Ironbound Medical Services Occupational Health Blog

New Hires Getting Injured? The Importance of Pre-Employment Physicals

mjmustillo@optonline.net (Matthew Mustillo) — Thu, 15 Aug 2024 17:20:13 GMT

Are your new hires getting injured?

You’re not alone. According to recent data from the WCRI , more than half of all work-related injuries occur during the first two years of employment, and another third occur in one year or less.

While poor training and inexperience are partially to blame, many new hires are just not physically fit enough to perform their job.

It’s paramount that new hires receive a pre-employment physical, which includes a thorough review of their medical history, a doctor examination, and specific job-related testing that ensures they meet the minimum physical requirements to perform their role.

By investing in pre-employment physicals, employers can expect lower OSHA recordables and less medical expenses down the road.

What is a Pre-Employment Physical?

A pre-employment physical is a medical exam that determines if a prospective employee is physically fit to perform their job.

The specific components of a physical vary based on job requirements, but typically include the following:

Medical History Review:

The prospective employee will fill out paperwork that asks about previous illnesses, surgeries, medications, and chronic conditions
A physician will thoroughly review the medical history and ask any necessary follow up questions

Physical examination:

Evaluation of vital signs like blood pressure, heart rate, as well as respiratory and cardiovascular health, vision and hearing testing, and more.

Functional tasks:

Evaluation of tasks related to the job, such as lifting, carrying, pulling, and pushing, and climbing

What are the Benefits of a Pre-Employment Physical?

1. Job-specific testing

A pre-employment physical not only assesses the overall health of a candidate, but allows an employer to order tests that are specific to the job function. For example, if a role requires a candidate to lift heavy objects, an IPCS test can be ordered to make sure they meet the minimum strength requirement. If a role requires a candidate to have good eyesight and strong depth perception and peripheral vision, a Titmus vision test can be ordered.

2. Save time and money

If a new hire is not physically fit to perform their job, the likelihood of them suffering an injury skyrockets. No employer wants to deal with their new hire missing time, or the high OSHA recordables, medical bills, and insurance premiums that come with it.

Fewer injuries also mean less time spent speaking to doctors, insurance companies, and looking for replacement workers.

Therefore, we believe that pre-employment physicals serve as an investment in a healthy workforce that will save managers significant time, money, and frustration.

3. Identify hidden medical issues

At Ironbound Medical Services, each week we see patients who didn’t know they were diabetic, pregnant, or had high blood pressure. These are just a few common examples.

Typically when we identify a medical condition, it doesn’t disqualify a candidate from the role. Instead, it allows them to address the condition before they begin working. This results in a win-win for both the employer and the employee.

4. Peace of mind

A pre-employment physical provides peace of mind to both the employer and the employee. An employer can rest assured that they have a healthy workforce, and that any injuries that occur will not be a result of a pre-existing condition. This helps employers better assess the effectiveness of their safety training and protocols.

An employee can be confident that they are fit to perform their job, and that any medical concerns they may have had were addressed. A healthy, confident workforce is a more productive one.

How should I choose a provider?

Here are a few things to keep in mind when looking for an occupational health provider to perform pre-employment physicals:

Will my prospective employees be seen by a board certified physician?

Many facilities use lesser trained nurse practitioners and physician assistants to perform pre-employment physicals as a way to cut costs.

Regardless of what they may tell you, a PA or NP does not receive anywhere near the level of training as a physician. They are less likely to ask the right questions, identify an underlying medical issue, or make the correct referral. This increases the likelihood that a physically unfit candidate slips through the cracks, and decreases the value of your investment in pre-employment physicals.

Does my provider incentivize quantity over quality?

Many large providers incentivize their physicians, NPs, and PAs to see a certain amount of patients each day. In other words, their pay structure is influenced by the number of patients they see each day. Inevitably, they spend less time with each patient, minimizing the chances of identifying a potential concern.

If you are going to make the investment in pre-employment physicals, you want to make sure they are being performed as thoroughly as possible. What you don’t want is someone who is checking boxes and trying to move on to the next physical. This also waters down your investment in pre-employment physicals.

Ask the right questions and choose your provider carefully to get the most for your money.

Wrapping Up

Pre-employment physicals are an investment in a healthy workforce. New hires have the highest chance of getting injured, and pre-existing medical conditions play a significant factor. By combining physicals with a strong safety program, employers can expect to see a lower injury rate in their new hires, saving them significant time, money, and frustration.

If you are in the Newark, New Jersey area, Ironbound Medical Services has been providing thorough pre-employment physicals to a multitude of companies for over 15 years. Learn about the IMS Difference today!

Heat Prevention: How to Keep Your Workforce Safe During a Historically Hot Summer

mjmustillo@optonline.net (Matthew Mustillo) — Tue, 30 Jul 2024 21:22:07 GMT

Time to Embrace the Heat

2023 was the Earth’s hottest summer ever on record. 2024 will likely eclipse it.

With the heat here to stay, and pending federal safety rules regarding workplace heat protection, it is in every safety manager's best interest to make sure they have a heat protocol in place.

First, we’ll discuss the impact of heat in the work environment. Then, we’ll detail preventative measures you can take to protect your workers from heat exposure.

The Impact of Heat in the Work Environment

Uncontrolled heat exposure has direct and indirect effects. Direct effects include heat stroke, heat exhaustion, heat cramps, heat rashes, or death, while indirect effects involve weakened psychomotor skills and a temporary decline in cognitive function. These indirect effects are often overlooked, and can lead to an unsafe work environment and an increase in OSHA recordables.

“Heat can increase workers’ risk of injuries, as it may result in sweaty palms, fogged-up safety glasses, dizziness, and may reduce brain function responsible for reasoning ability, creating additional hazards” says the NIOSH Criteria for a Recommended Standard: Occupational Exposure to Hot Environments.

Let’s paint an example. John is a forklift operator at a large distribution center that lacks adequate air conditioning. During the summer months, temperatures reach up to 95°F.

While moving a pallet, John becomes fatigued from heat exposure and zones out. When he snaps back into it, he realizes he is on a collision course with another operator. Trying to redirect his trajectory, John quickly veers the forklift in the opposite direction. However, his fogged-up glasses prevent him from noticing a nearby storage rack. John strikes the rack, causing several heavy boxes to fall. One of the falling boxes strikes John's co-worker on the shoulder, causing an OSHA recordable injury.

As you can see, the indirect effects of heat can be just as troublesome as the direct effects. A new study by WCRI showed that “compared to temperatures between 65 and 70 degrees, the overall number of work-related injuries increased between 5% and 6% when the daily maximum temperature rose above 90 degrees” (Laman 2024).

Heat’s impact in the work environment is significant, and it’s important to take preventative measures to limit the direct and indirect effects of heat.

Preventative Measures

OSHA does not currently have a heat standard, meaning that heat related hazards fall under OSHA’s General Duty Clause . However, the Labor Department has been working on a heat standard since 2021 , with support from the Biden Administration.

A white house official confirmed that “Penalties for heat-related violations in workplaces would increase significantly” under the standard.

Taking preventative measures now will help keep your workers safe while also preparing your business for what seems like an inevitable policy change.

There are three main categories of prevention:

Engineering Controls and General Guidelines:

In a controlled environment, heat stress can be managed through engineering controls. According to the NIOSH criteria , common controls include “increasing ventilation, bringing in cooler outside air, reducing the temperature of a radiant heat source, shielding the worker, and using air conditioning equipment.” Eliminating heat hazards from the work environment through engineering controls is a great first step.

Employees should also have constant access to water. NIOSH recommends drinking one eight ounce cup of water every 15-20 minutes on hot days. If an employee is going to be sweating for several hours, employers should provide electrolyte water.

Heat stress can also be managed by providing added rest periods for employees. Designated rest periods will eliminate prolonged heat exposure and allow workers to cool down, hydrate, and check on one another.

Lastly, new employees are at the highest risk for heat illness. By following CDC guidelines on heat acclimatization , managers can safely build up an employee's heat tolerance.

Pre Placement Medical Examinations:

Although most workers will respond well to acclimatization, some may be heat intolerant. While there is no specific test performed for heat tolerance, requiring a pre-placement physical for employees who will be exposed to the heat is the most effective way to assess their personal risk.

A pre-employment (or pre-placement) physical allows a physician to thoroughly review your employee’s medical history, identify potential risk factors like dizziness, diabetes, or obesity, ask about prior problems with heat exposure, and order any recommended additional testing.

Ironbound Medical Services has been providing thorough pre-placement physical exams for over 15 years in the Newark, NJ area.

When asked about the importance of pre-placement physicals for employers, IMS Medical Director Robert Mustillo said:

“Pre-placement exams are always a good idea for companies. We work with clients to assess which part of their workforce requires a physical and which components of a physical should be included, helping them prevent future workplace incidents at an affordable cost. In the long run, employers will save significantly on workers’ comp costs by screening out candidates who are at increased risk of problems like heat stroke, heart attacks, or cerebrovascular accidents while performing physical labor. Additionally, your employees will be able to rest assured that they are physically fit to perform their job, creating a new peace of mind for your workforce.”

To make sure your employees are receiving a thorough pre-employment physical, we recommend that you look for a facility that only staffs board-certified physicians. Physical examinations require experience and expertise, and despite this, many providers utilize lesser trained nurse practitioners and physician assistants.

Health and Safety Training:

You’ve introduced engineering controls and a heat protocol to your workplace. You’ve sent your employees to the company doctor to ensure they are physically fit to perform their job. Now it’s time to train your workforce on the signs and symptoms of heat injury.

The following chart from the CDC provides the symptoms and appropriate response to different heat-related illnesses.

Employees should also be trained on proper hydration, what to wear, the importance of acclimatization, and the effect drugs, alcohol, caffeine, obesity, and diabetes can have on heat tolerance.

NIOSH also points out that many workplaces may need to shift their cultural attitude toward heat stress . Workers may believe that they develop an immunity to the heat over time and stop consuming ample fluids or taking breaks. They also may believe they can train themselves to tolerate heat by intentionally denying fluids. Both of these behaviors are risky and must be discouraged through education.

Wrapping Up

In the next couple of years, we can expect rising temperatures to continue, and a federal workplace heat policy to be established. Employers need to prepare accordingly.

This starts with understanding that heat impacts the workplace both directly (through heat related illnesses) and indirectly (a decline in psychomotor or cognitive related tasks).

To eliminate heat related injuries, employers must protect workers by utilizing engineering controls, encouraging hydration, mandating safety breaks, and introducing acclimatization periods.

Pre-employment physicals are highly recommended to ensure a job candidate will be able to perform the physical component of their role, and will help to identify any issues a candidate may have with heat exposure.

Lastly, health and safety training will ensure your workers are well equipped to recognize the risk factors and side effects associated with heat related illness.

For employers looking to learn more about current heat exposure guidelines, please use the following link: https://www.cdc.gov/niosh/docs/2016-106/pdfs/2016-106.pdf?id=10.26616/NIOSHPUB2016106

For employers local to the Newark, NJ area, learn more about our services at https://www.ironboundms.com/

Why Are All My Employee Injuries Being Sent to Physical Therapy?

mjmustillo@optonline.net (Matthew Mustillo) — Tue, 09 Jul 2024 16:54:11 GMT

Physical therapy is costly to your business. It’s not always necessary.

A workers’ compensation medical exam involves communicating with the patient, making an accurate diagnosis, and deciding on a plan of action to ensure a quick, full recovery.

Conventionally, physicians often prescribe physical therapy and prescription medications for pains and strains, and book a follow-up appointment with the patient to check their progress.

Let’s dive into the costs of this approach, alternative solutions, and why it’s a common practice:

The Prevalence of Physical Therapy In Workers’ Comp

Physical therapy costs almost three times as much in workers’ comp as it does in group health, and workers’ comp patients are 45% more likely to receive physical therapy than group health patients.

While it’s true that physical therapy accessibility for work-related injuries has been encouraged at the state level to help reduce surgery and opioid prescriptions, this only applies to serious injuries.

What is often overlooked is how many minor workplace injuries are being sent to physical therapy when they can be treated just as effectively with over-the-counter pain medications and at-home exercises.

Next we’ll take a look at why that is.

Why are all my employees being immediately sent to physical therapy?

For many physicians, the simple approach is to write a physical therapy prescription, send the patient on their way, and re-evaluate them later on.

More glaring is the pay-per-performance model utilized by many large healthcare organizations to incentivize providers to generate more revenue.

“Pay-for-performance models use financial incentives and penalties to encourage hospitals, physicians, and other providers to meet (provider) performance standards. Providers are eligible to receive bonuses if their performance meets pre-determined measures related to the processes, use, and experience of care,” explains HealthAffairs.

Many physicians are financially incentivized to provide patients unnecessary services to increase revenue. Large healthcare organizations typically have their own physical therapy facilities, making at-home exercises a detrimental solution . Unfortunately, the burden falls on the person covering the service - in occupational medicine it comes back to the employer in the form of higher workers’ compensation premiums or, if paying directly, higher out-of-pocket costs.

Alternatives

When a physician evaluates a patient, it is their decision to determine the best course of action to return them back to work safely and quickly - whether it’s through light-duty or a return to full duty.

Providers with vested interests will claim that physical therapy does not make an injury OSHA recordable, and that it is a standard part of the recovery process for an injured worker. They will sell you under the common assumption that physical therapy is a worthwhile expense - it will aid an employee’s recovery and help them return to work as-soon-as-possible with a low risk of re-injury.

While it’s true that physical therapy does not alone qualify an injury as OSHA recordable, it is expensive and many times unnecessary.

A comparative study performed by surgeons demonstrated that there was no statistical significance in the difference between at-home therapy and outpatient physical therapy for patients recovering from a total knee arthroplasty - a major surgery.

Although in certain cases physical therapy is necessary, for menial injuries a smart, lesser-used approach is to first provide patients with at-home exercises, and then check in with them to gauge their recovery status.

Following a re-evaluation, an educated decision can be made as to whether physical therapy is required.

By utilizing this approach, physicians are able to save companies from costly claims while providing their employees the same outcome they would get from physical therapy.

The Bottom Line

Physical therapy is often the norm in occupational medicine, and over time this approach will cost your business significantly.
At-home therapy is an alternative solution that often provides the same results.
Many healthcare organizations with their own physical therapy facilities are financially motivated to prescribe physical therapy whether it is necessary or not.
We recommend looking into the percentage of your workforce being sent to physical therapy as a way to cut costs without sacrificing the quality of care your employees receive.

At Ironbound Medical Services, we believe in transparency and fair practices, prioritizing your needs over superfluous billings. We provide comprehensive occupational medicine services at an affordable cost, with physicians that each carry 30 plus years of experience. For the convenience of your injured employees, physical therapy is available at our location, BUT it is a completely separate business and no financial incentives are given to our physicians for referring patients there.