New opportunities opening for occ health in health care reform

Employers offering more health services onsite

There is no shortage of discussion on how the Patient Protection and Affordable Care Act will change things for patients and providers, but big changes are also in store for occupational health.

"Health care reform is a great opportunity," says Talei Akahoshi, director of occupational health at Piedmont Healthcare in Atlanta. "We are taking advantage of it by having a nurse practitioner onsite, and providing minor care services."

The way health care is delivered is going to change, says Akahoshi, and employers are going to look for different and convenient solutions. "This is an exciting time for us," she says. "We are already seeing how we can make a difference and be a part of an Accountable Care Organization."

Health care reform also ties in with your efforts to promote wellness, says Akahoshi. "As employees come in, we can work with their acute or chronic problems or identify gaps in care," she says. "We can refer them to wellness programs, or provide health education."

With the employee's permission, adds Akahoshi, occupational health nurses can use integrated electronic medical records to coordinate care with their primary care providers. "This improves care coordination, which is an objective of health care reform," she says.

According to Linda McCauley, PhD, RN, FAAN, FAAOHN, dean of the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, "all occupational health nurses and physicians need to be aware of the health reform momentum, and how we might play a role in that."

Higher level education needed

McCauley sees a definite trend of employers offering more health services onsite, which she says is good news for occupational health nurses.

"There is a potential for great growth in that area," she says. Nurse practitioners are particularly skilled in caring for workers with chronic diseases, she adds.

"It would be really exciting to see a model of care delivery in work settings where chronic diseases are managed, and workers can stay at work," says McCauley.

This is a "win-win" situation, she says, because the business benefits from increased productivity, while employees benefit from the convenience of being able to see a provider without leaving work.

McCauley notes that not all occupational health settings have nurse practitioners onsite, and many occupational health nurses have two-year-degrees. The October 2010 Institute of Medicine Report, The Future of Nursing: Leading Change, Advancing Health, is closely aligned with what is called for in health care reform, she says. "It points out that nurses need to achieve higher levels of education, particularly nurses with two-year degrees," McCauley says.

"Ultimately, the worker benefits as the nurses move toward more independent roles with increased education," she explains. "There need to be easier pathways for nurses to return to school. Industry has to figure out how they can support that."

Conversely, says McCauley, nurse practitioners need additional education on occupational health. "That has been a challenge for many years," she says. "Primary care clinicians need to be cognizant with occupational health issues."

With the onset of health care reform, one of the biggest challenges is access to care. If it takes a worker with a chronic illness several months to get an appointment — and it ends up being inconvenient to miss work on that particular day — that isn't good for the company or the worker, McCauley says.

"Clearly, people are going to have difficulty getting in to see physicians," she says. "We have to have other models of care — either at the worksite, or a network of companies utilizing a central clinic for occupational health services."


For more information on health care reform and occupational health, contact:

• Talei Akahoshi, RN, COHN-S/CM, SPHR, Corporate Director, Occupational Health Piedmont Healthcare, Atlanta, GA. Phone: (404) 605-2710. Fax: (404) 564-5965. E-mail:

• Linda McCauley, PhD, RN, FAAN, FAAOHN, Dean, Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, GA. Phone: (404) 727-7975. E-mail:

• Paul Papanek, MD, MPH, Chairman of the Board, Western Occupational Environmental Medical Association, San Francisco. E-mail: