also separated into ventila-tion systems covering every seven rowsor to limit the spread of germs.

Texas RTW OutcomesA report on return-to-work outcomes

in the Texas workers’ compensation sys-tem shows improvement since 2004 inhow quickly injured employees get backto their jobs. The improvement mayreflect reforms enacted five years ago,observers said. The percentage ofinjured workers returning to workwithin six months after injury report-edly rose from 74 percent in 2004 to 80percent in 2008. The use of treatmentguidelines was cited as one reason forimproved medical and return-to-workoutcomes. Refer tohttp://www.tdi.state.tx.us/reports/wcreg/documents/RTW_2010_final1.pdf

OSHA UpdateGrants Awarded: The

Occupational Safety and HealthAdministration (OSHA) has awarded$2.75 million in one-year grants to 16organizations to provide training ontopics including nanotechnology, greenjobs, work zone safety, confined spaces,fall protection, beryllium exposure andlandscaping/tree service injury preven-tion. Visit www.osha.gov/dte/sharwood.

On-Site Consultation Policy: Anotice published in the Sept. 3 FederalRegister proposes changes in regulationsgoverning the agency’s On-siteConsultation Program, which offersemployers free advice on the develop-ment of safety and health managementsystems. The proposal would give theagency more latitude in selecting com-panies qualified for consultative services.

State-run ProgramsScrutinized: OSHA has concludedan Enhanced Federal AnnualMonitoring and Evaluation (EFAME) ofstate-run OSH programs in 25 statesand territories. The evaluation was con-ducted in response to a 2009 investiga-tion that revealed serious operationaldeficiencies in Nevada’s program. Stateswere given 30 days to provide a formalresponse. Refer towww.osha.gov/dcsp/osp/efame.

Top Violators: Scaffolding ruleviolations topped the list again this fis-cal year, followed by fall protection andhazard communication violations.Meanwhile, an audit of 49,192 OSHAinspections of non-federal employersconducted between July 2007 and June2009 resulted in 142,187 citations and$523.5 million in penalties that werereduced by $351.2 million (67 percent),according to a an audit conducted bythe Inspector General’s Office. “OSHAneeds to evaluate the impact and use ofhundreds of millions of dollars inpenalty reductions as incentives foremployers to improve workplace safetyand health,” auditors said. The auditfound OSHA has not effectively evalu-ated the impact of the reductions. Toview the report and OSHA’s response,visit: http://www.oig.dol.gov/public/reports.

Whistleblower Report: Inresponse to a new GovernmentAccountability Office report,Whistleblower Protection: SustainedManagement Attention Needed to AddressLong-standing Program Weaknesses,OSHA will require all investigators andtheir supervisors to complete mandatoryinvestigator training over the next 18months. Refer towww.whistleblowers.gov.

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Successfully placing physiciansand other occupational healthprofessionals since 2001• Contingency based (no risk)• Credible• Well connected• 25+ years of industry experience

ProfessionalPlacement Service

For more information, visit www.naohp.com/menu/pro-placement/or call Roy Gerber, Senior Principal, at 1-800-666-7926, x16

ProfessionalPlacement Service

Recommended ResourcesThe DOT Medical Examination: A

Guide to Commercial Drivers’ MedicalCertification, 5th Edition; updatedguide on medical qualification determi-nation of a commercial driver; NHartenbaum, ed., with contributingauthors K Hegmann and E Wood; avail-able from OEM Press:www.oempress.com/product/388/1.

Essential Guide to WorkplaceInvestigations: How to HandleEmployee Complaints & Problems,2nd edition; L Guerin; Society forHuman Resource Management/Nolo,2010; http://shrmstore.shrm.org.

High Prevalence of Restless LegSyndrome Among Patients withFibromyalgia: A Controlled Cross-Sectional Study; study suggests thattreating RLS may improve sleep andquality of life in people with fibromyal-gia; M Viola-Saltzman, et al.; Journal ofClinical Sleep Medicine, Vol. 6, Issue 5,Oct. 15, 2010.

Physicians Slow to E-Mail Routinelywith Patients; in a national survey ofoffice-based physicians conducted bythe Centers for Studying Health SystemChange, only 6.7 percent routinely e-mailed patients while other studies showmost patients are receptive to such com-munication; www.hschange.org.

Respectful Management of SeriousClinical Adverse Events; J Conway, etal.; white paper introduces an overallapproach and tools to address proactivepreparation of a plan for managing seri-ous clinical adverse events and the reac-tive emergency response of an organiza-tion that has no such plan; Institute forHealth Improvement Innovation Serieswhite paper, Cambridge, Mass., 2010;www.IHI.org.

The Aging Nurse: Can EmployersAccommodate Age-Related Changes?authors suggest one way to maintaincurrent nursing staffing levels is to

retain older nurses at the bedside byadapting the work environment to meetthe needs and limitations associatedwith aging; S Keller, et al.; Journal of theAmerican Association of OccupationalHealth Nurses, Vol. 58, No. 10, October2010.

Use of Workers’ Compensation Datafor Occupational Injury & IllnessPrevention; findings from a NationalInstitute for Occupational Safety andHealth-sponsored Workers’Compensation Data Use Workshopdescribes differences among state laws,proper interpretation of common indus-try terms, proprietary interests in insur-ance data, public release of internalanalyses and methods for linking WCdata with other health and employmentdata; revised August 2010. NIOSHPublication No. 2010-152;http://www.cdc.gov/niosh/docs/2010-152.

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VISIONS

To list your event, email information to Karen O’Hara,VISIONS Editor: kohara@naohp.com

NOVDEC

FEB

MAR

APRMAY

November 6-10APHA Annual Meeting andExposition; sponsored by theAmerican Public HealthAssociation; Denver, CO.;www.apha.org/meetings.

November 7-10World Healthcare Innovationand Technology Congress; sponsored by World Congress;Hilton Alexandria Mark Center,Alexandria, VA; www.worldcongress.com.

November 10-1219th Annual Workers’Compensation and DisabilityManagement Conference & Expo, sponsored by Risk &Insurance and LRP Publications;Las Vegas Convention Center;www.WCConference.com.

November 16-17Workers’ CompensationResearch Institute’s 27th AnnualIssues & Research Conference;Boston Park Plaza Hotel;www.wcrinet.org.

November 30-December 3National Ergonomics Conferenceand Exposition; sponsored byErgoExpo; Caesars Palace, LasVegas; www.ergoexpos.com.

December 1-3Practical Training in OccupationalHealth Sales and Marketing;sponsored by RYAN Associates;Sutton Place Hotel, Chicago, IL;www.naohp.com; 800-666-7926.

December 5-822nd Annual National Forum onQuality Improvement in HealthCare; sponsored by Institute forHealthcare Improvement;Orlando, FL.; www.IHI.org.

March 26-29American Occupational HealthConference; annual meetingsponsored by the AmericanCollege of Occupational andEnvironmental Medicine; GrandHyatt, Washington, D.C.;www.acoem.org.

February 10-12Musculoskeletal Disorders andChronic Pain: Evidence-basedApproaches for Clinical Care,Disability Prevention and ClaimsManagement; sponsored byAmerican College of Occupationaland Environmental Medicine,Canadian Institute for the Reliefof Pain and Disability and otherprofessional organizations; Los Angeles, CA;www.cirpd.org/conference2011.

April 29-May 5American Association ofOccupational Health Nursesannual conference; Atlanta, GA;www.aaohn.org.

May 1-5Risk and Insurance ManagementSociety annual conference;Vancouver, Canada;www.rims.org/annualconference.

May 24-26Drug and Alcohol TestingIndustry Association annual conference; sponsored by DATIA;Doral Resort & Spa, FL:www.Datia.org/conference2011.

ASSOCIATIONS

Urgent Care Association of America(UCAOA) UCAOA serves over 9,000 urgent care centers.We provide education and information inclinical care and practice management, andpublish the Journal of Urgent Care Medicine.Our two national conferences draw hundredsof urgent care leaders together each year.Lou Ellen Horwitz • Executive DirectorPhone: (813) 657-0508lhorwitz@ucaoa.orgwww.ucaoa.org

BACKGROUND SCREENING SERVICES

Acxiom You can’t afford to take unnecessary risks.That’s where Acxiom can help. We providethe highest hit rates and most comprehensivecompliance support available–all from anunparalleled, single-source solution. It’s a cus-tomer-centric approach to backgroundscreening, giving you the most accurate infor-mation available to protect your companyand its brand.Michael Briggs • Sales LeaderPhone: (216) 685-7678 • (800) 853-3228Fax: (216) 370-5656michael.briggs@acxiom.comwww.acxiombackgroundscreening.com

CONSULTANTS

Advanced Plan for HealthAdvanced Plan for Health has a plan and aprocess to reduce the rising costs of healthcare. By partnering with APH, you can providecustomized plans to help employees of thecompanies, school systems and governmentoffices in your market. You can show theorganizations how to improve their healthplan, finances and employee productivity.Rich Williams Phone: (888) 600-7566 Fax: (972) 741-0400 richwilliams@aph-online.comwww.aph-online.com

Bill Dunbar and Associates BDA provides revenue growth strategies to hospitals and clinics throughout the U.S.BDA’s certified coders help increase reim-bursement to its clients by improving theaccuracy of their documentation, coding, andbilling. Clients also receive on-going stafftraining and coding support. David DannPhone: (800) 783-8014Fax: (317) 247-0499dbd@billdunbar.comwww.billdunbar.com

Medical Doctor Associates Searching for Occupational Medicine Staffingor Placement? Need exceptional service andpeace of mind? MDA is the only staffingagency with a dedicated Occ Med team ANDwe provide the best coverage in the industry:occurrence form. Call us today.Joe WoddailPhone: (800) 780-3500 x2161Fax: (770) 248-6701woddailj@mdainc.comwww.mdainc.com

Reed Group, Ltd.The ACOEM Utilization ManagementKnowledgebase (UMK) is a state-of-the-art solution providing practice guidelines infor-mation to those involved in patient care, uti-lization management and other facets of theworkers’ compensation delivery system. TheAmerican College of Occupational andEnvironmental Medicine has selected ReedGroup and The Medical Disability Advisor asits delivery organization for this easy-to-useresource. The UMK features treatment modelsbased on clinical considerations and four lev-els of care. Other features include ClinicalVignette – a description of a typical treatmentencounter, and Clinical Pathway – an abbrevi-ated description of evaluation, management,diagnostic and treatment planning associatedwith a given case. The UMK is integrated withthe MDA for a total return-to-work solution. Ginny Landes Phone: (303) 407-0692 Fax: (303) 404-6616 glandes@reedgroup.com www.reedgroup.com

Refer aVendor— Earn $100

Vendor, individualand institutionalmembers of the

NAOHP will receive a$100 commission forevery referral theymake that results in anew vendor member-ship. The commissionwill be paid directly tothe referring individualor their organization.There is no limit to thenumber of referrals. In other words, if fivereferrals result in fivenew memberships, thereferring party willreceive $500.

If you know of a vendor who would benefit from joining the NAOHP VendorProgram, please contactRachel Stengel at 800-666-7926 x12.

The following organizations and consultants participate in the vendor program of the NAOHP,including many who offer discounts to members. Please refer to the vendor program sectionof our website at: http://www.naohp.com/menu/naohp/vendor/ for more information.

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RYAN AssociatesServices include feasibility studies,financial analysis, joint venture devel-opment, focus, groups, employer sur-veys, mature program audits, MISanalysis, operational efficiencies, prac-tice acquisition, staffing leadership,conflict resolution and professionalplacement services.Roy GerberPhone: (800) 666-7926x16Fax: (805) 512-9534rgerber@naohp.comwww.naohp.com

ELECTRONIC CLAIMMANAGEMENTSERVICES

StoneRiver P2P LinkP2P Link provides electronic connectiv-ity between workers’ compensationpayers and medical providers. Since1999, P2P Link has been deliveringmedical bills and supporting documen-tation electronically. P2P Link facili-tates faster payments to medicalproviders while reducing administra-tive costs.Jewels MercklingPhone: (901) 653-2619julie.merckling@stoneriver.comwww.stoneriver.com/solutions/p2p-link

Unified Health Services, LLCUnified Health Services provides com-plete electronic work comp revenuecycle management services from“patient registration to cash applica-tion” for medical groups, clinics, andhospitals across the country. Thisincludes verification and treatmentauthorization systems, electronicbilling, collections, and EOB/denialmanagement. Provider reimburse-ments are guaranteed.Don KilgorePhone: (888) 510-2667Fax: (901) 255-6797dkilgore@uhsweb.comwww.uhsweb.com

WorkCompEDI, Inc.WorkComp EDI is a leading supplier of workers’ compensation EDI clear-inghouse services, bringing togetherPayors, Providers, and Vendors to promote the open exchange of EDI for accelerating revenue cycles, lower-ing costs and increasing operationalefficiencies. Marc MenendezPhone: (800)297-6906

Fax: (888) 454-2681MMenendez@WorkCompEDI.comwww.workcompedi.com

LABORATORIES &TESTING FACILITIES

Clinical Reference Laboratory Clinical Reference Laboratory is a privately held reference laboratorywith more than 20 years experiencepartnering with corporations in estab-lishing and conducting employee substance abuse screening programsand wellness programs. Barry FeingoldPhone: (800) 445-6917Fax: (913) 492-0208feingoldb@crlcorp.com www.crlcorp.com

eScreen, Inc. eScreen is committed to delivering innovative products and services whichautomate the employee screeningprocess. eScreen has deployed propri-etary rapid testing technology in over1,500 occupational health clinicsnationwide. This technology createsthe only paperless, web-based, nation-wide network of collection sites foremployers seeking faster drug testresults.Robert ThompsonPhone: (800) 881-0722Fax: (913) 327-8606 marketing@escreen.comwww.escreen.com

MedDirectMedDirect provides drug testing products for point-of-care testing, lab confirmation services and DOTturnkey programs.Don EwingPhone: (479) 649-8614Fax: (479) 648-3246dewing@gomeddirect.comwww.gomeddirect.com

MedTox Scientific, Inc.MEDTOX is committed to providingour clients with the best service andtesting quality in the industry andimplementing the newest technologiesavailable. We are SAMHSA certifiedand manufacture our own onsiteproducts–the PROFILE® line. We arethe first lab to create an electronicchain-of-custody system, eChain®, pro-viding our clients a paperless environ-ment with web-based managementtools that give them control over theirprogram. Our expertise also includes

wellness testing, biological monitor-ing, exposure testing and many moreservices needed by the occupationalhealth industry.Jim PedersonPhone: (651) 286-6277 Fax: (651) 286-6295jpederson@medtox.comwww.medtox.com

National Jewish HealthNational Jewish Health, world leaderin diagnosis, treatment and preventionof diseases due to workplace and envi-ronmental exposures offers practical,cost effective solutions for workplacehealth and safety. We specialize inberyllium sensitization testing, diagnosis and treatment, exposureassessment, industrial hygiene consultation, medical surveillance and respiratory protection. Visitwww.NationalJewish.org. Other metal sensitivity testing is available. Wendy NeubergerPhone: (303) 398-1367800.550.6227 opt. 6neubergerw@njhealth.orgwww.njlabs.org

Oxford ImmunotecTB Screening Just Got Easier withOxford Diagnostic Laboratories, aNational TB Testing Service dedicatedto the T-SPOT.TB test. The T-SPOT.TBtest is an accurate and cost-effectivesolution compared to other methodsof TB screening. Blood specimens areaccepted Monday through Saturdayand results are reported within 36-48hours.Noelle SneiderPhone: (508) 481-4648Fax: (508) 481-4672nsneider@oxfordimmunotec.comwww.tbtestingservices.com

Quest Diagnostics Inc.Quest Diagnostics is the nation’s lead-ing provider of diagnostic testing,information and services. OurEmployer Solutions Division provides a comprehensive assortment of pro-grams and services to manage yourpre-employment employee drug test-ing, background checks, health andwellness services and OSHA requirements.Aaron AtkinsonPhone: (913) 577-1646Fax: (913) 859-6949aaron.j.atkinson@questdiagnostics.comwww.employersolutions.com

VISIONS

VENDOR PROGRAM, cont.

MEDICAL EQUIPMENT,PHARMACEUTICALS,SUPPLIES AND SERVICES

Abaxis®

Abaxis® provides the portable PiccoloXpress™ Chemistry Analyzer. The analyzer provides on-the-spot multi chemistry panel results with compara-ble performance to larger systems inabout 12 minutes using 100uL ofwhole blood, serum, or plasma. TheXpress features operator touchscreens, onboard iQC, self calibration,data storage and LIS/EMR transfercapabilities.Joanna AthwalPhone: (510) 675-6619 Fax: (736) 262-6973joannaathwal@abaxis.comwww.abaxis.com/index.asp

AlignMedAlignMed introduces the functional and dynamic S3 Brace (Spine andScapula Stabilizer). This rehabilitationtool improves shoulder and spine func-tion by optimizing spinal and shoulderalignment, scapula stabilization andproprioceptive retraining. The S3 isperfect for pre- and post- operativerehabilitation and compliments physi-cal therapy. Paul JacksonPhone: (800) 916-2544 Fax: (949) 251-5121pjackson@alignmed.comwww.alignmed.com

Alpha Pro Solutions, Inc.Internationally recognized leader ofDrug Free Workplace and handhygiene training and consulting.Occupational Health clinics make greatre-sellers to employers (DERs, supervi-sor signs and symptoms, employeeawareness). Drug Collector, BAT andInstructor training via WEB andClassroom. Breathalyzer and screeningdevices. Instructor tools: WEB,PowerPoint, Manuals, Tests, Videos. Sue ClarkPhone: (800) 277-1997 x700Fax: (727) 688-2727sue@alphaprosolutions.comwww.alphaprosolutions.com

A-S Medication Solutions LLCA-S Medication Solutions LLC, officialAllscripts partner, introduces a newway to prescribe: PedigreeRx EasyScripts. PedigreeRx Easy ScriptsMedication Dispensing Solution is themost comprehensive option for physi-cian dispensing available today.

PedigreeRx Easy Scripts allows physi-cians to electronically dispense medica-tions easily to their patients at thepoint-of-care. This solution has theunique ability to integrate with theexisting technology infrastructure orto be used as a stand-alone system.PedigreeRx Easy Scripts will improvepatient care, safety and conveniencewhile generating additional revenuefor the physician’s practice.Lauren McElroyPhone: (847) 680-3515 x.4865Lauren.McElroy@a-smeds.comwww.a-smeds.com

Automated Health CareSolutionsAHCS is a physician-owned companythat has a fully automated in-office rx-dispensing system for workers’ com-pensation patients. This program is avalue-added service for your workers’compensation patients. It helpsincrease patient compliance with med-ication use and creates an ancillaryservice for the practice. Shaun Jacob, MBAPhone: (312) 823-4080Fax: (786) 594-4645sjacob@ahcs.com

Dispensing SolutionsDispensing Solutions offers a conven-ient, proven method for supplyingyour patients with the medicationsthey need at the time of their officevisit. For nearly 20 years, DispensingSolutions has been a trusted supplierof pre-packaged medications to physi-cian offices and clinics throughout theUnited States. Bernie TalleyPhone: (800) 999-9378Fax: (800) 874-3784 btalley@dispensingsolutions.com www.dispensingsolutions.com

Keltman Pharmaceuticals, Inc. Keltman is a medical practice serviceprovider that focuses on bringinginnovative practice solutions toenhance patient care, creating alterna-tive revenue sources for physicians.Keltman’s core service is a customiz-able point of care dispensing system.This program allows physicians to setup an in-office dispensing systembased on a formulary of pre-packagedmedications selected by the physician.Wyatt WaltmanPhone: (601) 936-7533Fax: (601) 936-7787wwaltman@keltman.comwww.keltman.com

Lake Erie Medical & SurgicalSupply, Inc./QCP For 24 years Lake Erie Medical hasserved as a full-line medical supply,medication, orthopedic and equip-ment company. Representing morethan 1,000 manufacturers, includingGeneral Motors, Ford and Daimler-Chrysler, our bio-medical inspectionand repair department allows us tooffer cradle-to-grave service for yourmedical equipment and instruments. Michael HolmesPhone: (734) 847-3847Fax: (734) 847-7921Mikeh@LakeErieMedical.com www.LakeErieMedical.com

PD-Rx PD-Rx offers NAOHP members a com-plete line of prepackaged medicationsfor all Point of Care and Urgent CareCenters. So if it’s Orals Medications,Unit Dose, Unit of Use, Injectables, IV,Creams, and Ointments or SurgicalSupplies that you need, let PD-Rx fillyour orders. 100% Pedigreed. Jack McCallPhone: (800) 299-7379 Fax: (405) 942-5471jlm@pdrx.comwww.pdrx.com

U.S. Preventive MedicineUS Preventive Medicine offers ThePrevention Plan(tm), a suite of com-prehensive health management prod-ucts to improve the health, productiv-ity and quality of life for members,while reducing health care costs foremployers, insurers and governmententities. Health systems across thecountry are realizing the value of ThePrevention Plan.Richard Maguire-GonzalezSr. Vice President, NetworkDevelopmentPhone: (866) 665-0096rgonzalez@USPreventiveMedicine.comwww.USPreventiveMedicine.com orwww.ThePreventionPlan.com

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VISIONS

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PROVIDERS

Methodist Occupational Health CentersMethodist Occupational HealthCenters (MOHC) is an Indiana basedprovider of clinic based occupationalhealthcare and a national provider ofworkplace health services for employ-ers looking to reduce overall employeehealthcare costs. In addition, MOHCIprovides revenue cycle services nation-ally to other occupational health programs and health systems.Thomas BrinkPhone: (317) 216-2526 Fax: (317) 216-2839tbrink@clarian.orgwww.mohci.com

New England Baptist HospitalOccupational Medicine CenterNew England’s largest hospital based occupational health network offers a full continuum of care. Areas ofexpertise include biotechnology,orthopedics, drug and alcohol testing,immunizations, medical surveillanceand physical examinations.Irene AndersonPhone: (617) 754-6786 Fax: (617) 754-6453Ianderso@caregroup.harvard.edu

PUBLICATIONS

Center for Drug TestInformationWe are here to help you find theanswers to your questions about alco-hol and drug testing and the StateLaws that apply. We provide specificstate information and court cases youcan use to protect your organizationand save money by knowing yourstate’s incentives and workers’ com-pensation rules.Keith DevinePhone: (877) 423-8422Fax: (415) 383-5031info@centerfordrugtestinformation.comwww.centerfordrugtestinformation.com

REHABILITATION

Stretch It Out!©

Stretch It Out!© (SIO!) is a comprehen-sive safety resource designed to assistemployers in developing, implement-ing, and sustaining an effective work-place stretching program. SIO! can beutilized in a variety of work environ-ments for both large and small

employers. SIO! can be utilized as acomponent of a wellness initiative oras part of a more comprehensiveapproach to preventing musculoskele-tal injuries. SIO! licenses are offeredfor both single and multi-siteemployer users. A SIO! ConsultantLicense is also available. Go towww.egesolutions.com for moredetails.Scott EgePhone: 815-988-7588Fax: 815-624-6216scott@egesolutions.comwww.egesolutions.com

SOFTWARE PROVIDERS

Integritas, Inc. Integritas, Inc. offers Agility EHR™, afully integrated EHR and practice management solution for high volumeclinics treating a mix of patients foroccupational medicine, urgent care,and family practice. Includes auto-mated code entry directly fromprovider charting. Agility EHR 10 is aCCHIT Certified® 2011 AmbulatoryEHR, providing added assurance theproduct meets all national standards,verified by an independent standardsorganization. Integritas will apply forARRA certification within a month.Integritas’ well-known Stix® productmeets the needs of those occ medorganizations that do not require anEMR; it sells at a lower price point.Both Agility EHR and Stix are availableand configured to meet the special-ized needs of hospital employeehealth. Competitively-priced, all products can be licensed either as ahosted (cloud) application, or locallyinstalled solution. An interface expert,all Integritas’ products eliminate duplicate entry and reduce input errorby interfacing with other software inyour health system, using the stan-dardized HL7 format. Integritas soft-ware is used in over 700 clinic loca-tions throughout the United States.Dan ShirkPhone: (952) 890-3036Genevieve MusonPhone: (800) 458-2486Fax: (831) 657-20012010sales@Integritas.comwww.integritas.com

MeditraxMediTrax™ is a user-friendly softwarethat meets real-world information management needs. Features includepoint-and-click appointment schedul-ing, workflow-driven-data entry, “one-

minute” patient registration andcheckout, voice-recognition supportfor clinical dictation, automated ICD9and CPT4 coding, integrated workers’comp and OSHA reporting, testing-equipment interfaces, and occupation-specific surveillance programs. Joe Fanucchi, MDPhone: (925) 820-7758Fax: (925) 820-7650drjoe@meditrax.com www.meditrax.com

Occupational Health Research SYSTOC SYSTOC® is a powerful, comprehensivepractice management EMR softwarewithtap2chartTM technology forurgent/ primary care, occupationalhealth, rehabilitation, and wellness. SYSTOC®

provides quick, accurate documenta-tion, sophisticated billing, and flexiblereporting, along with outstanding sup-port and training.OHR Sales & Marketing TeamPhone: (800) 444-8432Fax: (207) 474-7944sales@systoc.comwww.systoc.com

OHM/Pure Safety Get empowered to do more – withmore. Put the industry’s most compre-hensive and effective OH&S softwaresolution at your fingertips: OHM fromPureSafety. Experience the Power ofOHM® – from PureSafety OHM is theoriginal “total solution” for your occupational safety, health and med-ical management needs.Tom GaudreauPhone: (888) 202-3016Fax: (615) 367-3887tom.gaudreau@puresafety.comhttp://www.puresafety.com

Practice VelocityWith over 600 clinics using our soft-ware solutions, Practice Velocity offersthe VelociDoc™—tablet PC EMR forurgent care and occupational medi-cine. Integrated practice managementsoftware automates the entire rev-enue cycle with corporate protocols,automated code entry, and automatedcorporate invoicing.David Stern, MDPhone: (815) 544-7480Fax: (815) 544-7485info@practicevelocity.comwww.practicevelocity.com

Medical Director/ Staff Physicians

• Georgia (Medical Director)—NEW POSITION

• South Carolina (Medical Director)—NEW POSITION

• D.C. Area (Medical Director)—NEW POSITION

• Chicagoland (Medical Director)

• Central Texas (Staff Physician)

• Northern California-Monterey Area (Staff Physician)

• Southern Oregon (Medical Director)

• Northern California (Medical Director)

For details, visit www.naohp.com/menu/pro-placement.

The NAOHP/RYAN Associates Professional Placement Service is seeking qualified candidates for the following positions:

226 East Canon PerdidoSuite M

Santa Barbara, CA 93101

1-800-666-7926www.naohp.com

PresidentJewels Merckling, Vice President,Provider DevelopmentP2P LinkCamden, MO 901-653-2619; jmerckling@p2plink.com

Northeast – DE, MD, New England states, NJ, NY, PA, Washington D.C., WVDr. Steven CrawfordCorporate Medical DirectorMeridian Occupational HealthWest Long Branch, NJ 732-263-7950;scrawford@meridianhealth.com

Southeast – AL, FL, GA, MS, NC, SC, TN, VALeonard Bevill, CEOMacon Occupational MedicineMacon, GA478-751-2925; lbevill@maconoccmedicine.org

Great Lakes - KY, MI, OH, WIKaren Bergen, R.N., AdministratorMarshfield Clinic Marshfield, WI715-847-3465kosidowski-bergen.karen@marshfieldclinic.org

Midwest - IL, INTom Brink, President and CEOMethodist Occupational Health CentersIndianapolis, IN317-216-2520; tbrink@clarian.org

Heartland – AR, IA, KS, LA, MN, MO, MT, NE, ND, OK, SD, TXMike Schmidt, Director of OperationsSt. Luke’s Occupational Health ServicesSioux City, IA 712-279-3470; schmidMS@stlukes.org

West – AK, AZ, CA, CO, HI, ID, NM, NV, OR, UT, WA, WYVacant

AT LARGEMichelle McGuire, Software Solutions SpecialistOccupational Health Research/SystocLawrence, Kansas207-474-8432; mcguire@systoc.com

Denia Lash, R.N. Director, Occupational HealthBlount Memorial HospitalMaryville, TN865-273-1707; dlash@bmnet.com

NAOHP Regional BoardRepresentatives and

Territories

Board Roster