Duane Hoffmann / MSNBC
By
msnbc.com contributor
updated 11/4/2004 9:18:22 AM ET 2004-11-04T14:18:22

When she needed some specialized surgery recently, Nancy Mudd, 40, a systems analyst in Northern Virginia, took a 400-mile trip, each way, to New York City in order to be operated on by a specialist trained in the procedure. But later, when Mudd needed a few post-op stitches removed, her travel time was shortened to a mere minute — the time it took for an elevator ride from her second-floor office down to the first floor.

Mudd works for Freddie Mac, a congressionally chartered corporation that helps banks with mortgages. In September, the company finished renovations at its headquarters in McLean, Va., and now devotes space to an on-site medical clinic staffed with health professionals who can diagnose the flu, dispense medicine, perform medical screening tests, and, yes, even remove many types of stitches.

Clinics like the one at Freddie Mac are a growing service at many firms, say experts. Employers, including the Treasury Department, Continental Airlines and USA Today, have on-site clinics that are open during the business day and, in some cases, for extended hours. Their staff treat routine problems, like the flu or a bad cut, but can also monitor an injured patient’s recovery after an accident, be on hand for on-the-job accidents or sudden illnesses, and hold workshops on such issues as smoking cessation and weight loss.

Some clinics, such as Continental’s clinic for employees in Guam, are open to employees' dependents as well.

Clinics complement health insurance
The clinics, which are usually staffed by at least one highly credentialed nurse as well as one or more physicians, don’t replace health insurance, they complement it.

"Our services are ancillary to the employee’s health insurance,’’ says James Hummer, CEO of Whole Health Management, which runs close to 100 on-site clinics throughout the United States, including ones at several federal agencies such as the Treasury Department, the Food and Drug Administration and the Labor Department in Washington. At most locations, including those run by Whole Health, employees pay no fees for services, nor for drugs which are often stocked on site.

The clinic at Freddie Mac, which opened this past September, is among the newest on-site clinics. "We … believe on-site health and wellness care will enable employees to better meet both their professional and personal obligations," says Mike Hager, senior vice president of Freddie Mac’s Human Resources Department. 

Translation: human resource personnel are hoping that on-site clinics will cut down on the average four-hour leave employees take when they have to go to the doctor.

Ask Mudd. She anticipated having to take a half day off from work for the pre-op lab tests required by the hospital in New York. Instead, the staff at Freddie Mac’s Wellness Center quickly took care of her blood tests and sent the information to the hospital for her.

Reduced costs for employers?
Employer costs are another reason more companies are taking a closer look at on-site clinics. "By providing easier access to preventative care and other minor treatments, we anticipate that over the next 12 to 18 months, the company will realize substantial cost savings,’’ said Freddie Mac’s Hager in a statement announcing the center’s opening.

But that outcome remains to be seen. Ken Abramowitz, a Wall Street health-care analyst, says that the highest medical costs corporations face — perhaps 80 percent of the total — are actually generated by older, sicker retirees in need of expensive, chronic care. He maintains that companies don’t stand to gain much in terms of reining in health-care costs when they add the clinics.

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But others dispute that argument. Darrel Douglas, head of human resources for Blue Ridge Paper in North Carolina, which opened an on-site clinic last April, says 80 percent of employee visits have been taken care of by clinic staff with no need for outside — and more costly — medical visits. Douglas says health-care cost reductions have been 8 percent to 9 percent above the estimates made before the clinic opened, in part because the on-site pharmacy encourages employees to use generic drugs when they’re available.

Dr. Jim Thiel, Whole Health’s regional director in the Washington area and medical director at the firm’s clinic at the U.S. Patent and Trademark Office in Crystal City, Va., says the clinics run by Whole Health also get very involved in health education. The medical staff offers programs, for example, in weight-loss management and smoking cessation, aimed at preventing illness later on. And, Freddie Mac’s Hager says, the clinics also allow employers to create individualized programs based on needs they identify in company health claims data.

"If we were to see a 20-percent increase in treatment cost for diabetes, we could mount a big initiative to see if employees have undiagnosed diabetes and then create prevention programs to help those at risk," says Hager.

Cash benefits for employees
Like most medical offices in the United States these days, few on-site clinics have flu vaccine on hand for their patients, but they are at least able to help employees feel better during the flu season. Frank Martin, CEO of I-Trax Inc., which runs 160 on-site clinics in 32 states, says he expects that many of the company’s clinics will be well-stocked with antiviral medicines, which can shorten the duration of flu symptoms by a day or two if treatment begins soon after signs of the flu develop.

Help for the flu may be what patients remember most about on-site clinics this year, but they can count on other benefits, including, in some cases, more cash in their pockets. Employees who see an on-site clinic doctor or nurse are not charged a copay as they would often be if they went to see their own doctor. And medicines dispensed on-site are usually given out free of charge as well.

For patients who opt for Health Savings Accounts, a new form of health insurance that offers lower-than-average premiums but requires consumers to pay down a high deductible before getting coverage, free of charge visits could save them from costs of $100 to $150 per visit; more if the visit is for something serious.

Helen Darling, president of the National Business Group on Health, which encourages its members to add on-site clinics to improve costs and productivity, says some firms have started small with just on-site pharmacies.

"But that alone has shown to cut down on some time away from the office, and on medicine costs, since the pharmacies often only stock the drugs allowed by the company’s health plan," says Darling. More expensive alternatives have to be purchased off site, and often employees are happy enough with the convenience to pick the company-approved drug, she adds.

Having an on-site clinic also improves the chances that some employees, who otherwise might not have scheduled a trip to the doctor, will stop in for a visit.

Manson Messer, an hourly worker at Blue Ridge Paper, visited the clinic to get a regular checkup when a nurse noticed a mole on his arm. She referred him to a specialist for an appointment the next day.

Thanks to the nurse's quick assessment and action, Messer was diagnosed with melanoma at an early stage and so far has needed only surgery to remove the mole. Follow-up checkups? He easily fits them in during his lunch hour, and still has time for lunch.

Francesca Kritz is a freelance writer in the Washington, D.C. area who has written for the Washington Post, Parenting, BabyTalk and other publications.

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