Industrial Expansion

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August/September 2001

By Mark Hyland, OTR/L, CHT, DABDA, and Julianne Ruggles, PT

Mark Hyland, OTR/L, CHT, DABDA, and Julianne Ruggles, PT

Over the past several years, a slow but steady shift from community-based work injury management services to work-site-based services has occurred.1 One of the growing services is on-site therapy and rehabilitation. Our practice has seen the amount of interest in on-site work injury management services triple over the past 5 years.

Providing on-site therapy services in industry is similar to providing athletic training to a sports team. Offering such on-site services can provide your practice with an advantage over local competitors. Not only can you create a new revenue source, but you also can provide a service that more mid- to large-sized businesses are considering as they compete for valued employees and try to retain those they have.

However, providing therapy services outside the comfort zone of the traditional practice setting requires careful analysis and planning. Initially, managers or practice owners need to evaluate their business community. While all types of employers can utilize the various services offered by the on-site practitioner, companies with high injury rates and 500 or more employees are prime targets. Traditionally, industry sectors, such as warehousing, manufacturing, assembly, mining, and food processing, are excellent starting points.

Pursuit Through Proposal

Once identified, these prospective local employers can be pursued in many ways. A few suggestions follow:

Analyze your practice's current industrial patient base and chat with these patients. So much can be learned with this approach and many times a contact name can be discovered.
Get your work injury management and marketing staff involved with organizations like the local Chamber of Commerce, workers' compensation claims associations, self-insured associations, and manufacturing associations.
Register your practice to receive solicitations and requests for proposals from larger employers and state and local governments (some of the biggest purchasers of these services). Usually, your local Chamber of Commerce can assist you in setting up this bid information for a small fee. We suggest hiring a consultant to assist you in writing a proposal especially if you have little or no experience in this area.

The point at which an organization enters into this process will determine where you will start. For instance, if a prospect is responding to a request for proposal (solicitation), you know the organization is already sold on the benefits of on-site therapy. In most cases, though, you will need to convince your prospect that on-site therapy services will provide the following advantages: cost savings realized through the benefits of early intervention strategies and keeping injured workers at the job site2,3; convenience for workers; increased productivity and morale; improved communications; an excellent source of health and wellness information for the company and its employees; and improved outcomes by having a practitioner who understands the work, worker, and worksite.

In addition, you will need to analyze a company's current revenue losses due to injury, workers' compensation experience, absenteeism rates, and injury patterns to better evaluate the impact on-site services will provide them. Then a proposal can be delivered to the employer that, using the above criteria, outlines the services you can provide, cost of those services, and potential return on investment.

Your proposal should be fair and reasonable in regard to pricing. Questions to consider when pricing include: how much do you need to cover costs and build in a profit margin?; how much will the current market bear?; and what is currently being charged in your area?

There are typically three methods to structure how you will be compensated for your services. The first is to set up an hourly charge system. The second and probably the most desirable method of compensation is to bill the company's current industrial insurance carrier. A percentage discount from the fee schedule may be offered as a sign of goodwill. The third and least desirable method of payment would be the flat rate system.

Following are some of the common work injury management services that can be offered to industries: acute care injury evaluation and treatment; ergonomic job analysis; functional job description development; injury prevention education and training; functional/work capacity evaluations; transitional return to work programs; postoffer testing and development; and Americans With Disabilities Act consultation.

Sign On the Dotted Line

Once you have earned a company's business, the next step is to obtain a signed contract. In some instances, the employer will have a contract for you that will be restructured to fit your proposal. Our experience, however, is that most companies and organizations have not used these types of services before. This may afford managers or practice owners an opportunity to develop their own contract. Whatever the case, items that should be addressed in the contract include: services that you will be providing; suitable space for your on-site clinic provided by the company; length of contract; days, hours, and times services will be provided; compensation for services; noncompete and nonhire clauses that cover any staff; and termination clause should either party need to end the relationship. Of course, you will want to have your attorney review any contract prior to signing.

Just as it is important to agree on a contract that will outline the scope of services and support financial compensation, it is important to maintain the contract like any other working relationship. Continued marketing efforts and collaborative efforts should be encouraged in the community. Contractors are often invited to participate in employee-related functions, which provides an opportunity to foster closer relationships with the client. Therapists on-site should be aware of their obligations to keep the relationships workable, positive, and dynamic. In order to obtain a clear understanding of the job demands of each worker, therapists must be out on the floor observing what their patients are required to do when returning to regular duty.

The question and answer process should be continuous. Regular satisfaction surveys should be conducted to determine which areas of the rehabilitation services are meeting and exceeding expectations and which may be fall- ing short.

However the billing and invoicing are being conducted, monthly or quarterly cost analysis, injury rate, and return-to-work reports should be submitted to the client company. The administrative personnel who accepted the proposal and signed the agreement should be kept abreast of the cost savings and made aware of the benefits of having on-site rehabilitation services.

The Importance of Staffing

A key factor to consider is staffing. Many therapists who provide on-site services are the owners of their clinic or are independent contractors. Larger rehabilitation companies often employ the clinicians, or hire a contracted physical or occupational therapist to provide rehabilitation and/or consulting. In any case, the therapist providing the service should have a solid knowledge base of general orthopedics, ergonomics, and work injury management.

Therapists who have been trained to perform functional capacity and ergonomic evaluations, administer work conditioning programs, and develop functional job descriptions are most desired in this case because the focus of services is safe physical functioning in the work environment. Excellent collaborative skills are required as effective and thorough communication with all team members enhances the continuous process of case management.

Be sure to consider the workplace environment when placing a therapist in an on-site clinic. Many facilities have little, if any, dedicated space or equipment for rehabilitation services. In such cases, it is imperative that the therapist be flexible, creative, and able to work independently in a nontraditional environment.

Whether to place a physical or an occupational therapist in this type of position can depend on the case mix of patients treated. However, the needs of the client company should dictate the level of expertise and credentials required.

With prudent preparation, planning, and high-quality services, rehabilitation professionals can participate successfully and easily integrate on-site work injury management services into their current programs or practices.

Mark Hyland, OTR/L, CHT, DABDA, is the American Occupational Therapy Association, Work Programs Special Interest Section communications liaison and the director of clinical operations for Strength Training and Rehabilitation, Phoenix. He can be reached via email: markhyland@strengthtrainingrehab.com. Julianne Ruggles, PT, is Strength Training's clinical site manager. She can be reached at: julianneruggles@strengthtrainingrehab.com.

References

Shrey DE. Disability management in industry: the new paradigm in injured worker rehabilitation. Disabil Rehabil. 1996;18:408-414.
Hochanadel CD, Conrad DE. Evolution of an on-site industrial physical therapy program. J Occup Med. 1993;35:1011-6.
Isernhagen S, ed. The Comprehensive Guide to Work Injury Management. Gaithersburg, Md: Aspen Publishers; 1995:269-278.

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August/September 2001