Award-winning occ-health program can be duplicated

Adding nurse practitioner cuts absenteeism, costs

Community Memorial Hospital in Menomonee Falls, WI, had an occupational health and wellness program that had served its 1,500 employees quite well for many years. But the rocketing costs of health care benefits suddenly meant that Community Memorial's occ-health program had to do more.

"Our [human resources] department was having to make decisions on benefits and cost sharing, and the vice president of HR came to me and said, 'What can you do to help us with this?'" says Shirley P. Rosien, RN, BSN, COHN-S, director of occupational health and wellness at Community Memorial.

What Rosien and her colleagues in occ-health did was gather experts from throughout the hospital, from management to clinical, and create a strategic plan for delivery of better health care to employees at work by integrating a nurse practitioner component within the health and wellness program.

Sharing what works

Community Memorial and Rosien received several awards and recognition in 2005 for both the long-term success of the occ-health program at the hospital and the changes to the program that are providing better care to employees while containing benefit costs for the hospital.

She told Occupational Health Management that she and her co-workers are eager to share what they've learned, because the results can be duplicated not only in other hospitals but at any work site that can establish a relationship with a hospital or clinic.

Community Memorial received the American Association of Occupational Health Nurses (AAOHN) Business Recognition Award for its occupational and environmental health nursing services within the corporate structure for businesses with more than 750 employees. The award is considered highly prestigious in the occ-health industry, recognizing the work of the department over a five-year period.

Community Memorial and Rosien herself received the AAOHN Innovations in Occupational Health Award for 2005 for the creative implementation by nurse practitioners to improve the effectiveness of occupational health care services at the hospital.

While Rosien says the program developed at her hospital was tailored to fit the Community Memorial employee population, similar ideas have worked elsewhere and can work in other companies.

"We took a currently successful occupational health program with several certified occupational health nurses and capitalized on what they already do and then integrated an on-site option for health care for our employees," she explains.

Expanding on what a nurse can provide

When Community Memorial sat down to evaluate its program and the hospital's need to control health care benefit costs for its employees, Rosien says, they learned that one of the limitations of the existing employee health program was the restriction on what a nurse could provide in the way of care.

"As nurses, we can assess, triage, and provide some treatment, but there was always some stumbling block if the employee needed further diagnostic work to find out what the illness or injury was, or if they needed medicine to recover we weren't able to do that," she says. "Some programs opt to hire a physician, but when we looked at our philosophy and our practice, we saw that the nurse practitioner, in philosophy and practice, came out ahead from both the cost standpoint and how they treat the employees — holistically, focusing on prevention, treatment, and maintenance of health along the lifespan."

Employee acceptance was enthusiastic. What started out as a half-time position was increased to full-time midway through the first year, and Rosien says she has just received approval to add another half-time nurse practitioner.

"The outcomes have been very positive, and customer satisfaction has been very positive," she says. "The nice thing is that [the satisfaction] is both on the employee side and the employer side."

Rosien admits she would love to see dramatic decreases in office visits and emergency room visits; the decreases are there, but aren't dramatic. However, the real benefit is the cost avoidance the employer is seeing in its health plan.

"The way we fashioned the plan, employees don't pay an office fee to see the nurse practitioner. In the past, office visits were out-of-plan, out-of-pocket costs," she says, which makes the nurse practitioner popular with employees for whom copays and office fees are consequential expenses.

"We have set up a tracking mechanism to track office calls [to the nurse practitioner] and set up a database to track what the cost would have been for a [physician] office visit," she says.

Employee response good, and surprising

While nurse practitioners at the work site is not a new idea, Rosien says the occ-health staff wasn't sure what the response would be to bringing in a nurse practitioner to provide care to health care workers — a population "not noted for their self-care."

But response has been terrific, she says, particularly among two patient populations. One was expected — those who have no extra income at the end of each pay period, who benefit from not having a copay.

The other high-end user group was a surprise, Rosien says.

"It is upper management, and they say the No. 1 reason for them [to use the nurse practitioner on site] is the time savings. They love the convenience," she says.

At the end of the first year, 50% of the health program clients were employees who said that if the nurse practitioner weren't there on site, they would not have sought medical care as early or wouldn't have been diligent in following up for tests.

"We are saving [physician] office calls and saving emergency room visits," she points out. "Instead of going to the emergency room with insulin shock, they're getting help sooner and not going into insulin shock."

Medication 'tryouts' another popular aspect

Community Memorial added another feature that enhances the nurse practitioner's ability to prescribe medications. Through an arrangement with a vendor of medication-dispensing machines, employees who receive a prescription from the nurse practitioner can, in many cases, also get a sample dose, so that they don't invest in a full prescription without knowing it will work for them.

The machine tracks the medicines used most frequently, benefiting the vendor when it comes to working on sales to the hospital pharmacy, as the core medicines used most frequently are identified.

And in the case of some conditions, including strep throat and pinkeye, they benefit very quickly from the loading dose of antibiotic, enabling the patient to walk out of the nurse practitioner's office with an initial dose already in them can reduce absenteeism and presenteeism by speeding recovery.

The availability of on-site care also cuts down absenteeism caused by several hours away from work for an off-site office visit. The typical visit to the Community Memorial health clinic is 30 minutes or less, and so employees usually return to work that day.

Community Memorial is working with other employers in the area to develop their own on-site programs.

"It can be duplicated in almost any setting," she says. "There are some things that we're able to access that expedite care in the hospital setting, with the labs and diagnostics readily available.

"What I'd recommend to people who aren't in a hospital is to set up a collaboration with a hospital or clinic so they can have ready, easy access to some of the diagnostics. Those are the costs to the employer in money and productivity."

For more information, email Rosien at