Urgent Care Services: Exploring Occupational Medicine – Part 1

Urgent cares encompass a wide array of services. One of those services is in the form of occupational medicine. Occupational medicine consists of employer-requested services to aid in employee screenings, benchmarks for safety, and work performance standard – which in the end help to reduce work injuries while on the job.

There are several forms of occupational medicine services. In 1988, the Drug-Free Workplace Act was put in place by the United States Department of Labor. Employers were encouraged to put in place company protocols and guidelines outlining their compliance to a drug-free work environment.

The Urine Drug Screen (UDS) is the most common form of employment screening to comply with per this act. Urine drug screening is an office procedure that can enhance workplace safety, monitor patients’ medication compliance, and detect drug abuse ^1. There are two methods of determining UDS results – EMIT or Enzyme Multiplied Immunoassay Techniques. Urine Drug Screens are usually used by employers as a screening or in pre-employment testing in the form of an Insta-cup or instant results. Or in the case of a Commercial Truck Driver, a DOT-certified UDS or a split screen (a collection-only specimen) is required where the results may be read in-house by the Medical Review Officer (MRO) or sent out for confirmation to a third party MRO.

The second most common form of this is the GCMS, or gas chromatography/mass spectrometry; GCMS is the “confirmation” test. This is the test that legally validates a positive finding. Most work place drug testing programs mandate this “confirmation” to rule out the false positives. Most urgent cares utilize the 5-panel UDS; there are other UDS tests that range from 8-12 test results, which include Ecstasy, Benzodiazepines, Phencyclidine, and even tricyclic Anti-depressants.

The U.S Department of Transportation requires successful completion of a qualified training program and passing a monitored proficiency demonstration as stated in the CFR 49 ². Solid staffing knowledge and training is a must in this area of services. USDOT and DATIA are excellent organizations to aid in the proficiencies. This is an excellent opportunity for clinics to market their clinic and services by tailoring the needs of the employer to the clinics’ services and availability.

So many times we convolute what occupational medicine really is. Occupational medicine is services performed by qualified and knowledgeable staff and or physicians in your urgent care at the direction of the employer – most often paid by the employer as a screening tool. These are not used to treat or assess an injury presentation.

There are an array of services to help market and provide to employers, which ultimately can improve your clinics’ patient volumes and connect you to the employers in your area. Some of the more popular services include:

• Pre-Employment Physical
• Fit-for-Duty Physicals
• DOT and OSHA Physicals
• BAT (Breathe/Blood Alcohol Testing)
• Immunizations and Titers
• Bio-metric screenings
• Audiogram Hearing Testing
• Wellness Testing
• Onsite Services providing screenings and items like yearly influenza vaccinations

Employers usually pay for services rendered in the screening or services requested. Using the Occ Med protocols in Experity will enable excellent tracking of company specific protocols, pricing, and other detailed information about employer instructions and policies. DocuTAP has billing mechanisms to split bill services if the need arises. Sometimes a drug screen will get billed to one party and a pre-employment physical to another.

The next question one will ask is—then where does workers’ injuries, or workers’ compensation, come into play with occupational health? We’ll take a look at that in Part 2 of this blog, coming soon.

References:

(1)   Standridge, J.B., Adams, S.M., and Zotos, A.P., (2010). Urine Drug Screening: A Valuable Office procedure. University of Tennessee College of Medicine, Am Fam Physician. 2010 Mar 1;81(5):635-640.

(2)   USDOT (2007). Office of Drug & Alchol Policy and Compliance.  http://www.dot.gov/sites/dot.dev/files/docs/ODAPC