Why your local healthcare system isn’t helping you control work comp costs!

Most employers rely on Traditional Health Care (THC) for their work-related injuries. After all, THC has the facilities, technology and staff to care for an injured employee, right?

When you think about it, who has gotten us into the health care crisis? Of course, the answer is our traditional, third-party payer-based health care system, facilitated by government regulation. Do you really think they have a vested interest in helping you contain your costs; let alone reduce them? After all, THC makes money by billing insurance… from the moment your employee walks in their door, the insurance billing process begins.

Those of us is Sports Medicine know there is a better option. Do the Yankees get their healthcare from a healthcare system in New York? Do the Packers go to an off-site facility when they need therapy? Of course not! They hire their own employees to care for their elite, most-performance driven workforce in the world!

"But the cost must be outrageous", you say. Quite the contrary! The Sports Medicine Model (SMM) provides top-quality care at a much lower cost by being proactive while maintaining some internal control over care.

Here are 6 (of the many) weaknesses of using THC for work-related injuries and how the SMM is different:

  1. THC is reactive. SMM is proactive.
    • THC sits in their office waiting for a patient to walk-in or an injury to occur.
    • SMM is on the plant floor talking to employees, building rapport and trust, and educating on the signs and symptoms of musculoskeletal disorders so as to catch an injury early on.
  2. THC is passive. SMM is aggressive.
    • THC says, “wait 2 weeks and call me.”
    • SMM says, “same day treatment, multiple treatments per day (not 2 treatments per week!), and what CAN the injured employee do,” not what they CAN’T do like THC.
  3. THC is uncoordinated. SMM is coordinated.
    • THC has multiple case managers including the Doctor, the Nurse, the Case Manager, the HR Director, the Safety Manager, and worst of all… the injured employee!
    • SMM has coordinated care and that is the Athletic Trainer, the same healthcare professional that coordinates care for professional athletes.
  4. THC will use multiple diagnostics. SMM is evidence based medicine.
    • THC often involves multiple x-rays, CAT scans, etc., which are unnecessary; they order and bill for these additional diagnostics because they can, and willingly do so.
    • SMM only orders diagnostics when medically appropriate, then acts upon them promptly.
  5. THC relies on outside referrals. SMM treats as much as possible in-house.
    • With THC, once an employee enters the traditional healthcare system they are susceptible to multiple physician visits, unwarranted work restrictions, poor return to work plan, and other factors that drive up costs, yet keep the injured employee out of work for a longer time period.
    • SMM does as much as possible in house to avoid billing insurance.
  6. THC is pay for procedure. SMM bills a flat fee.
    • THC gets paid by billing insurance so wouldn’t it make sense for THC to bill for lots of procedures so as to be able to bill a lot to insurance?
    • SMM will never bill an insurance company. Do you think the Patriots submit an insurance bill for reimbursement if Tom Brady gets injured? Of course not

What do you think of these differences? Any experiences you want to share about THC and worker’s comp?

For more information on how the SMM can benefit your company, please visit our website www.TheIndustrialAthlete.com or call 877-SMART-11