Keeping workers well Medicine: Baltimore's Mercy Medical Center has increased business by building an occupational health network.

March 18, 1996|By M. William Salganik | M. William Salganik,SUN STAFF

As hospitals look for new sources of patients and revenue, an increasing number are turning to occupational health. Baltimore's Mercy Medical Center provides a dramatic example.

In a little more than two years, Mercy has built a network of a dozen affiliated centers from Cumberland to Cambridge, the majority run by other community hospitals. And Mercy was up to 2,871 visits in December (the most recent total available), an increase of more than 400 percent from the 561 visits in December 1993.

"Other hospitals have occupational medicine, but not networks," said Dr. James D. Levy, medical director of Mercy's program, which it calls business health services. "Across the country, we've been unable to find anybody with the type of statewide capability we have."

Next month, Mercy will open a new occupational health facility to replace its now-jammed 4-year-old one at its hospital in downtown Baltimore, with 12 examining rooms instead of the current five.

The growth of Mercy's program represents the confluence of several trends in occupational medicine.

First, employers, even large ones, are learning that it may be cheaper to contract for most services rather than have a doctor and health center on site for such services as pre-employment physicals and treatment of on-the-job injuries.

"The pendulum is swinging from large in-house operations to decentralized and outsourced operations," said Dr. Kent Peterson, president of a Virginia occupational health consulting firm and president-elect of the American College of Occupational and Environmental Medicine.

"If you want to hire a corporate medical director, you have to pay $120,000 to $150,000 in salary plus fringes," said Dr. Brian S. Schwartz, director of the occupational medicine residency program at the Johns Hopkins School of Public Health. "You can buy that service from the outside for $50 to $100 an hour."

Second, as patients are less likely to be admitted to the hospital more and more services are being performed on an outpatient basis and stay fewer days when they are admitted, hospitals are looking for other sources of revenue.

And while managed-care insurers are squeezing fees in many areas, Dr. Schwartz said, occupational medicine is attractive because it is still largely paid on the old fee-for-service system.

"Providers like it because the employer pays 100 percent," he said. "Also, it provides a population of patients. When they have non-work-related disease, they may think of the hospital."

And third, employers are seeing they can save money by keeping employees healthier.

Stephen Ziobro, director of human resources at Harbor Court Hotel, says the hotel previously used Mercy for treating on-the-job injuries. Then, Mercy came to make a presentation about other services they offered, such as weight loss counseling and smoking cessation.

Mr. Ziobro said he's been particularly pleased by an annual visit from Mercy staffers to give flu shots.

Employees who get the shots have less absenteeism than those who don't, Mr. Ziobro says, producing savings for the hotel that exceed the cost of the shots.

"When you're a 24-hour-a-day, seven-day-a-week operation," he says, "you need people who are as healthy as possible."

Competition

While hospitals are attempting to move into occupational medicine, they are facing competition from multispecialty group practices and from for-profit clinics.

"Nonprofits are slower moving and don't have the access to capital," said Dr. David Michaels, a professor of occupational medicine at City University of New York Medical School and director of a research group called the Compensation and Prevention Research Institute.

Mercy hired Dr. Levy just over two years ago from one of its competitors, CMC Occupational Health, which runs five centers in the Baltimore area. Dr. Levy said the hospital had decided to move into occupational health "in a full-blown and aggressive manner."

Pat Ercolano, a nurse and director of Mercy's business health services, said Mercy looked at clinics around the state to see which would fit into its network.

In most cases, they were clinics affiliated with hospitals, including Calvert Memorial in Prince Frederick, Union Hospital in Elkton and Dorchester Hospital in Cambridge.

Others in the network are free-standing emergency clinics. The Mercy-affiliated centers are free to accept non-Mercy patients as well.

And Mercy owns and operates two centers itself, one at the hospital and one in Towson.

"We're looking for more," said Dr. Levy, particularly in the Annapolis area.

Eventually, he said, Mercy may have 15 to 20 centers statewide, but "we're not interested in having 100 clinics."

Overall, according to Ms. Ercolano, about 40 percent of visits to Mercy's centers are from work-related injuries and 20 percent are for pre-employment physicals. The remaining 40 percent are for other employment-related problems, such as testing for exposure to lead or asbestos.

Drug testing, she said, is done by 60 to 70 percent of employers using Mercy.

Case management

Dr. Levy said employers find Mercy's services attractive in part because of Mercy's data collection and management: "We can report on lost time. We can report on diagnosis by job position. Employers need to know what they're spending and where."

Also, he said, employers like Mercy's case management approach.

"We get involved with an injury right from the start," said Beverly Farace, one of two registered nurses who serve as case managers at the center in Mercy Medical Center. "We call the [injured worker's] supervisor, and fax them a report at discharge."

The case managers make appointments for follow-up visits and referrals.

"And we're in touch with the treatment center at least once a month to make sure the patient completes his treatment," Ms. Farace said.

Pub Date: 3/18/96

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