Change is in the air in all areas of healthcare reimbursement, and this is particularly true in the workplace.
Employers are dealing with rising insurance costs that are taking a big bite out of the bottom line. They are searching for an answer that will reduce costs and maximize the productivity of their employees, while protecting their profitability.
At the same time, chiropractors are searching for ways to decrease their dependence on third-party insurance reimbursement with cash-based services. This confluence of factors creates a significant opportunity for those interested in expanding their role in occupational healthcare.
Post-offer examinations
Many workplace injuries can be prevented by performing an assessment of prospective employees’ abilities to perform the functions required by the job they are seeking. These assessments, performed after an offer of employment has been tendered, are referred to as “post-offer examinations.”
Post-offer examinations provide employers with a functional baseline of performance and ensure that the employee can safely meet the physical demands of performing the essential functions of the job. They also reduce the costs associated with employees’ unidentified pre-existing conditions. A post-offer baseline exam can identify pre-existing disabilities and distinguish them from any disability resulting from future on-the-job injuries.
The post-offer process involves setting up a job-specific examination that tests the essential functions that the employee will perform.
These procedures include testing the frequency of various work postures and work activities such as reach up, reach out, bend, stoop, and squat, along with other functional assess- ments. Physical demand levels and dynamic lifting procedures may also be performed and evaluated.
The more objective the evaluation procedures, the more likely they will protect employees from injuring themselves on a job that they don’t have the physical ability to perform. An objective exam can also protect employers from the financial risk of hiring workers who are prone to injury.
For these reasons, computer-assisted assessments are preferred to manual assessments due to their validity and reproducibility. There are several reputable manufacturers of computerized functional assessment equipment and training that service the chiropractic profession.
Not the typical exam
Most employers perform some sort of cursory physical screening of prospective hires to determine if they are fit for the job. However, these screenings typically do not evaluate the essential functions of the position, establish a pre-employment functional baseline, or identify any pre-existing functional impairments. This means that employers are essentially blind to an employee’s ability to perform the job being offered as well as their potential future liability should that employee be injured on the job.
You might wonder why employers would pay for inadequate screening exams. In fact, many employers are indeed asking themselves this question.
The rules of the game
An important first step in the post-offer examination is to obtain a thorough understanding of the rules and regulations involved as they relate to the Americans with Disabilities Act (ADA). According to the ADA, a post- offer exam can only be performed after the prospective employee has received a “real job offer.”
A job offer qualifies as “real” if the employer has evaluated all of the relevant non-health related information that it reasonably could have obtained and analyzed prior to tendering the job offer. After a real job offer has occurred, an employer can ask disability-related questions and require a functional health-related exam. The job offer may be conditional based on the results of post-offer disability-related questions and functional exam findings.
If an employer asks post-offer disability-related questions, or requires post-offer functional examinations, there are specific procedures to follow: All prospective employees in the same job category must be subject to the same exam or inquiry, regardless of their disability. The objectivity and design of the post-offer exam needs to meet the ADA standardization requirements.
For example, an employer may ask potential hires at the post-offer stage whether they have had back injuries. If the employer learns that some of the individuals have had back injuries, the employer has the right to require a functional exam to diagnose back impairments on all prospective candidates for the position as long as it is related to the back injuries identified in the initial inquiry and is standard in format.
The first line of defense
Employers must comply with the ADA when revoking an offer of employment based on post-offer findings of a disability that would limit the employee’s ability to perform the job. The employer must notify an individual (orally or in writing) if his or her placement was in any way adversely affected by the results of a post-offer exam or disability-related questions.
Additionally, when possible, an employer must provide reasonable accommodations to the employee to assist him or her in performing the job being offered. Once again, the post-offer exam provides employers with confidence that they can legally revoke an offer of employment.
Your post-offer exam is the first line of defense for an employer should a potential employee question the reason an offer of employment was revoked due to a disability. When an individual alleges that a disability affected his or her hiring, the U.S. Equal Employment Opportunity Commission (EEOC) scrutinizes whether a disability was the reason. If disability was the reason, the EEOC will determine whether the action was consistent with business necessity.
Where to begin
Do your homework before contacting employers to propose providing post-offer exams. Your point of contact will most likely be a human resources or risk management manager. An important component of the post- offer process is to have a thorough understanding of the essential functions and demands that must be performed. Ask if the employer has a written job description in place that you can review to design a job-specific examination.
You may offer to take a walk- through of the employer’s facility. Employers typically like to show off their facilities, and you can evaluate and digest the information they share.
Allow the decision-makers to have the stage while you evaluate the work environment. This will help you to tailor job-specific post-offer exams.
Opportunities for growth
Post-offer examinations are not reimbursable by third party payers and are paid for by the employer directly to the provider. This provides a sustain- able source of non-insurance income for your practice, while you provide a valuable service to the employers and employees in your community. As you begin to develop relationships with employers, more opportunities will arise. Many employers are seeking healthcare professionals to give safety talks, and attend their health fairs or wellness screenings.
If you can provide high quality post-offer exams, you will be their natural choice. There has never been a better time for chiropractors to embrace occupational healthcare and step off the “hamster wheel” of insur- ance reimbursement.
Mark Sanna, DC, ACRB Level II, FICC, is a member of the Chiropractic Summit, the ACA Governor’s Advisory Cabinet, and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching and can be contacted at 800- 723-8423 or through mybreakthrough.com.
