VIsIonsVolume 20, Number 6

May/June 2010

The Periodical of the

National Association

of Oc cupa t iona l

Health Professionals

“Better a thousandtimes careful thanonce dead.”— A Proverb

By Karen O’Hara

Sometimes a tragic lossresults in a calling. When Shawn Boone,

33, died in 2003 of burns suf-fered in an aluminum dustexplosion at his workplace inIndiana, his sister, TammyMiser, took a crash course in

work-relatedfatalityinvesti-gations.“In my

struggleto obtaininforma-

tion, it became clear to methere was a need for a central-ized resource for familiesexperiencing a workplacedeath,” she said. “You assumethere is a process, but youdon’t know what it is or whatthe regulations are, becauseyou never expect somethinglike this to happen.”Ms. Miser made it her mis-

sion to establish the UnitedSupport Memorial forWorkplace Fatalities

(USMWF), a non-profitorganization that assists fami-lies and others affected byworkplace deaths. USMWFadvocates on behalf of vic-tims’ rights, lobbies for occu-pational health and safetyprotections, and provides abroad range of resources tosurvivors, including an onlinememorial page with photosand tributes. “Part of my motivation was

that I wanted to understandour family’s legal rights andwhat we were entitled toknow,” she explained. “Thereare some people with whomyou are so close – like mybrother was to me – andwhen you suddenly lose them,you need to know exactlywhat happened.”

Ms. Miser estimates aboutone-third of reported work-related fatalities in the U.S.find their way onto theUSMWF website(www.usmwf.org) from a vari-ety of sources. Regardless ofthe cause of death, if it hap-pens at work, USMWF willpost it. The organization’smotto is: “…Because going towork shouldn’t be a gravemistake!”

Fatalities MountDespite efforts to protect

them, people die on the job,and each work-related deathrepresents incalculable loss interms of human suffering.In 2008, the most recent

year from which comprehen-sive data are available, 5,214

continued on page 4

Workplace Fatalities, Disabling InjuriesTrigger Personal, Regulatory Response

InsIde

2 Education

3 Member Mentions

10 OutcomesElectronic Records Making Inroads

12 TrendsettersMOM awarded NAOHP Certification

15 In the Numbers

16 RegulatoryAgenda

18 Recommended Resourcess

19 Calendar

20 Vendor Program

24 Job Bank

The NAOHP Board held its quar-terly meeting via conference callon May 3. Executive Director

Frank Leone and staff members KarenO’Hara and Rachel Stengel were also inattendance.

Bi-Annual National Survey: Mr. Leone reported that the

NAOHP’s bi-annual survey allows theNAOHP to create benchmarks andtrack changes in the marketplace. The2010-2011 survey will be fielded elec-tronically this summer. Board Memberswere invited to review the draft surveyinstrument and submit questions. Mike Schmidt suggested adding well-ness-related questions, noting the growing interest on the part of employ-ers. Ms. O’Hara suggested data on theuse of electronic medical records beincorporated.

Member Recruitment andRenewals:Mr. Schmidt encouraged board

members to send reminder emails toNAOHP members who have notrenewed their membership for 2010. Ms.Stengel reported positive renewal ratesin all membership categories. She alsoinvited the board to suggest prospectivenew vendor members. Ms. Stengelreported success with the NAOHP’s firstonline Vendor Fair and said recruitmentfor the live 2010 Vendor Exhibit atRYAN Associates’ National Conferenceis on track for the fall.

Staff and Clinician Relationships:Ms. Merckling said team building is

a major focus of the board’s Staff/

Clinician Relationships Committee.She proposed a session on team buildingduring the 2010 national conference(which has since been incorporated intothe curriculum). Ms. O’Hara notedplans to offer pre-conference MedicalReview Officer certification and OSHArecordkeeping courses in conjunctionwith the American College ofOccupational (ACOEM) andEnvironmental Medicine for the firsttime this year. In related activity, Ms. O’Hara

reported on the recent AmericanAssociation of Occupational HealthNurses (AAOHN) conference and thepotential for an expanded relationshipbetween the NAOHP and AAOHN,with both parties complementing eachother’s educational programs.

Information Management: Board Member Michelle McGuire

reported continued efforts to interviewJoint Commission-certified programs fora future VISIONS article. Ms.Merckling reported on her investigationinto translation software companies andplans to develop a list of compatibilitiesbetween practice management vendorsand e-signature devices.

Publications: Ms. O’Hara reiterated plans to launch

an NAOHP blog this summer. As pro-posed, the blog would feature contentsimilar to that of current publicationsbut written in a commentator format.The goal of the blog is to promoteactive discussion of current occupa-tional health-related issues.

Member Education and Services:Ms. O’Hara announced plans to final-

ize the 2010 national conference agendaby mid-May and asked the board toreview the agenda and respond withfeedback. Board Member Denia Lashreported interest in case management,wellness, personal health care costs andtopics related to national health care

reform. Mr. Rankin suggested offering acourse on on-site services. Mr. Schmidtand Ms. McGuire proposed electronicmedical record interfaces as a topic.

Member Benchmarking: Mr. Leone reported the NAOHP has

submitted an RFP to Press Ganey andPicker as part of an ongoing patient satisfaction benchmarking project.

Promoting National Visibility: Mr. Leone reported continued discus-

sions with ACOEM regarding jointefforts, noting pre-conference offeringsfor both 2010 and 2011 national confer-ences. He also gave an update on hisinvolvement in a UCLA study on occu-pational medicine physicians’ time ontask. Mr. Rankin reported on continuedefforts to forge relationships with substance abuse professionals’ groups. The next board conference call is

scheduled for Aug. 18.

2

NAOHP Board Holds Spring Conference Call

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 20, Number 6May/June 2010

To: NAOHP MembersRe: Spring QuarterConference CallFrom: Rachel Stengel,NAOHP MemberServices Coordinator

3

NAOHP member organizationWorkingWell, a division of Sisters ofSt. Francis Health Services in Indiana,is the first occupational health providerever to receive ISO 9001:2008Certification, the program announcedJune 15. ISO certification was a logical next

step following NAOHP Quality-Certification in late 2008, said TimRoss, regional administrative director.(Refer to Trendsetters in VISIONS, Vol.19, No. 4, January/February 2009.) TheNAOHP seal of approval is based oncompliance with performance standardsin six categories: administration, opera-tional framework, staffing, quality assur-ance, product line development andsales/marketing.

ISO – the International Organizationfor Standardization – is the world’slargest developer and publisher of inter-national standards. Its standards areimplemented in 162 countries under thesupervision of the Central Secretariat,Geneva, Switzerland. ISO requires thatcertain standards be applied to all keybusiness processes. While it has been aninternational leader in quality certifica-tions for the steel and manufacturingindustries for more than 63 years, ISO9001:2008 requirements are generic andare intended to be applicable to allorganizations, regardless of the type, sizeand product provided.According to Mr. Ross, ISO certifica-

tion has manybenefits in thehealth care industry. It is also somethingISO-certifiedemployers canappreciate.“The quality-

management system provides a foundation ofbest practices,resulting in thehighest qualityhealth care,improved out-comes andreduced errors for

patients,” he said. “ISO 9001:2008ensures the effectiveness of all docu-mented processes, and commitment totheir use for every patient. By followingISO standards for quality management,we are demonstrating a proactiveapproach that prevents errors andincreases patient safety and satisfaction.”

“Through the achievement of ISO9001 Certification, WorkingWell hasmade a serious commitment to a high-quality standard of excellence andintends to exceed the expectations oftheir customers and the community,”said Chris Vanni, regional manager ofperformance improvement, Sisters of St. Francis Health Services.Mr. Ross and Ms. Vanni will speak

on the process at RYAN Associates’National Conference, Oct. 11-13 inBoston.Any business seeking ISO

Certification must go through a rigorousaudit of its quality management system.Quality goals are set and monitored fora continuously improving quality sys-tem. The WorkingWell ISO audit wasconducted by Dale Kramer of PerryJohnson Registrars, Inc.“WorkingWell is the top of the line!

Overall, a nice system – very classy and sophisticated.” said Mr. Kramer. “The best I have ever seen.”WorkingWell has five locations serv-

ing employers in northwest Indiana,

southwest Michigan and southeastChicago. It also has two locations in the Indianapolis metropolitan area. The Sisters of St. Francis HealthServices operates a network of eighthospitals on 12 campuses in Indianaand northeast Illinois.

u u u

ACOEM Installs New President

Natalie P. Hartenbaum, M.D.,M.P.H., is the new president of theAmerican College of Occupational andEnvironmental Medicine (ACOEM).Dr. Hartenbaum, an expert on trans-portation medicine, assumed office May4. She has spoken at numerous RYANAssociates’ conferences over the years.Dr. Hartenbaum is Chief Medical

Officer of OccuMedix, Inc., Dresher,Pa., and Adjunct Assistant Professor ofEmergency Medicine at the Universityof Pennsylvania. She is also MedicalDirector of the Federal Reserve Bank ofPhiladelphia and Chief Medical ReviewOfficer of FirstLab in North Wales, Pa.

u u u

In MemoriamACOEM members paid tribute to the

late Elizabeth Genovese, M.D., 53, atits annual conference in May. Dr.Genovese died April 19 of complica-tions relating to a rare form of cancer.She was Medical Director of IMXMedical Management Services, BalaCynwyd, Pa., and last year’s recipient ofthe college’s Robert A. Kehoe Award ofMerit. The award is presented to indi-viduals who have shown distinction inand made significant contributions toOEM. Dr. Genovese was acknowledgedfor her commitment to the principles ofevidence-based medicine as exemplifiedthrough her work on ACOEM’sOccupational Medicine PracticeGuidelines, specifically as a lead authorof a revised chronic pain chapter and amember of the spine panel.

Tim Ross, right, regional administrative director of WorkingWell, accepts theprogram’s ISO 9001:2008 Certification from auditor Rich Shelhamer of PerryJohnson Registrars, Inc.

workers were killed on the job – anaverage of 14 a day – and an estimated50,000 more died from occupational dis-eases, according to U.S. governmentstatistics. In April of this year, 29 men died in a

blast at Massey Energy Co.’s mine inWest Virginia. The BP oil rig explosionin the Gulf of Mexico killed 11 men,and seven more workers suffered fatalinjuries in a fire at the Tesoro refineryin Anacortes, Wash. These types of disasters garner

national media attention and serve as awakeup call. Singular fatalities get farless publicity, but they have a profoundcumulative effect.In the last eight days of April alone,

nine other fatalities and one incidentinvolving multiple hospitalizations werereported to the federal OccupationalSafety and Health Administration(OSHA).(1) Several of the fatalities thatoccurred between April 23-30 involvedpressurized equipment failures. A deputywas shot; a plumber slipped while load-ing a truck; a man working in a cornstorage bin suffocated when he wasengulfed by grain; a track maintenancesupervisor was electrocuted by a high-voltage rail; a slate roofer fell 18 feetonto a porch; and a man was crushedwhile cutting a bundle of pipe.

Weekly Toll: Death in the Workplace, ablog to which Ms. Miser and otherUSMWF volunteers contribute, suggestsadditional fatalities occurred during thelast week of April that were notreported to OSHA. For example,USMWF bloggers posted the following:two police officers killed in separatevehicle-related incidents; two minerswho died when a roof fell; a construc-tion worker killed when a trench col-lapsed; a train conductor who fell andwas struck by a locomotive; and asewage treatment facility explosion thatkilled one worker. The discrepancy between OSHA sta-

tistics and blog entries may be attrib-uted, in part, to ongoing investigationsabout work-relatedness, timing lapsesand varying information sources, Ms.Miser said.

Injury RatesIn addition to fatalities, approxi-

mately 4.6 million occupational injurieswere reported in 2008. On a positive note, non-fatal work-

place injuries and illnesses among pri-vate industry employers in 2008occurred at a rate of 3.9 cases per 100equivalent full-time workers, a declinefrom 4.2 cases in 2007, the Bureau ofLabor Statistics reports. The totalrecordable injury and illness incidencerate among private industry employershas declined significantly each yearsince 2003, when estimates from thenational Survey of OccupationalInjuries and Illnesses were first pub-lished using the 2002 North AmericanIndustry Classification System.However, government officials and

labor leaders believe the actual numberof injuries that occur annually is consid-erably higher than what is reported. Inthe 2010 edition of Death on the Job:The Toll of Neglect, the AFL-CIO citesestimates ranging from 9 to 14 millionwork-related injuries a year, with associ-ated direct and indirect costs of $156-$312 billion.(2)

According to OSHA, more than halfof reported cases require a job transfer,work restrictions or time off.Meanwhile, approximately 9,000 work-ers are treated daily in hospital emer-gency departments; about 200 of themare hospitalized.

Loss is CostlyTo quantify the monetary cost of acci-

dents, injuries and fatalities, theNational Safety Council (NSC), a non-profit organization focused on injuryand fatality prevention, estimates bothdollars spent and income lost.(3)Estimates are approximate, because somany factors can come into play. Forexample, calculable costs of work-related motor-vehicle crashes includewage and productivity losses, medicaland administrative expenses, vehicleand property damage, and employers’uninsured costs.In Table 1, total per-death costs are

estimated using averages based on

respective injury/death ratios.Multiplying the number of deaths bythese average costs provides an estimateof the economic loss associated withboth deaths and injuries in these categories. In terms of death rates by industry,

the agriculture, forestry, fishing andhunting industries topped the list in2008, with 29 fatalities per 100,000workers, surpassing mining with 21,transportation and warehousing with13, and construction with nine per100,000 workers. While statistics show that some occu-

pations are inherently dangerous, othersinvolve risks that are not as readilyapparent. For instance, scientists at theNational Institute for OccupationalSafety and Health (NIOSH) recentlyreported that the wholesale and retailtrades sector accounts for a dispropor-tionately high percentage of work-related injuries and illnesses in privateindustry. In a study, they found thatoverexertion and contact withobjects/equipment are the leadingcauses of injury or illness in that sector,accounting for 57 percent of incidents.(4)

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continued on page 6

continued from page 1

Table 1: Average Economic Cost of Fatal and Non-fatal Injuries by Class of Injury, 2008

Home injuries (fatal and non-fatal) per death $3,300,000

Public non-motor vehicle injuries (fatal and non-fatal) per death $4,600,000Work injuries (fatal and non-fatal) per death

• without employers’ uninsured costs $39,600,000• with employers’ uninsured costs $42,500,000

VIsIons

5

In a recentonline dia-logue on Whatto do AboutSafetyIncentives,(1)

Dr. DavidMichaels, assis-tant secretaryof labor, Occupational

Safety and Health Adminstration,(OSHA) told more than 1,000 listenerswhy he considers the link betweenaccurate injury tracking and appropri-ate workplace safety incentives to beof paramount importance.

In his remarks, he discussed chal-lenges the agency faces in identifyingappropriate incentives and invitedoccupational health and safety profes-sionals to submit comments andresearch on proven safety programs aswell as incentives that fail to producedesired results.

During the hour-long call, Dr.Michaels also discussed concerns aboutunder-reporting, citing a MichiganState University (MSU) study on work-related amputations as an example. Inthe study, the Department of Laborrecorded 160 official employer reportsof traumatic amputations in 2007.MSU researchers counted an addi-tional 251 amputations on workers’compensation claims and 597 in emergency department records. Theresearchers concluded that official statistics based on employer reportingundercounted the true number ofwork-related amputations by 77 per-cent. (Of the 708 total amputations,95 percent involved fingers; the lead-ing cause was power saws).(2)

“We know we’re missing recordableinjuries,” Dr. Michaels said. “The ques-tion is, why are we missing theseinjuries? What’s happening to them?”

In response, OSHA has launched anational emphasis program on record-keeping to assess the accuracy ofinjury and illness data recorded byemployers. The project involvesinspecting records prepared by busi-nesses and enforcing regulatoryrequirements when employers arefound to be under-recording injuriesand illnesses.

Excerpts from the session sponsoredby the American Society of SafetyEngineers follow:

“OSHA encourages employers to

have safety programs. Many of theseprograms include incentives and disin-centives. We understand that. The dif-ficulty we – and you – face is distin-guishing between the programs thattruly encourage safe work from theones that discourage injury reporting.

“Effective safety programs rely onaccurate injury reporting.Unfortunately, it appears there aresome employers, particularly in high-hazard industries, that have imple-mented programs inadvertently, or bydesign, that discourage injury report-ing. If accurate injury records are notcompiled because workers believethey will not be required to report aninjury, or supervisors fear they will losetheir bonuses, or even their jobs, ifworkers report injuries, real safety isnot being achieved.

“Depending on the environment,workers may fear being fired if theyreport an injury or they may feel pres-sured by co-workers not to report inorder to avoid jeopardizing a groupreward (such as a pizza party for aninjury-free work week). The result isthat certain employers appear to besafer. That may or may not be true,and it certainly puts other employerswho don’t have safety incentive pro-grams at a competitive disadvantage.

“Furthermore, nothing can belearned from the injury itself. That’simportant because we know thatmuch can be learned from injury inves-tigations conducted by employers,workers, OSHA and safety profession-als. Also, if an injury is not reported,the injured worker is denied access toworkers’ compensation benefits he orshe should rightfully receive.Inaccurate statistics also impact OSHA,misdirecting our inspections awayfrom high-risk employers.

“Why do I think this is a major prob-lem? There are a tremendous amountof injuries that OSHA is not aware ofthat are not being recorded in therates that are collected by the LaborDepartment. Every year, according tothe Bureau of Labor Statistics, theinjury rate in the U.S. goes down orremains relatively flat. At the sametime, there are some indications instudies done by academic researchersthat we are missing a significant por-tion of those injuries. The question is,how much are we actually missing?

“One thing we (recently) announcedis a new initiative to move toward

electronic injury and illness record-keeping and recording. Right now formost employers our requirement is tofill out the OSHA log on paper andkeep it in on hand in a top drawer. We don’t collect it. Many employersalready do this electronically. We wantto implement a system where employ-ers will have to provide this informa-tion electronically. We may or may notrequire them to send it to us.

“I don’t know the answers. We arevery much wrestling with these issuesand we are looking for your help. Weare committed to working with ourstakeholders, especially safety andhealth professionals who are workingin the field. We are eager to knowmore.”

References 1. What To Do About Safety

Incentives; http://eventcenter.commpartners.com/se/Meetings/Playback.aspx?meeting.id=504812.

2. Work-related Amputations inMichigan, 2007; Michigan StateUniversity and Michigan Departmentof Community Health; Dec. 2009;www.oem.msu.edu/userfiles/file/AnnualReports/Amputations.

OSHA Director on Safety Incentives: It’s Not About Pizza

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continued from page 4

Disabling InjuriesEven though a community generally will not be

able to estimate the number of disabling injuriesthat occur in work, home and public non-motor-vehicle situations in any given year, it is useful tounderstand the approximate economic loss perdeath and per disabling injury in these three classesof accidents, NSC officials say. Table 2 from theNSC shows the per-case average cost of wage andproductivity losses, and medical and administrativeexpenses. The figures do not include any estimateof property damage or non-disabling injury costsand is not intended to be used to estimate totaleconomic loss to a community from these kinds of injuries.

Table 2: Average Economic Costby Class and Severity, 2008

Death DisablingInjury

Home injuries $1,030,000 $8,100Public injuries $1,030,000 $9,500Work injuries

• Without employer costs $1,290,000 $44,000• With employer costs $1,310,000 $48,000

According to the Liberty Mutual Safety Index,2009, which is based on 2007 data compiled byLiberty Mutual, a leading workers’ compensationinsurer, the U.S. Bureau of Labor Statistics and theNational Academy of Social Insurance (NASI), anon-profit organization, more than $52 billion indirect U.S. workers’ compensation costs are attrib-uted annually to disabling work-related injuries andillnesses. (5) Overexertion is the leading cause ofthese injuries, followed by falls. In August 2009, the NASI released a study on

U.S. workers’ compensation payments for medicalcare and cash benefits for workers injured on thejob: Payments increased 2 percent to $55.4 billionin 2007, the most recent year with complete data.The grand total includes $27.2 billion for medicalcare (an increase of 3 percent compared to the prioryear) and $28.3 billion in wage replacement bene-fits for injured workers (an increase of 0.8 percent). “The costs to employers for workers’ compensa-

tion are what they pay each year. For employerswho buy insurance, costs are premiums they pay toinsurance companies plus benefits they pay underdeductible arrangements in their insurance poli-cies,” the NASI reports. “For employers who insuretheir own workers, costs are the benefits they payplus administrative costs. In 2007, employers paid a total of $85 billion nationwide for workers’ compensation.”

Federal ResponseWorkers Memorial Day, marked annually on

April 28, honors men and women who have suf-

OSHA Gains MomentumUnder New Leadership

The federal Occupational Safety and Health Administration(OSHA) appears to be emerging from a period of the regulatorydoldrums, industry observers say.

“It doesn’t mean things were always bad in the past, but I dobelieve recent activity has increased the credibility of the agency,and that’s a very positive thing,” said Aaron Trippler, director ofgovernment affairs for the American Industrial HygieneAssociation (AIHA). “The prior two-year session of Congress isthe first time I can recall where not one issue was enacted deal-ing with occupational health and safety…Let’s hope we see someaction as we move forward.”

Mr. Trippler made his observations during a recent web-basedconference sponsored by Occupational Healthy & Safety maga-zine and OHS Online.

Co-presenter Dave Heidorn, manager of government affairsand policy for the American Society of Safety Engineers (ASSE),added: “Our members participate very heavily in the voluntaryconsensus process They look at that process and ask, ‘Why can’twe do that at the federal level?’ It’s not easy, but we hope withthe approach the current administration is taking in the leader-ship they picked for OSHA that we can find ways to move standards forward.”

Both noted that health care reform, other “mega-concerns”such as immigration and finance reform, and the death of Sen.Edward Kennedy, a strong occupational safety and health proponent, have all contributed to pushing regulatory issues to the back burner this year. Hearings held this year on at least one major piece of proposed legislation—the ProtectingAmerica’s Workers Act—are not expected to result in a final votethis term. As proposed, the act would amend the OccupationalSafety and Health Act of 1970 to expand whistleblower protec-tions and increase civil and criminal penalties for certain viola-tors, they said.

In the 2010 edition of Death on the Job: The Toll of Neglect,the AFL-CIO reports that “eight years of neglect and inaction bythe Bush administration seriously eroded safety and health pro-tections.” The labor organization goes on to say: “The Obamaadministration is returning OSHA and the Mine Safety andHealth Administration (MSHA) to their mission to protect work-ers’ safety and health.” The report cites the appointments of Dr.David Michaels at OSHA and Joe Main at MSHA as positive stepstoward a renewed focus on safety and health protections andregulatory enforcement.

On April 28, when the nation marked Workers Memorial Day,events highlighted the 40th anniversary of enactment of theOSH Act of 1970 and the 39th anniversary of the creation of theNational Institute for Occupational Safety and Health (NIOSH) inthe U.S. Department of Health and Human Services and OSHA inthe U.S. Department of Labor.

According to labor and industry groups, many OSHA stan-dards are out of date, and others need to be created. For exam-ple, there is ongoing discussion about ways to control ergonomichazards and regulate exposures to silica, coal dust, combustibledust, infectious diseases, and risks associated with constructionand the use of cranes and derricks.

The Department of Labor requested $573 million for OSHA inFY 2011, which is $14 million more than the agency received inFY 2010. Some of the funds will be used to beef up enforcement.

“You are going to see about a 100-person increase in enforce-ment,” Mr. Trippler predicted. “This is big news, because that isthe one area where they are going to be shifting dollars.”

7

VIsIons

fered job-related injuries, illnesses anddeath. Acknowledging the day, JohnHoward, M.D., NIOSH director, said: “The challenges and opportunities

that we face as occupational health andsafety professionals are clear:1. We must work to eliminate, once

and for all, the hazards that still per-sist in the industries on which oureconomy is built. No one should suf-fer a job-related injury or illness.

2. We must anticipate and engage thehealth and safety needs of thechanging workplace. A rising gener-ation of strong, capable workers isvital for America’s economic recoveryand prosperity.

3. We must develop and use new tech-nologies and methodologies thatwill shape more rapid, more effec-tive workplace interventions.

“Scientific research is a fundamentaldriver of progress. NIOSH is honored tolead the strategic efforts that contributeto better recognition and understandingof occupational hazards, developmentand application of new preventivemeasures, and evaluation of those meas-ures. We are committed to working withour diverse partners in those endeavorsas wisely and as diligently as we can. Inmemory of the men and women who arehonored on Workers Memorial Day2010, we can do no less.”

(Editor’s Note: Dr. Howard will be the keynote speaker at RYAN Associates’National Conference, Oct. 11-13 inBoston. Watch for details in the next edition of VISIONS.)On the same occasion, Labor

Secretary Hilda Solis noted: “In April,our nation’s consciousness was jarred bythe loss of workers in the Upper BigBranch Mine disaster in West Virginia,an oil rig explosion south of Louisianaand a refinery fire in Washington state.“The pain brought on by each of

these tragedies is beyond comparison,and we should not think of the inci-dents as isolated. The fact is they allinvolve worker safety issues, whichmerit national attention and point to adisturbing pattern of deadly neglect thatour country can no longer tolerate.“…The mission of the Department of

Labor’s worker safety and health protec-tion agencies is clearer than ever. And,our effort to save lives throughenhanced enforcement, a forward-look-ing and progressive regulatory agenda,

expanded outreach and a relentlesscommitment to enforcing the law hasnever been more necessary.”

OSHA ActivityOSHA is among federal agencies

placing a renewed emphasis on work-place safety. For example, the agencyplans to use a fiscal 2011 budget boostto significantly increase its regulatoryenforcement efforts, which diminishedwhen the Bush administration empha-sized voluntary compliance and protec-tion programs.In recent testimony before the Senate

Health, Education, Labor and PensionsCommittee, Dr. David Michaels, anoccupational and environmental health professor who recently took over the helm at OSHA, made severalsuggestions:• Make violations of the Occupational

Safety and Health (OSH) Act thatresult in a death or serious bodilyinjury felony offenses.

• Require employers to abate serious,willful and repeat hazards after acitation is issued, regardless ofwhether the case is contested.Currently, abatement is not requiredduring the contest period, which canextend for years. Dr. Michaels saidOSHA has identified at least 30workers who died on the jobbetween 1999 and 2009 during thecontest period triggered by a cita-tion. “The only situation worse thana worker being injured or killed onthe job by a senseless and preventa-ble hazard is having a second workerneedlessly felled by the same haz-ard,” he said in prepared remarks.

• Trenching fatalities and seriousinjuries should result in presumptivewillful citations, because hazardsassociated with unprotected trenchwork are widely recognized.

• Give OSHA inspectors authority to“tag” a hazardous condition thatposes an immediate danger of deathor serious injury, which wouldrequire the employer to take imme-diate corrective action or shut downthe operation. The Mine Safety andHealth Administration (MSHA)already has this authority.

• Allow repeat citations for similar vio-lations at workplaces in states withtheir own OSH enforcement agencies.

• Provide OSHA protections to publicemployees, unless the state wherethey work does.

• Give the agency greater latitude toprotect contract workers by amend-ing the OSH Act’s general dutyclause.

Efforts are already under way to reviseoutdated regulations. In addition,OSHA scheduled a series of daylongmeetings in June to collect public com-ments on proposed rules for Injury andIllness Prevention Programs, known asI2P2. As proposed, rather than wait foran inspection or a workplace incident totrigger correction, employers would berequired to implement a plan to proac-tively identify and eliminate hazards. Meanwhile, OSHA released 15 years

of data on worker exposures to toxicchemicals. These data provide insightsinto the levels of toxic chemicals com-monly found in workplaces, and howexposures to specific chemicals are dis-tributed across industries, geographicalareas and time.“We believe this information, in the

hands of informed, key stakeholders,will ultimately lead to a more robustand focused debate on what still needsto be done to protect workers in all sec-tors, especially in the chemical indus-try,” Dr. Michaels said.

Other Agencies on BoardMining: Following the Big Branch

mine disaster, the MSHA launched acoal mine inspection blitz in an effort touncover workplace health and safetyviolations. At a May 20 hearing, JoeMain, MSHA director, told a U.S.Senate subcommittee the Justice

8

Department is conducting a “seriouscriminal investigation”“ into what ledto the explosion at the mine. Mr. Mainsaid MSHA is evaluating organizationalchanges to better cover the high con-centration of coal mines in WestVirginia.

Transportation: In the Department ofTransportation, Secretary Ray LaHoodformed a safety council to tackle criticalissues facing the department’s 10 operat-ing divisions, including the FederalMotor Carrier Safety Administration(FMCSA), which oversees the truckingindustry.“Now is the time to identify and

address the top safety issues that cutacross our agencies,” Mr. LaHood said.“The council will take our commitmentto safety, which is our highest priority,to the next level.”

Minerals Management: Secretary ofthe Interior Ken Salazar has ordered arestructuring of the Minerals Manage-ment Service to ensure the independ-ence of its inspection and enforcementduties. Mr. Salazar also sent a letter toCongressional leaders asking for theirinput on agency reforms.“We have a responsibility to ensure

that the operation and oversight of off-shore operations are following the law,protecting the workers, and guardingagainst future incidents and spills,” hesaid in a letter to Congressional leaders.“The reforms will change the way theDepartment of the Interior does busi-ness in the offshore program to ensurethat we fully attain these goals.”

Emergency Management: FederalEmergency Management Agency(FEMA) Administrator Craig Fugateannounced the launch of a new mobileweb site, m.fema.gov, to make it easy fordisaster victims to access emergencypreparedness and disaster assistanceusing a smartphone. A companion site,www.disasterassistance.gov/disasterinfor-mation/deepwater.html – is designed tohelp Gulf residents and businessesaffected by the oil spill file claimsagainst BP.

Grassroots InterventionsWhile change at the federal level is

percolating, there remains an ongoingneed at the grassroots level to addressrisk factors that contribute to work-related injuries, illnesses and fatalities.

Risk factors to which employees aresubject are numerous. Beside inherentlydangerous conditions in some industries,they include stress, depression andfatigue. Studies show employees whofeel unappreciated at work, have per-sonal problems or are involved in con-flicts with supervisors or co-workers aremore likely to be inattentive or careless.Other risk factors include productionquotas; inadequate training; ineffectiveuse of personal protective equipment,lax rule enforcement; and failure toidentify and eliminate hazardous conditions.Some employees with chronic med-

ical conditions have repeated absences.Others show up for work but are notfully productive because they are inpain, are taking medications that affectfunction or simply lack energy.It is widely acknowledged that many of

these factors can be addressed by occu-pational health and safety professionalswith preventive solutions such as:• onsite education and safety training;

• behavioral health evaluations andinterventions, including medication,bio-feedback and/or counseling;

• ergonomic assessments and worksta-tion/tool adjustments;

• medical surveillance;

• pre-placement and fitness-for-dutyphysical screening; and

• exercise, weight loss and smokingcessation programs.

In addition, occupational health pro-fessionals can help employers create afoundation for workplace safety year-round by emphasizing what may seemon the surface to be relatively benignrisks, according to Job Genius, a publi-cation of Express Services, Inc.Oklahoma City.(6) For example:

Sleep: For every 90 minutes of sleeplost per night, daytime alertness isreduced by 32 percent, studies show. Ina National Sleep Foundation survey,about one-third of respondents said lackof sleep affects their quality of life. Notgetting enough sleep is associated withdiabetes, heart disease, obesity anddepression. The Centers for DiseaseControl and Prevention recommendsadults get seven-to-nine hours of sleep a day.

Stress: Stress is linked to healthissues such as high blood pressure,

headaches and stomach ailments, anxi-ety and depression, and it can lead tojob dissatisfaction, poor performance,absenteeism and turnover. Employersand employees should be encouraged tofocus on task management (priority-set-ting) and sustaining a healthy work-lifebalance.

Overexertion: Strains and sprainsresulting from overexertion on the jobcan largely be avoided with ergonomicinterventions, training on proper liftingand work posture, job rotation, fre-quently scheduled stretch breaks andother mechanisms.

Overtime: Employers and workersshould be aware of the dangers of work-ing harder, not smarter. Studies suggestthat working excessive overtime affectsone’s attitude as well as one’s cardiovas-cular fitness. Finally, employers and employees are

strongly encouraged to prohibit the useof cells phones and other electronicdevices while driving. According to theNational Safety Council, motor vehicleaccidents are the leading cause of work-related fatalities, and it is estimated atleast 25 percent of all crashes involvetalking on a cell phone. Last year, morethan 200 state bills were introduced toban cell phone use while driving.

References1. Weekly fatality/catastrophe report;

www.osha.gov/dep/fatcat.2. Death on the Job: The Toll of

Neglect, 2010; AFL-CIO;www.aflcio.org.

3. Injury Facts,® available in bookletform or on CD-ROM under a multi-uselicense; www.nsc.org.4. Occupational Fatalities, Injuries,

Illnesses, and Related Economic Loss inthe Wholesale and Retail Trade Sector;V Anderson, et al., NIOSH; Am J IndMed, ©2010 Wiley-Liss, Inc.; availableahead of print:www3.interscience.wiley.com.5. Workplace Safety Index, 2009;

Liberty Mutual Research Institute for Safety; www.libertymutual/researchinstitute.6. Five Risky Things You Do at

Work – Break These Habits to StaySafe: www.expresspros.com/us/jobgenius/2010/06.

9

VIsIons

Children suffer both emotionallyand economically when a parent diesor becomes severely disabled in awork-related accident. College plans,for example, often get shoved to thebackburner.

But there is a way for families toovercome this harsh reality: Kids’Chance, a non-profit organization,offers educational opportunities andscholarships to children affected byworkplace fatalities and catastrophicinjuries.

Kids’ Chance of America and itsstate chapters are supported by acoalition of groups within the work-ers’ compensation system, including

attorneysand thejudiciary;insurers,medicalproviders,vocationalrehabilita-tion spe-cialists andemployers.S. WoodsBennett,presidentof the Kids’

Chance of America Board of Directors,said the organization fills a niche notaddressed in workers’ compensationand benefits systems.

“Workers’ compensation benefitsonly go so far,” said Mr. Bennett, aMaryland workers’ compensationdefense attorney. “In most cases, stateworkers’ compensation laws andnational programs such as theLongshore and Harbor Workers’Compensation Act and the Black LungBenefits Act do not provide benefitsfor children of injured workers to helpthem with their educational expenses.

“When there is a material impact onthe income of the family, Kids’ Chancesteps in and provides scholarship assis-tance so children can pursue their educational goals.”

Kids’ Chance OutreachSince the first Kids’ Chance scholar-

ship was awarded in Georgia in 1988,thousands of children have collectivelyreceived nearly $5 million in educa-tional assistance. However, there aremany other youngsters who could

potentially benefit but never learnabout the opportunity.

In addition to fund-raising, Kids’Chance – nationally and at the statelevel – faces the challenge of findingqualified applicants.

“NAOHP members and other occu-pational health and safety profession-als can help us by identifying childrenwho would benefit,” Mr. Bennett said.“We are always looking for ways toincrease our visibility.”

In 2009, Kids’ Chance of Americaserved as an umbrella organization for17 state chapters. An additional eight,state-specific scholarship organizationsare listed on the Kids’ Chance website(www.kidschance.org). The relativelynew national organization is focusedon fund-raising methodology anddeveloping existing Kids’ Chanceorganizations by ensuring they usebest practices for non-profit organiza-tions, Mr. Bennett explained.

State chapters raise scholarshipfunds through grants and donations.Consequently, each chapter establishesits own qualification criteria. Somechapters exclusively provide scholar-ships in cases involving either a work-related fatality or permanent, totaldisability. Others also may awardscholarships when a parental injury isdeemed sufficiently serious to materi-ally impact the family’s source ofincome. State chapter rules related tothe age of qualifying children alsovary, although the majority of fundsgo to teen-agers after they graduate

from high school, Mr. Bennett said.In letters and testimonials,

scholarship recipients express theirappreciation.

“Over the past four years, you haveprovided more than $25,000 to helpfund my education,” writes a recentgraduate. “You gave me the opportu-nity to learn and grow…in ways thatwill shape my life. You allowed me toenjoy a full college experience. OnMay 15, one day shy of the seventhanniversary of the death of my father,I graduated with a degree in computerscience, and I have secured a positionas a web developer.

“Without you, it would have been amuch more arduous road. You wentabove and beyond to include me inKids’ Chance events, not just duringmy first year in college but every year.For this I will always be grateful.”

Kids’ Chance Awards Scholarships When Parents are Killed or Disabled

10

In preliminary findings, 67 percentof occupational physicians whoresponded to a national survey said

they use electronic medical records(EMRs) in some form.Members of the American College

of Occupational and EnvironmentalMedicine (ACOM) fielded the surveyon the use of EMRs in occupationalmedical practice in the first quarter ofthis year. The early results are based on605 responses to a web-based question-naire. An additional 540 writtenresponses are being tabulated. KirkHarmon, M.D., an occupational physi-cian affiliated with the MulticareHealth System, Tacoma, Wash., pre-sented the preliminary findings atACOEM’s 2010 AmericanOccupational Health Conference inOrlando. When asked about their professional

status in occupational medicine, 27 per-cent of respondents identified them-selves “group;” 21 percent “hospital;” 13percent “solo;” 4 percent “academic;” 6percent a “combination;” and 29 per-cent “other.” Among responding physi-cians, 38 percent reported they see 51 to100 patients a week and 36 percent see21 to 50 patients a week. Of those usingEMR systems, 46 percent said they pri-marily use them for “billing and clinicalsupport;” 37 percent “mainly clinical;”and 17 percent “mainly billing.” In other findings:

• 22 percent of respondents who arenot using an EMR system said thereis an 80-100 percent likelihood ofadoption within the next year, com-pared to 37 percent who cited a 0-19percent likelihood.

• One third of respondents have usedEMR software for two to five years;25 percent five to 10 years; 25 per-cent less than two years; and 16 percent 10 or more years.

• Asked about their satisfaction withEMR, one-third said they are “verysatisfied;” 26 percent are “slightlysatisfied;” 12 percent are neutral; 15percent are “slightly dissatisfied;”and 14 percent are “very dissatisfied.”

• When asked about the most satisfac-tory aspects of their EMR softwareprogram, 54 percent cited documen-tation of medical records. Schedulingcapabilities were considered thenext-most-valuable feature by 33percent of respondents. The leastvaluable feature was clinical proto-cols contained within the EMR system.

• Electronic documentation of medicalrecords was considered the “mostimportant” feature of EMR softwareby 83 percent of respondents. Thenext most important feature washandling of laboratory examinationsand imaging modalities.

• Regarding quality, 66 percent ofrespondents felt EMRs improvedquality either ”considerably” or“somewhat;” 7 percent felt EMR use“worsens quality somewhat” andless than 2 percent felt it “worsensquality considerably.” Open-endedcomments related to qualityincluded: “Improved legibility ofmedical care,” “Neater medicalrecord” and “Accessible.” On thenegative side: “…the quality ofrecords is markedly declining due toincreasingly widespread use of copyand paste functions…” and “I spendmany hours a week reviewing otherproviders’ medical records. Thosewith Dx templates are universallythe worst records. That a globalswitch to EMR will improve qualityand reduce cost is a myth.”

• 64 percent felt EMRs improve safety“considerably” or “somewhat.”About 30 percent were neutral.

• Respondents were asked about pri-mary barriers to EMR use. Nearlyone-quarter of respondents said

EMRs are “time consuming” and“not convenient.” Other less signifi-cant barriers included cost, complex-ity and lack of familiarity. Commentsincluded: “Clinical documentation istime-consuming.” “I cannot use itand see patients at the same time.”“Just about all the EMRs I’ve usedare not well-suited for occupationalhealth.”

Other Insights on EMRsExperts agree that both patients and

providers stand to benefit from the con-venience, portability, efficiency,improved accuracy and clinical decisionsupport tools associated with EMRs.However, it is not yet certain how theiruse will affect patient safety and carequality. For example, in a survey conducted

recently by the Center for StudyingHealth System Change, clinicians saidsome features are “distracting” duringpatient visits and may compromiseinter-personal communication withpatients and other clinicians. During a session on Electronic Medical

Records in Occupational MedicinePractice: A State-of-the-Art Review at theACOEM conference, ElpidoforosSoteriades, M.D., of Cyprus, a visitingscientist at the Harvard School ofPublic Health, said EMRs have inherentlimitations relative to their effect oncare quality.“The IT industry is not yet standard-

ized, and the technology is not wellenough advanced to support improve-ments in safety and care quality,” hesaid. “Research in this area is still in anembryonic stage, especially in the U.S.,”which lags behind most other industrial-ized nations in EMR adoption.Alluding to a New England Journal of

Medicine article published in April 2009by Harvard researchers on the status of

Electronic Records Making Inroads in Occupational Medicine Practice

11

VIsIons

HITECH ActImpacts MedicalProviders

When President Obama signedthe American Recovery andReinvestment Act of 2009, he alsosigned the Health InformationTechnology for Economic andClinical Health (HITECH) Act, allo-cating nearly $20 billion to spurthe widespread adoption of elec-tronic medical records (EMRs).

Under the act, hospitals andphysicians must “meaningfullyuse” EMRs to qualify for Medicareand Medicaid incentive payments.Meaningful use is expected toinclude electronic prescribing;information exchange among systems; qualitative survey andreporting methods; and specificcoding parameters.

However, “meaningful use” provisions have not yet been fullydefined and may present somebarriers to adoption, observers say.A work group of a national HITPolicy Committee reportedly wasscheduled to release its recommen-dations on the definition of“meaningful use” June 16. Ifapproved by the committee, therecommendations will be for-warded to the Office of theNational Coordinator for HealthInformation Technology for consideration.

In another development, Healthand Human Services (HHS)Secretary Kathleen Sebeliusannounced on June 3 the award of$83.9 million in grants to helpselected health care organizationsadopt EMRs and other healthinformation technology systems.The funds are part of $2 billionallocated to HHS’ Health Resourcesand Services Administration (HRSA)to expand services to low-incomeand uninsured individuals throughits health center program.

“These funds will help safety-netproviders acquire state-of-the-arthealth information technology systems as they work to providequality health care to millions ofpeople in need,” said HRSAAdministrator Mary Wakefield.

EMRs in hospitals, Dr. Soteriadessaid the hospitals most likely tohave fully functional systems todayare major urban teaching institu-tions, particularly those with dedi-cated coronary care units. He citedan average implementation cost of$45-$50,000 as a deterrent forsmaller organizations. Nevertheless, he encouraged

ACOEM members to move forwardwith the transition from paper todigital records. He recommendedthe Health Resources and ServicesAdministration (www.hrsa.gov),Department of Health and HumanServices (www.hhs.gov/recovery/programs) and the Agency forHealth Care Research and Quality(www.ahrq.gov) as useful resources.Steven Schumann, M.D., another

speaker at the ACOEM conference,said electronic records represent anopportunity for occupational medi-cine physicians to enhance qualityof care while protecting patientsafety – with some caveats.

“EMRs should make care easier,better and safer, but the large vari-ety of software applications, most ofwhich do not communicate witheach other, and other issues presentbarriers to adoption,” said Dr.Schumann, a practicing occupa-tional medicine physician and for-mer software developer and clinicowner. “For this to work, it has tobe available where we see patients.”Dr. Schumann cited the following

as key features of an EMR:

• Patient demographics and insurance information;

• Medical notes, including vitalsigns, immunizations, past medical history and provider-generated content;

• Consultants’ reports;

• Lab, x-ray and imaging data;

• Accounts receivable and otherfinancial information;

• Personal genomic information;

• Hospital and other specialtyfacility information; and

• Directives.

Going forward, Dr. Schumannsaid there are a number of potentialbarriers to implementation that willneed to be addressed. These includethe ability of providers to qualify forgovernment incentives under“meaningful use” provisions thathave not yet been fully defined.“To qualify for federal incentives

for EMR implementation, providersand system vendors will need toremain alert in order to complywith government requirements,” he said. Other factors include patient pri-

vacy concerns, lack of physicianinput in EMR system selectionprocesses at many institutions, andunease of providers and others usingthese systems. Another potentialpitfall, he said, is a tendency to per-ceive the electronic medical record– rather than the care provided – asthe work product.

12

Want to Improve Your Program? Ask MOM

By Karen O’Hara

Everyone would benefit if allemployers and workers had aMOM who cares as much as

this one.Macon Occupational Medicine,

fondly referred to as MOM, is the firstprogram in Georgia to be awarded athree-year Quality Certification by theNational Association of OccupationalHealth Professionals (NAOHP). Theprogram was recognized for“Outstanding Achievement,” with ascore of 97.75 percent compliance tostandard out of a possible 100 percent,following a May site visit.The award acknowledges that MOM

offers a high level of occupational andenvironmental medicine expertise toemployers and employees in centralGeorgia. NAOHP Site Surveyor DonnaLee Gardner, a nurse and RYANAssociates consultant who was instru-mental in developing the NAOHP’sperformance standards, said she is par-ticularly impressed with MOM’s empha-sis on qualified staff, documentation andcommunication practices, and contribu-tions to the community at large.“I want to commend all of the Macon

Occupational Medicine team members,”Ms. Gardner said. “There are manyaspects of the practice that truly set itapart, and they have been very generousabout sharing their knowledge with others.”MOM has been serving Central

Georgia employers and employees witha diverse array of services since 1990.The privately held company has oper-ated from a freestanding clinic in down-town Macon since 2001. It also providesservices at local worksites and offers 24-hour access to care via affiliations withlocal hospitals and urgent care clinicsunder detailed operational protocols.

“The NAOHP seal of approval says

we provide excellent service,” saidLeonard Bevill, CEO. “We are pleasedwith our performance to date, and wewill integrate lessons gleaned from thecertification process into our continuousquality improvement activities.“We have many companies that look

to us to provide the best possible serv-ice. Now, as we reach out to new clientsand payers, we can tell them we are theonly certified program in Georgia.”While the NAOHP standards are

extensive, Mr. Bevill found the certifi-cation process relatively seamless andeasy to accomplish with informationsupplied in advance by the NAOHPand Ms. Gardner.“My staff was able to put 95 percent

of the material together in an organizedmanner prior to the site visit,” he said.“Of course, like anything else of thisnature, we were anxious to get thereview underway.”

For other programs considering a cer-tification, he believes there is no timelike the present.“A major aspect of certification is

that you can take advantage of the sur-veyor’s expertise to enhance your over-all operation and specific processes,” Mr.Bevill explained. “For us, just the fine-tuning adjustments we made in docu-mentation and coding as a result ofDonna Lee’s recommendations paid forthe certification times two-or-three fold. Meanwhile, he noted, “with health

care changing dramatically as we speak,NAOHP certification means that yourfacility is doing what it needs to do tobe in compliance with best practicesand set itself apart.”

Noteworthy Attributes During her site visit, Ms. Gardner

noted that MOM places a particularemphasis on staff training and certifica-tion in clinical areas.

Carrie Brown, C-M.T., checks a patient's blood pressure.

13

VIsIons

“Certification is extremely important, especially in an occu-pational medicine environment. That is one of the ways wehave been able to differentiate ourselves,” Mr. Bevill said.“We take pride in the fact that our staff has obtained trainingand certification in their areas of expertise.“When you have the appropriate certifications and creden-

tials, you can help your clients avoid potentially litigioussituations. We don’t have on-the-job trainees or non-certifiedstaff.”Outcomes measurement is another area where MOM

distinguishes itself, Ms. Gardner reported.“We do a lot of outcome analysis and reporting for our

clients, which has helped raise our program to the next level,”Mr. Bevill said. “Cindy Stephens, a licensed claims adjusterand case manager, keeps us in tune and ensures that patientsdon’t get lost in the system. That is how we adhere to guide-lines and communicate effectively with all parties to avoid aspiral into lost time and disability. We strive to remain at thecenter of all of the touch points.” MOM reports a national average of four physician visits for

the treatment of an acute work-related injury and an averageof six-to-eight rehabilitation visits. To adhere to these bench-marks, it has developed a protocol to manage cases more effi-ciently and effectively. Under the protocol, if an injured employee exceeds the

fourth physician visit or eighth rehabilitation visit, systemsoftware automatically flags the chart for a physician to con-duct an in-depth case review. Information on the review isprovided to the employer via a medical note and/or phonecall. This may include referral for diagnostic testing, referralto an outside physician for evaluation, and/or future physicianand rehabilitation visits. Functioning as a case manager, Ms. Stephens verifies the

medical rationale for physician recommendations and keepsthe employer and insurer informed of patient status. In addi-tion to her work as a case manager, Ms. Stephens functions inan educational capacity.

Continued on page 14

MOM Points of Pride

Credentials and Certifications• Professionals on the team include board-

certified physicians/certified medical reviewofficers; registered nurses; licensed practicalnurses; and certified medical assistants.Other certified/licensed staff: industrialhygienists; safety professionals; ergonomicevaluators; radiological and medical tech-nologists; physical therapists; exercise physi-ologists; impairment evaluation specialists;work capacity evaluators; hearing conserva-tion specialists; breath-alcohol technicians;audiometric technicians; professional collec-tors and a professional collector trainer.

• Accredited by the Drug and Alcohol TestingIndustry Association

• Certified Drug Free Workplace

Memberships• American College of Occupational and

Environmental Medicine

• American and Georgia Physical TherapyAssociations

• American Association of Travel Medicine

• Better Business Bureau

• Council on Alcohol and Drug Abuse

• Greater Macon Chamber of Commence

• National Association of Occupational HealthNurses

• National Association of Occupational HealthProfessionals

• National Hearing Conservation Association

• Society for Human Resource Management

Awards• 2007 Partner in Economic Development,

Macon Economic Development Commission

• 2005 Small Business of the Year, GreaterMacon Chamber of Commerce

• 2004 Better Business Bureau Torch AwardWinner for Marketplace Ethics

Community Partnerships• Has contributed more than $250,000 to

local charities.

• Conducts free educational seminars forhuman resource and safety professionals.

• Promotes community involvement throughaffiliations with numerous local community-based and philanthropic organizations.

Cindy Nix, P.T., focuses on work injury rehabilitation.

“A lot of offices have nurses whodo that – and that’s fine – but weprovide that added piece by flaggingcases. We know that by the fourthdoctor’s visit the patient is not get-ting better in the timeframe wewould typically expect,” Mr. Bevillsaid. “Many employers, especially atsmaller companies, don’t understandthe workers’ compensation rules inGeorgia. Cindy educates companieson the basic concepts.” This approach is consistent with

MOM’s slogan: The health of yourbusiness may depend on us.”

Looking AheadMOM is focusing now on refining

its wellness and health promotionofferings, with an eye toward devel-oping a total health managementdelivery model. One step in thatdirection involves a new contract tomanage employee disability for thecity of Macon, which includes a well-ness component. The contract sup-ports a nurse with disability manage-ment experience. It also involvesconsolidation of services in a singlelocation, saving the city more than$100,000 a year.Meanwhile, MOM continues to

work with county government todevelop an education and diseasemanagement program targeting high-risk conditions in response to estab-lished baseline biometrics.

In general, as national policies takeshape in response to health carereform, Mr. Bevill says he will bewatching closely to see how it plays out.“With workers’ compensation

being a state-sponsored system, whoknows what will happen? But Ibelieve wellness is what is reallygoing to take off,” he predicted.“Prevention and disease managementare major aspects of the reform act.”To take advantage of the monu-

mental shift from reactive medicalcare to proactive intervention, headvises occupational health providersto strive to clearly demonstrate returnon investment and “value added” toclients and payers. Occupationalhealth programs have an opportunityto take greater advantage of theirability to help companies save moneyon their insurance premiums, he said.

14

Trendsetters, continued from page 13

About NAOHPCertification

Occupational health programsand clinics undergoing NAOHPQuality Certification are evaluatedin comparison to establishednational standards in six categories: • Administration

• Operational Framework

• Staffing Processes

• Quality Assurance

• Product Line Development

• Sales and Marketing

“Outstanding Achievement” is95-100 percent compliant withNAOHP standards, “ExcellentAchievement” is 92-95 percentcompliant” and “HonorableAchievement” is 90-92 percentcompliant; 70-89 percent compli-ance to standard results in a one-year provisional certification.

The NAOHP Site CertificationProgram was established in 2006as part of ongoing efforts to rec-ognize occupational health profes-sionals for their contributions tothe health and well being of thenation’s workforce. The NAOHPalso awards a Certificate ofCompetency in OccupationalHealth Practice Management toindividuals who pass a writtenexamination. For information, visitwww.naohp.com or send a requestby email to info@naohp.com.

Three Key Certification Takeaways• Fine-tuned documentation templates to facilitate cross-referencing by

clinical staff and validate coding levels to maximize reimbursement butnot over-charge.

• Modified coding and billing processes to obtain reimbursement for nursecase management interventions previously provided without charge.

• Launched statewide marketing campaign to promote MaconOccupational Medicine as the first program in Georgia to becomeNAOHP-certified and increase the association’s visibility with employersand payers.

Sherri Austin, C-M.T. and Medical Director Lance Atkinson, M.D., view a foot X-ray.

15

VIsIons

Hospital-owned practices were themost successful in attractingphysicians in 2009. More than

half (65 percent) of established physi-cians were placed in hospital-ownedpractices and 49 percent of physicianshired out of residency or fellowshipwere placed in hospital-owned practices,according to the Medical GroupManagement Association (MGMA)Physician Placement Starting SalarySurvey: 2010 Report Based on 2009Data.

“Physicians are moving to hospital-owned practices for a number of rea-sons,” said Brenda Lewis, president ofB.E.L. & Associates, Inc., and MGMAsurvey advisory committee member.“There is uncertainty of reimbursementfor the future. Physicians are looking tosustain income to pay office overheadand have a paycheck to take home, andthose with large Medicare populationsare more likely to want to move to hos-pital-employed positions.”Higher starting compensation could

be one of the drivers for this trend asprimary care and specialty care physi-cians in hospital-owned practices wereoffered more in first-year guaranteedcompensation than those in non-hospi-tal practices. Historically, freestandingpractices have offered higher first-yearguaranteed compensation to specialtyphysicians. The gap between first-yearguaranteed compensation offered forspecialty care physicians had beenshrinking since 2007. Primary carephysicians reported median first-yearguaranteed compensation of $160,000in 2009; specialists reported $230,000 inthe first year.MGMA’s data also show that:

• First-year guaranteed compensationhas decreased 2 percent since 2006for specialists in single-specialtypractices while primary care first-year guaranteed compensation

increased 17 percent in the sametimeframe.

• First-year guaranteed compensationfor specialty care physicians in multi-specialty practices increased 3 per-cent since 2006. During this sameperiod, first-year guaranteed com-pensation for primary care physi-cians in multi-specialty practicesincreased 14 percent.

About the SurveyThe MGMA survey is produced in

conjunction with the NationalAssociation of Physician Recruiters. Itfeatures data on more than 4,100providers categorized by specialty andstarting salary for more than 1,500physicians directly out of residency.This year the report includes a newtable that displays first-year guaranteedcompensation by U.S. Department ofHealth & Human Services regions, newtables for loan forgiveness amounts andexpanded key findings offering analysison location of placement trends. Visitwww.mgma.com.

Middle Class UninsuredPopulation Surges

Barely Hanging On: Middle-Class andUninsured, a March 2010 report fromthe non-partisan Robert Wood JohnsonFoundation, chronicles state-by-statehealth coverage trends. Researchers at the State Health

Access Data Assistance Center at theUniversity of Minnesota averaged datafrom the U.S. Census Bureau from1999/2000 and 2007/2008 and datafrom the U.S. Department of Healthand Human Services. They found:• More middle-class Americans are

uninsured. Nationwide, the totalnumber of uninsured, middle-classpeople increased by more than 2million since 2000, to12.9 million in2008.

• The average employee’s costs forhealth insurance rose, while incomefell. Nationwide, the average cost anemployee paid for a family insurancepolicy rose 81 percent from 2000 to2008. During the same period,median household income fell 2.5percent (adjusted for inflation).

• Fewer people were offered, eligiblefor, or accepted insurance coveragethrough their jobs.

• Nationwide, the percentage of peo-ple who worked for firms that didnot offer insurance increased to 12percent in 2008.

• The number of workers who wereineligible for employer-sponsoredinsurance —even though theiremployer offered it—was 22 percentin 2008, meaning more than one infive people who work in firms thatoffer health insurance weren’t eligi-ble for it.

• The percentage of employeesnationwide who did not acceptemployer-sponsored insuranceincreased three percentage pointssince 2000; 21 percent of employeesoffered insurance in 2008 did notaccept it.

“The facts show that everyone is suf-fering right now, regardless of income,”said Risa Lavizzo-Mourey, M.D., presi-dent and CEO of the Robert WoodJohnson Foundation. “For middle-classfamilies, changes in the cost of insur-ance far outweigh changes in income.That means a bigger piece of the house-hold budget must go to insurance, orfamilies have to go without coverage,delay needed care and face bankruptcyif anyone in the family gets seriously ill.Business owners can’t afford to shouldermore of the burden of health care costs.And states can’t afford the influx oflaid-off workers into public programs.It’s a crisis in need of solutions.”

Reference:www.rwjf.org/files/research/58034.pdf.

Hospitals Gaining Ground in Physician Recruitment

16

Carcinogens in CigarettesPeople who smoke certain U.S. ciga-

rette brands are exposed to higher levelsof cancer-causing nitrosamines intobacco products than people whosmoke some foreign cigarette brands,according to a new study. Researchersfrom the U.S. Centers for DiseaseControl and Prevention (CDC) com-pared mouth-level exposures and urinebiomarkers among smokers from theUnited States, Canada, the UnitedKingdom and Australia. The resultsappear in the June 2010 issue of CancerEpidemiology Biomarkers and Prevention.

Contractor ComplianceThe Office of Federal Contract

Compliance Programs reportedly is scru-tinizing contractor compliance withaffirmative action obligations related tocovered veterans and individuals withdisabilities. Federal contractors mustemploy, and advance in employment,covered veterans and individuals withdisabilities pursuant to the Vietnam-EraVeterans Readjustment Assistance Actand Section 503 of the RehabilitationAct.

Exposure StandardLoweredThe Environmental Protection

Agency (EPA) lowered the one-hourhealth standard for sulfur dioxide expo-

sures to 75 ppb to protect against short-term exposures and revoked 24-hourand annual standards. The Clean AirAct requires the EPA to set national airquality standards for sulfur dioxide andfive other pollutants considered harmfulto public health and the environment.The EPA estimates health care savingsassociated with this rule are $13 to $33billion a year, including preventing anestimated 2,300 to 5,900 deaths and54,000 asthma attacks.Meanwhile, the EPA is proposing to

add 16 chemicals to the Toxics ReleaseInventory list of reportable chemicals,the first expansion of the program inmore than a decade. Visit www.epa.gov.

Firefighter StudyThe National Institute for

Occupational Safety and Health(NIOSH) and the United States FireAdministration are examining thepotential for increased risk of canceramong firefighters due to exposures fromsmoke, soot and other contaminants inthe line of duty. The multi-year studywill involve more than 18,000 currentand retired career firefighters. The project will improve upon previouslypublished firefighter studies by signifi-cantly increasing statistical reliability,officials said.

Mine SafetyChanges in simplified proceedings

under the Federal Mine Safety and

Health Review Commission, the inde-pendent appellate court for enforcementactions, have been proposed to help thepanel deal more expediently with alarge backlog of cases.

Motor Carrier BackgroundScreening Program A new voluntary Federal Motor

Carrier Safety Administration Pre-Employment Screening Program allowsmotor carriers to pay $10 each for adriver history (up to five years of crashdata and up to three years of inspectiondata) after they pay an annual subscrip-tion fee of $100, or $25 for carriers withless than 100 power units. A contractor,National Information ConsortiumTechnologies, LLC, will provide thedata to motor carriers with the operatorapplicant’s written consent. TheAmerican Trucking Association report-edly has had the program on its safetyagenda for the past eight years. Visitwww.psp.fmcsa.dot.gov.

Ohio Changes Approachto Drug-free WorkplaceThe Ohio Bureau of Workers’

Compensation will replace its Drug-FreeWorkplace Program with a Drug-FreeSafety Program beginning July 1. Thenew program will be mandatory forcompanies that bid and work on stateconstruction projects and voluntary foremployers who wish to obtain a workers’compensation premium discount. Thenew program combines drug-free effortswith a comprehensive workplace safetyprogram. It offers a 4 percent premiumdiscount for a basic program and 7 per-cent for an advanced program.

Oil, Add Hurricane – Stir Vigorously The National Oceanic and

Atmospheric Administration (NOAA)has issued a series of oil spill responsefact sheets including one detailing howhurricanes may impact, or be impacted,by the oil spill in the Gulf of Mexico.According to the document, if the oil

VIsIons

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slick in the gulf remains small in com-parison to a typical hurricane’s generalenvironment and size (200 to 300miles), the oil is not expected to appre-ciably affect either the intensity or thetrack of a fully developed tropical stormor hurricane. The high winds of a hurri-cane would mix with the sea andweather the oil, which could help accel-erate the biodegradation process,NOAA notes. The high winds also maydistribute oil over a wide area, but theagency points out that it is difficult tomodel exactly where. Refer towww.noaa.gov/factsheets.

Patient HandlingDr. James Collins, a senior scientist in

the Division of Safety Research atNIOSH, testified as an expert witnessbefore the Senate Subcommittee onEmployment and Workplace Safety onthe potential for injury when liftingpatients and safe-lifting alternatives.

Pesticide Training GrantThe Office of Pesticide Programs is

seeking applicants for a Pesticides andNational Strategies for Health CareProviders Clinical Training Program.The program supports training for clini-cians and other stakeholders in the agri-cultural and medical communities torecognize and manage pesticide-relatedhealth conditions. Visithttp://go.usa.gov/3Ud.

Public Safety LegislationThe proposed Public Safety Employer-

Employee Cooperation Act pending inCongress would usurp the authority ofstates to manage their own public safetyemployees, according to attorneys withJackson Lewis, a national firm specializ-ing in employment law. The act would

require states to recognize the right oflaw enforcement officers, firefightersand emergency medical services person-nel to bargain collectively. As proposed,the Federal Labor Relations Authoritywould enforce the legislation. The mostsignificant impact would be felt at thelocal level, where bargaining, potentialinterest arbitration and union represen-tation have the potential to signifi-cantly increase the cost of providingpublic services, attorneys said.

Reform Law AnalyzedThe recently enacted federal health

care reform law provides insurance cov-erage to the largest possible number ofAmericans while keeping federal costsas low as reasonably possible, accordingto a new analysis from the RANDCorporation, a non-profit think tank.The RAND analysis estimates that 28million Americans will be newly insuredby 2016 under provisions of the PatientProtection and Affordable Care Act. Researchers simulated more than

2,000 different policy scenarios usingRAND Compare, a micro-simulationmodel. The only alternatives that wouldhave covered more Americans at alower cost to the federal governmentwere all politically untenable,researchers said. The findings appear in the June edition of the journal Health Affairs.

Responder Settlement A federal judge in Manhattan

approved a plan to settle more than10,000 health claims from police offi-cers, firefighters and others who saythey developed respiratory problems andcancers in the wake of Sept. 11. Afterthe judge balked at a lower amountthree months ago, New York City andits $1 billion federally funded insurer,the World Trade Center CaptiveInsurance Co., agreed to add up to $55million to the settlement, bringing it to$625 million to $712.5 million, withmost of the additional money goingtoward compensation for fatalities, seri-ous injuries, certain cancers and severerespiratory injury, Newsday reported. Inaddition, lawyers for the victims agreedto reduce their compensation from 33percent to 25 percent, leaving theirclients with an additional $50 million.

OSHA Actions

Infectious Disease TransmissionThe agency published a request for

data about infectious diseases beingtransmitted to patients and workers inhealth care settings, stating that somestudies indicate voluntary infection con-trol measures aren’t consistently fol-lowed. “Another concern is the move-ment of health care delivery from thetraditional hospital setting, with itsgreater infrastructure and resources toeffectively implement infection controlmeasures, into more diverse and smallerworkplace settings with less infrastruc-ture and fewer resources, but with anexpanding worker population,” theagency’s request stated. Responses aredue Aug. 4. Visit www.regulations.gov.

Safety TrainingA new training component emphasiz-

ing workers’ rights is required content in10- and 30-hour Outreach TrainingProgram classes. Topics include whistle-blower rights and how to file a com-plaint. Visit www.osha.gov/dte/outreach/teachingaids.html.

Slips, Trips and FallsThe agency issued a notice of pro-

posed changes to Walking-WorkingSurfaces and Personal ProtectiveEquipment standards. The rule changewould update fall protection standardsin general industry and allow OSHA tofine employers who let workers climbcertain ladders without fall protection.Most existing standards for walking-working surfaces are more than 30 yearsold and inconsistent with both nationalconsensus standards and more recentlypromulgated OSHA standards address-ing fall protection, officials said. Toreview the Notice of ProposedRulemaking, visit http://edocket.access.gpo.gov/2010/2010-10418.htm.

Spill ResponseThe federal coordinator for the BP

Deepwater Horizon response andOSHA signed a memorandum of under-standing concerning the safety andhealth of clean-up crews. The memo-randum clarifies joint efforts to monitorcompliance with safety standards and toprotect workers.

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Frank H. LeonePresident and CEO

Since 1985

Karen J. O’HaraSenior Vice President

Since 1990

Roy K. GerberSenior Principal

Since 1998

Donna Lee GardnerSenior Principal

Since 1997

RYAN Associates’ Consulting Services650 OCCUPATIONAL HEALTH-SPECIFIC ENGAGEMENTS SINCE 1985

1-800-666-7926, X16 • WWW.NAOHP.COM

I N C H A L L E N G I N G T I M E S

experience reigns

Best Practices in On-Site WellnessSeries: Fingerstick or Venous BloodDraw for Health Screenings?Summit Health white paper discusses options;www.summithealth.com/whitepaper_blood_draw2.html.

Disability, Health and LeaveManagement Blog; sponsored byJackson Lewis, a national firm spe-cializing in employment law;www.disabilityleavelaw.com.

Effectiveness of exercise on workdisability in patients with non-acutenon-specific low back pain; exerciseinterventions are found to have asignificant effect on work disabilityin patients with non-acute non-spe-cific low back pain in the long term;P Oesch, et al.; J RehabilMed,42,March 2010; http://jrm.medicaljournals.se.

Grant Funding for Wellness andHealth Promotion Programs; specialreport with examples of fundingopportunities; WellnessManagement Information Center;www.healthresourcesonline.com/health_grants.

Guide for Using Documents Relatedto Metalworking or Metal RemovalFluid Health and Safety, with a ref-erence on Standard Practice forPrevention of Dermatitis in the WetMetal Removal Fluid Environment;ASTM Management;www.astm.org/COMMIT.

Gulf Oil Spill Health Hazards; reportdescribes the toxicity of chemicals incrude oil and dispersants being usedin and along the Gulf of Mexico;Sciencecorps, Lexington, Mass., June14, 2010; www.sciencecorps.org/crudeoilhazards.htm.

Nursing Handoffs: A SystematicReview of the Literature; minimalresearch has been done to identifybest practices, despite well-knownnegative consequences of inade-quate handoffs when shifts change;L Riesenberg, et al.; Am J Nursing,Vol. 110, Issue 4, April 2010.

Physician Ownership of AmbulatorySurgery Centers Linked to HigherVolume of Surgeries; doctorsinvested in outpatient surgery cen-ters in Florida performed an aver-age of twice as many surgeries asdoctors without a financial stake forfive common outpatient procedures;J Hollingsworth, et al.; HealthAffairs, Vol. 29, No. 4, April 2010.

Rapid and Simple Kinetics ScreeningAssay for Electrophilic DermalSensitizers Using Nitrobenzenethiol;researchers report on a simple,rapid, inexpensive test for chemicalsthat can cause allergic contact der-matitis; Chem Res Toxicol, 23 (5),April 19, 2010; http://pubs.acs.org.

State Indicator Report on PhysicalActivity 2010; Centers for DiseaseControl and Prevention reportsmany states do not have policy orenvironmental measures in place tohelp citizens meet recommendedlevels of physical activity;www.cdc.gov/physicalactivity/professionals/reports.

Workstyle in Office Workers:Ergonomic and PsychologicalReactivity to Work; asymptomaticoffice workers with higher levels ofself-reported adverse workstyleresponded to a manipulation ofwork demands with greater psycho-logical and biomechanical straindemands; C Harrington, MFeuerstein; JOEM, Vol. 52, Issue 4,April 2010.

Recommended Resources

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

JUL

AUGNOV

SEPOCTJuly 17-2235th Annual National WellnessConference; sponsored by theNational Wellness Institute;University of Wisconsin-StevensPoint; www.nationalwellness.org.

July 20-22National Workers’ Compensationand Occupational MedicineConference; sponsored by SEAK,Inc.; Cape Cod, MA;www.seak.com.

July 29-30Mobile Health (mHealth)Summit; sponsored by WorldCongress; The Lenox Hotel,Boston, Mass.; www.world-congress.com/mHealth.

August 4-62010 Federal Occupational HealthConference; sponsored byChesapeake Health EducationProgram, Inc.; Sacramento, Calif.;www.chepinc.org/conf.

August 15-1865th Annual Workers’Compensation EducationalConference; sponsored by theFlorida Workers’ CompensationInstitute; Orlando World CenterMarriott; www.fwciweb.org.

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

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

September 26-29 Changing Care, Changing Lives:Delivering on Quality for AllAmericans; Agency forHealthcare Research and Quality2010 conference; Bethesda, Md.;http://meetings.capconcorp.com/ahrq.

September 30-October 2Western Occupational HealthConference; sponsored by theWestern Occupational andEnvironmental MedicineAssociation; Newport BeachMarriott Hotel & Spa;www.woema.org/WOHC.vp.html.

September 2010 to May 2011International Program inOccupational Health Practice;enrollment deadline July 31;sponsored by University of Illinoisat Chicago; online programoffers three courses over a nine-month period; www.uic.edu/sph/glakes/ce/IntPrgOHP.html; email: syn@uic.edu or nlwagner@uic.edu.

October 3-8National Safety Council Congress & Expo; San DiegoConvention Center; www.congress.nsc.org/nsc2010.

October 11-13Prospering in a ChangingOccupational HealthEnvironment, 24th annualnational conference; sponsoredby RYAN Associates; HyattRegency, Boston, Mass.;www.naohp.com; 800-666-7926.

ASSOCIATIONS

Urgent Care Association of America(UCAOA) UCAOA serves over 9,000 urgent care centers.We provide education and information in clinicalcare and practice management, and publish theJournal of Urgent Care Medicine. Our twonational conferences draw hundreds of urgentcare 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’swhere Acxiom can help. We provide the highesthit rates and most comprehensive compliancesupport available–all from an unparalleled, single-source solution. It’s a customer-centricapproach to background screening, giving youthe most accurate information available to pro-tect your company and 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 health care.By partnering with APH, you can provide cus-tomized plans to help employees of the compa-nies, school systems and government offices inyour market. You can show the organizationshow to improve their health plan, finances andemployee 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’scertified coders help increase reimbursement toits clients by improving the accuracy of theirdocumentation, coding, and billing. Clients also receive on-going staff training and codingsupport. David DannPhone: (800) 783-8014Fax: (317) 247-0499dbd@billdunbar.comwww.billdunbar.com

Medical Doctor Associates Searching for Occupational Medicine Staffing orPlacement? Need exceptional service and peaceof mind? MDA is the only staffing agency with adedicated Occ Med team AND we provide thebest 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 informa-tion to those involved in patient care, utilizationmanagement and other facets of the workers’compensation delivery system. The AmericanCollege of Occupational and EnvironmentalMedicine has selected Reed Group and TheMedical Disability Advisor as its delivery organi-zation for this easy-to-use resource. The UMKfeatures treatment models based on clinical considerations and four levels of care. Other features include Clinical Vignette – a descriptionof a typical treatment encounter, and ClinicalPathway – an abbreviated description of evalua-tion, management, diagnostic and treatmentplanning associated with a given case. The UMKis integrated with the 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, finan-cial analysis, joint venture development,focus, groups, employer surveys, matureprogram audits, MIS analysis, operationalefficiencies, practice acquisition, staffingleadership, conflict resolution and pro-fessional placement services.Roy GerberPhone: (800) 666-7926x16Fax: (805) 512-9534rgerber@naohp.comwww.naohp.com

ELECTRONIC CLAIMMANAGEMENTSERVICES

StoneRiver P2P LinkP2P Link provides electronic connectivitybetween workers’ compensation payersand medical providers. Since 1999, P2PLink has been delivering medical billsand supporting documentation electron-ically. P2P Link facilitates faster paymentsto medical providers while reducingadministrative 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 “patientregistration to cash application” formedical groups, clinics, and hospitalsacross the country. This includes verifica-tion and treatment authorization systems, electronic billing, collections,and EOB/denial management. Providerreimbursements are guaranteed.Don KilgorePhone: (888) 510-2667Fax: (901) 255-6797dkilgore@uhsweb.comwww.uhsweb.com

WorkCompEDI, Inc.WorkComp EDI is a leading supplier ofworkers’ compensation EDI clearing-house services, bringing together Payors,Providers, and Vendors to promote theopen exchange of EDI for accelerating revenue cycles, lowering costs and increasing operational efficiencies. Marc MenendezPhone: (800)297-6906Fax: (888) 454-2681MMenendez@WorkCompEDI.comwww.workcompedi.com

LABORATORIES &TESTING FACILITIES

Clinical Reference Laboratory Clinical Reference Laboratory is a privately held reference laboratory withmore than 20 years experience partner-ing with corporations in establishing and conducting employee substanceabuse screening programs and wellnessprograms. 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 clinics nation-wide. This technology creates the onlypaperless, web-based, nationwide net-work of collection sites for employersseeking faster drug test results.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 DOT turnkeyprograms.Don EwingPhone: (479) 649-8614Fax: (479) 648-3246dewing@gomeddirect.comwww.gomeddirect.com

MedTox Scientific, Inc.MEDTOX is committed to providing ourclients with the best service and testingquality in the industry and implementingthe newest technologies available. Weare SAMHSA certified and manufactureour own onsite products–the PROFILE®

line. We are the first lab to create anelectronic chain-of-custody system,eChain®, providing our clients a paper-less environment with web-based man-agement tools that give them controlover their program. Our expertise alsoincludes wellness testing, biological mon-itoring, 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 Health#1 Respiratory Hospital in the U.S., 10Consecutive Years - U.S. News & WorldReportDiagnostic Testing The Advanced Diagnostic Laboratories(ADx) at National Jewish Health per-forms a Beryllium Lymphocyte Prolifera-tion Test (BeLPT) which is a blood testthat examines how disease-fighting cellsknown as lymphocytes react to beryl-lium. The BeLPT identifies beryllium sensitization earlier and better than anyother clinical test presently available.Additionally, ADx provides specializedtesting in the areas of complement func-tion, immunology/immune deficiency,mycobacteriology, infectious diseasepharmacokinetics, genetics, and pro-teomics. ADx is a CAP/CLIA laboratory.Many of our laboratories are GLP forPre-clinical and Phase I and II clinical trials testing. For more information go to www.njlabs.org or call 800.550.6227opt. 6.Medical Evaluation, Surveillance andRespiratory ProtectionThe Division of Environmental andOccupational Health Sciences is a worldleader in recognition, treatment andprevention of diseases due to workplaceand environmental exposures. Our services include: Medical Evaluations,Comprehensive Screening and Surveil-lance Programs, Respirator Fit Testing,Audiometry, Spirometry, IndustrialHygiene (workplace and residential)Consultations, Risk Communication,Education and Training.www.DEOHS@NJHealth.orgLearn About the Family Air Care® IndoorAllergens and Mold Test Kit Developed by physicians and scientists atNational Jewish Health, this do-it-your-self kit is the most advanced test systemfor allergens and molds available on themarket today. www.familyaircare.comWendy NeubergerPhone: (303) 398-1367neubergerw@njhealth.orgwww.njlabs.org

Oxford ImmunotecTB Screening Just Got Easier with OxfordDiagnostic Laboratories, a National TBTesting Service dedicated to the T-SPOT.TB test. The T-SPOT.TB test is an accurate and cost-effective solution compared to other methods of TBscreening. Blood specimens are acceptedMonday through Saturday and resultsare reported within 36-48 hours.Noelle SneiderPhone: (508) 481-4648Fax: (508) 481-4672nsneider@oxfordimmunotec.comwww.tbtestingservices.com

VIsIons

Vendor program, cont.

Quest Diagnostics Inc.Quest Diagnostics is the nation’s leadingprovider of diagnostic testing, informa-tion and services. Our Employer Solu-tions Division provides a comprehensiveassortment of programs and services tomanage your pre-employment employeedrug testing, background checks, healthand wellness services and OSHA requirements.Aaron AtkinsonPhone: (913) 577-1646Fax: (913) 859-6949aaron.j.atkinson@questdiagnostics.comwww.employersolutions.com

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 comparableperformance to larger systems in about12 minutes using 100uL of whole blood,serum, or plasma. The Xpress featuresoperator touch screens, onboard iQC,self calibration, data storage andLIS/EMR transfer capabilities.Joanna AthwalPhone: (510) 675-6619 Fax: (736) 262-6973joannaathwal@abaxis.comwww.abaxis.com/index.asp

AlignMedAlignMed introduces the functional and dynamic S3 Brace (Spine and ScapulaStabilizer). This rehabilitation toolimproves shoulder and spine function by optimizing spinal and shoulder align-ment, scapula stabilization and proprio-ceptive retraining. The S3 is perfect forpre- and post- operative rehabilitationand compliments physical 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 hand hygienetraining and consulting. OccupationalHealth clinics make great re-sellers toemployers (DERs, supervisor signs andsymptoms, employee awareness). DrugCollector, BAT and Instructor training viaWEB and Classroom. Breathalyzer andscreening devices. 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 new wayto prescribe: PedigreeRx Easy Scripts.PedigreeRx Easy Scripts MedicationDispensing Solution is the most compre-hensive option for physician dispensingavailable today. PedigreeRx Easy Scriptsallows physicians to electronically dis-pense medications easily to theirpatients at the point-of-care. This solu-tion has the unique ability to integratewith the existing technology infrastruc-ture or to be used as a stand-alone sys-tem. PedigreeRx Easy Scripts will improvepatient care, safety and conveniencewhile generating additional revenue forthe physician’s practice.Lauren McElroyPhone: (847) 680-3515 x.4865Lauren.McElroy@a-smeds.comwww.a-smeds.com

Automated Health CareSolutionsAHCS is a physician-owned company thathas a fully automated in-office rx-dis-pensing system for workers’ compensa-tion patients. This program is a value-added service for your workers’ compen-sation patients. It helps increase patientcompliance with medication use and cre-ates an ancillary service for the practice. Shaun Jacob, MBAPhone: (312) 823-4080Fax: (786) 594-4645sjacob@ahcs.com

Dispensing SolutionsDispensing Solutions offers a convenient,proven method for supplying yourpatients with the medications they need at the time of their office visit. Fornearly 20 years, Dispensing Solutions hasbeen a trusted supplier of pre-packagedmedications to physician offices and clinics throughout the United 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 bringing inno-vative practice solutions to enhancepatient care, creating alternative rev-enue sources for physicians. Keltman’score service is a customizable point ofcare dispensing system. This programallows physicians to set up an in-officedispensing system based on a formularyof pre-packaged medications selected bythe 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 has servedas a full-line medical supply, medication,orthopedic and equipment company.Representing more than 1,000 manufac-turers, including General Motors, Fordand Daimler-Chrysler, our bio-medicalinspection and repair department allowsus to offer cradle-to-grave service foryour medical 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, UnitDose, Unit of Use, Injectables, IV, Creams,and Ointments or Surgical Supplies thatyou need, let PD-Rx fill your 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 compre-hensive health management products toimprove the health, productivity andquality of life for members, while reduc-ing health care costs for employers,insurers and government entities. Healthsystems across the country are realizingthe value of The Prevention Plan.Richard Maguire-GonzalezSr. Vice President, Network DevelopmentPhone: (866) 665-0096rgonzalez@USPreventiveMedicine.comwww.USPreventiveMedicine.com orwww.ThePreventionPlan.com

PROVIDERS

Methodist Occupational Health CentersMethodist Occupational Health Centers(MOHC) is an Indiana based provider ofclinic based occupational healthcare anda national provider of workplace healthservices for employers looking to reduceoverall employee healthcare costs. Inaddition, MOHCI provides revenue cycleservices nationally to other occupationalhealth programs and health systems.Thomas BrinkPhone: (317) 216-2526 Fax: (317) 216-2839tbrink@clarian.orgwww.mohci.com

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New England Baptist HospitalOccupational Medicine CenterNew England’s largest hospital based occupational health network offers a full continuum of care. Areas of expert-ise include biotechnology, orthopedics,drug and alcohol testing, immunizations, medical surveillance and 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 alcoholand drug testing and the State Laws thatapply. We provide specific state informa-tion and court cases you can use to pro-tect your organization and save moneyby knowing your state’s incentives andworkers’ compensation rules.Keith DevinePhone: (877) 423-8422Fax: (415) 383-5031info@centerfordrugtestinformation.comwww.centerfordrugtestinformation.com

REHABILITATION

Stretch It Out!©Stretch It Out!© (SIO!) is a comprehensivesafety resource designed to assistemployers in developing, implementing,and sustaining an effective workplacestretching program. SIO! can be utilizedin a variety of work environments forboth large and small employers. SIO! canbe utilized as a component of a wellnessinitiative or as part of a more compre-hensive approach to preventing muscu-loskeletal injuries. SIO! licenses areoffered for both single and multi-siteemployer users. A SIO! ConsultantLicense is also available. Go towww.egesolutions.com for more details.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 man-agement solution for occupational medi-cine, urgent care, and family practice.The product is particularly well-suited forhigh volume clinics treating a mix of

patients. Agility EHR 9.1 is CCHIT ‘08 certified, providing added assurance theproduct meets state-of-the-art standards,verified by an independent standardsorganization. Integritas’ well-knownStix® product meets the needs of thoseocc med organizations that do notrequire an EMR; it sells at a lower pricepoint. Both Agility EHR and Stix areavailable and configured to meet thespecialized needs of hospital employeehealth. Competitively-priced, all productscan be licensed either as a hosted (cloud)application, or locally installed solution.An interface expert, all Integritas’ prod-ucts eliminate duplicate entry andreduce input error by interfacing withother software in your health systemusing the standardized HL7 format.Genevieve 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 scheduling,workflow-driven-data entry, “one-minute” patient registration and check-out, voice-recognition support for clinicaldictation, automated ICD9 and CPT4 coding, integrated workers’ comp andOSHA reporting, testing-equipmentinterfaces, 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 for urgent/primary care, occupational health, rehabilitation, and wellness. SYSTOC®

provides quick, accurate documentation,sophisticated billing, and flexible report-ing, along with outstanding support 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 medicalmanagement needs.Tom GaudreauPhone: (888) 202-3016Fax: (615) 367-3887tom.gaudreau@puresafety.comhttp://www.puresafety.com

Practice VelocityWith over 600 clinics using our softwaresolutions, Practice Velocity offers theVelociDoc™—tablet PC EMR for urgentcare and occupational medicine.Integrated practice management soft-ware automates the entire revenue cyclewith corporate protocols, automatedcode entry, and automated corporateinvoicing.David Stern, MDPhone: (815) 544-7480Fax: (815) 544-7485info@practicevelocity.comwww.practicevelocity.com

Medical Director/ Staff Physicians

• Chicagoland (Medical Director) —NEW POSITION

• 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 469-417-7757; 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, WYRick Rankin, DirectorOccupational Health Adventist Medical CenterPortland, OR 97216503-261-6030; rankinrd@ah.org

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