According to the old business cliché, time is money. Nowhere is that more true than when an employee misses time from work due to a job-related injury or medical screening.

According to the American College of Occupational and Environmental Medicine, the indirect costs of lost productivity resulting from a worker injury can be four times the actual cost of medical treatment.

The longer the worker is off the job, the more it costs the company.

As the health care system has become more overloaded with patients, wait times in doctors’ offices and emergency rooms have become longer.

That’s prompted a new type of medical clinic to emerge, focusing on the specific needs of businesses. These occupational medicine practices can speed workers through their medical encounters and get them back to their jobs as soon as possible.

Tucked away on the north end of the Cascade Village Shopping Center in Bend, Cascade Occupational Medicine operates what appears to be a mini-emergency room: two beds, no waiting. The clinic, which opened in August, treats only patients with work-related medical needs, substantially limiting the number of patients they see.

“We can take care of anything from broken bones to crush injuries or lacerations,” said Kasandra Reams, client services coordinator for Cascade Occupational. “The only thing we ask is a little common sense; if someone has passed out, please take them to the ER.”

With an average of only 16 to 18 patients a day — many of whom are there for scheduled screenings such as drug testing or physicals — there’s hardly ever a delay. Workers can get in and out quickly, with many returning to their jobs that same day.

“They’re not sitting in waiting rooms with people who are getting their blood pressure checked or somebody who’s got pulmonary issues, or the cold, or the flu,” Reams said. “Their workers aren’t exposed to those things. This is for work injuries only.”

That’s a huge boon to delivery companies, for example, who hire additional staff around the Christmas holidays and must send drivers to doctors’ offices for physicals in the midst of flu season. Or for the construction worker who cut his hand and needs three stitches and might otherwise sit for hours in the emergency room as doctors treat more serious cases.

“Quite frankly, do you need an emergency-trained physician to put three stitches in somebody’s finger?” asked Dr. Chris DiGiulio, the lone physician at Cascade Occupational. “For those minor types of injuries, this (clinic) is probably a better use of resources.”

According to Reams, Cascade Occupational treats workers at one-third the cost of a hospital emergency room. And by helping get the worker back to work sooner, they keep productivity losses to a minimum as well.

“We’re very careful about time-loss issues for employers,” DiGiulio said. “I often know if there’s a light-duty job appropriate for this employee. If you have a broken ankle, are you going to sit home and watch TV for six weeks while it heals, or does your employer have something that you might be able to do?”

Physicians in other settings might not have the time to research such options and instead just advise the patient to stay home from work. But studies have shown that when injured workers return to the job sooner, they heal more quickly than if they stay home.

“There’s something that happens to the worker mentally when he’s no longer in the work game,” DiGiulio said. “He’s staying home and watching daytime television, and he’s no longer part of the community. Getting a patient back to work helps him mentally, and I also think it helps him recover from his injuries.”

Trygve Bolken, human resources manager for Enter Prises USA, a climbing wall manufacturer with 60 workers at production facilities in Bend and Redmond, said the new clinic has been a big timesaver for his company and its workers.

“We were going to urgent care and sitting around for hours,” he said, but at Cascade Occupational, his workers get immediate attention.

“They love it. We go right in,” he said. “I usually go in with the employee, and I take care of the paperwork while he’s being treated. We get really clear instructions from the doctor as to what the injury was and what we can do. He even gives us suggestions on what we could do to prevent it in the future.”

The clinic also has on file information about all the chemicals that Enter Prises uses in its facilities, so if a worker is exposed to a chemical, the doctor can pull up the information and know immediately how to treat that patient.

Under one roof

Cascade Occupational has imaging equipment on site, eliminating the delays in getting X-rays or MRI results. For musculo-skeletal injuries, they have their own physical therapist on staff. Patients can often get their first therapy treatment the same day as the injury.

Keith Kadlecik, the physical therapist at Cascade Occupational, said that can cut down on the number of therapy visits. Companywide — Cascade Occupational Medicine has four physical therapy outlets in the Portland area as well — patients average only five visits after an injury. The industry standard for injured workers is about 12 visits, Kadlecik said.

Having the referring doctors just down the hall also helps to eliminate delays.

“If I have a question about a diagnosis, I can walk right over there and we can look at the X-rays,” Kadlecik said. In contrast, he recently treated a patient referred by an outside doctor and needed to find out whether there were X-rays of the injured leg. It took a week for the doctor to respond to his call and another week to get the patient in for an X-ray.

“I could have marched him in for X-rays right here,” he said.

Kadlecik and DiGiulio also make site visits to companies that use their services. They can do ergonomic evaluations there to suggest ways for workers to avoid injuries, and they get an idea of the different tasks the workers perform.

“When a worker comes in and says. ‘I was on the punch press line,’ we know exactly what his duties are, so we know how to strengthen him and get him back to work,” Kadlecik said.

When they perform therapy or testing, they try to simulate actual work tasks as closely as possible. It makes for some interesting equipment in the therapy room.

They have a keg to test whether workers for a beverage delivery company can safely lift it. They’ve built a simulated roof pitch to test whether roofers can safely carry a 75-pound roll of tar paper up and down a roof.

“We try to be as work-specific as we can,” Kadlecik said. “If they can lift what they do on the job, the tests are much more accurate than someone who’s mimicking lifting the same thing.”

Throughout the entire clinic, procedures and equipment are all tailored to meet the specific needs of businesses and their workers.

Parts of the whole

But Dan Montoya, the physician assistant who manages Bend Memorial Clinic’s Occupational Medicine Department, said there’s a drawback to totally separating occupational medicine from traditional medical practice. It can lead to fragmented care, he said.

At Bend Memorial Clinic, Montoya has access to a vast array of specialists under the same roof.

“If I see somebody for a (commercial driver) exam and there’s a problem that might concern his heart, I have a cardiologist right upstairs,” he said. “I can call upstairs or walk upstairs and talk to them. And if it’s a serious issue, a lot of times they’ll see the patient the same day.”

He also has access to the patient’s medical records if that worker sees a clinic physician for his or her standard care.

“I can pull up a chart, and I can look at every blood pressure his doc has taken for the past year,” Montoya said.

He acknowledges that the emergence of the new dedicated occupational medicine clinic has accelerated Bend Memorial Clinic’s plans to streamline care for injured workers. Rather than having them wait in the clinic’s urgent care facility, those workers could soon be directed straight to the occupational medicine department, eliminating wait times.

“We have been working towards this end for some time,” he said. “That’s the way occupational medicine should be done.”

But having urgent care on site also gives workers more options. The occupational medicine department at Bend Memorial Clinic is open only from 8 a.m. to 5 p.m., the same hours as Cascade Occupational. Workers can visit Bend Memorial’s urgent care after hours or on weekends at either the main east-side clinic or the newer west-side location.

“Then what we might do is tag team urgent care and occupational medicine,” he said. “Whoever is free can see the patient first.”

Different approach

Many physician offices and clinics offer occupational medicine services, such as pre-employment physicals, as an adjunct to their standard practice.

Cascade Medical Clinic in Redmond, for example, conducts both pre-employment physicals and drug screening in addition to their primary focus, which is family practice. Mountain Medical Intermediate Care in Bend sees many injured workers in their urgent care department but provides other standard screening services and physicals through their occupational medicine practice.

It can often be a challenging line of business for doctors who are used to dealing with health insurance carriers and regulations. Workers’ compensation claims involve a different billing system and different insurance carriers, and often it isn’t worth the hassle for the small number of worker injuries that come through the door.

Cascade Occupational is paid exclusively through workers’ compensation insurance or directly by the company for scheduled screenings.

But there’s a philosophical shift for doctors as well, who must consider all the parties involved, not solely the patient.

“When you come in, we take into account the employee, the employer and the insurance carrier,” Montoya said. “Then everybody is on the same sheet of music. That eliminates the problem when in some clinics the employee leaves, and they tell the employer a different story. They go back and say, ‘Gee, they told me I should be off work for two weeks.’”

In standard medical settings, federal regulations require strict confidentiality of a patient’s medical information. Under workers’ compensation rules, the company is entitled to know information pertinent to the injury. A worker’s HIV status may not be germane to a broken ankle, but a previous medical history of breaks in that ankle could be.

Occupational medicine doctors generally go out of their way to keep the employer informed and to be available for questions. That’s another major shift from standard practice, DiGiulio said.

“When I was in private family practice, to be quite honest with you, if an insurance company called me, I wouldn’t even answer the phone,” he said. “If an employer called me and wanted to talk to me about the worker restrictions I wrote for a job, I wouldn’t answer. I’ve got to see my patients, I’ve got to get to my refills, I’ve got to answer my calls. It’s way down on the priority list to answer questions for the company.”

Both DiGiulio and Montoya said in their occupational medicine practices, they pick up the phone and let the company know what’s happened to its worker and when he or she could return to work. They try to find the middle ground that allows the worker time to heal without taking advantage of the company.

“We’re going to make someone mad every day,” DiGiulio said. “One day the employer is going to be angry because a patient is not back to full duty and the next day a patient is going to be angry because I’m sending him back. You’ve just got to ensure that the anger is equal on both sides.”