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Low-Cost Medical Exams, Part 1

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Your employees come in contact with patients on a daily basis, and the level of their exposure to patients and illness or injury will determine the level of your annual medical examinations. Your employees are your best asset and should be maintained at least as well as you maintain your equipment and vehicles. This means providing the appropriate medical examinations to limit health risks and to identify any risks before they become serious. Here are some tips on how to how obtain a good medical exam and keep costs to a minimum.

An annual medical examination is not the same as the pre-employment medical examination given to new employees. That exam is designed to identify any health problems that could be a liability to your organization or would prevent the potential employee from being able to work for your agency. The purpose of an annual medical exam is to evaluate each employee s current health status and to screen for exposures to infectious or contagious diseases. In general, you can require your employees, as providers of a public-safety service, to yield to periodic, job-related medical exams. Objections are usually avoided when the exams are presented as a program designed to improve employee health and well-being, and not as a means to punish or terminate employees for health reasons.

Annual medical exams will usually consist of three or four parts:

  • A physician exam that includes certain physical evaluations;
  • Lab work that is obtained from each employee;
  • Other tests like X-rays, ECGs and a TB test; and
  • Optional tests, such as stress treadmill.

Financial considerations may dictate the degree of the annual medical exam or may require the organization to make other arrangements for some of the testing. An average comprehensive medical examination ranges from $250-750, depending on the extent of the examination. But there are some ways to reduce costs and still provide a good examination.

An MD exam

First, you should contact the physician your organization uses for medical examinations. Meet with them to discuss options for types of annual medical exams that will meet the needs of your organization, protect your employees health and screen for potential problems. Don't be afraid to negotiate a fee for each medical examination or a group rate for the organization. Especially if you use them for workers -compensation and return-to-duty examinations, they should be able work within your financial parameters.

Specifically, the physician should evaluate and record findings of the following during each employee's medical examination:

  • Height;
  • Weight;
  • Heart and breath sounds;
  • Blood pressure;
  • Pulse;
  • Respirations;
  • Reflexes;
  • Vision;
  • Hearing;
  • Ears, eyes, nose and throat;
  • Skin condition for signs of cancer which is critical because skin cancer can be detected early and has a high rate of successful treatment;
  • Any hernias, abdominal or inguinal; and
  • Rectum for enlarged prostate or blood in the stool.
  •  

Labs

Hundreds of different lab tests could be included; you should determine which are job-related or can provide a medical benefit to your employees. The lab work can be obtained at the time of the medical examination, or in some cases, the physician may suggest that you contract with a testing lab to obtain certain lab results prior to the examination. You should be able to negotiate a considerably lower cost per test than what you would be charged by the physician's office. You can have employees fill out the necessary paperwork and have paramedics within your service do the blood draws. The testing company will send a courier to your station to pick up the samples, and in a few days the results are returned to employees to provide to the physician when they are examined. This process requires you to plan ahead and have all tests done prior to each employee s scheduled medical examination.

Which lab tests do you obtain? I recommend an annual check for Hepatitis B and C antibodies and antigens, both surface and core. These tests can report if your employees have been exposed to any Hepatitis or contracted the disease. Your employees should be vaccinated for Hepatitis B, and the test will confirm the status of the vaccination.

Other tests include the following:

  • UA (urine analysis);
  • Blood fasting glucose;
  • Triglycerides;
  • Cholesterol;
  • Liver function tests;
  • Mammograms for female employees who are older than 40; and
  • PSA for male employees who are older than 40, overweight, have a history of cancer or have an enlarged prostate found on rectal exam. This test, which is more accurate than a digital examination, measures a chemical substance produced by the prostate gland called prostate specific antigen (PSA) in the blood sample.
  •  

If your employees respond to hazardous material incidents or are involved in hazmat operations where they wear self-contained breathing apparatus (SCBA) or Level A or B suits with SCBA, then you might want to also consider testing for pulmonary function and heavy metals profile II/blood.

My next column will continue on this topic with information about other critical tests and concerns.

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