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On-site medical treatment: a prescription for some cost-anxious employers.

Article Excerpt
Corporate America is engaged in a frustrating campaign to stem rising medical costs. Within the past 15 years, the cost management struggle has witnessed the rise and demise of tightly managed care plans such as , HMOs and the newfound popularity of "consumerism." Medical benefit costs have the attention of boards of directors and "C-level" management of most companies as employers contend with double-digit medical cost increases that assume importance in the intensely competitive global economy.

With HMOs and PPOs having failed to control costs over the long term, many employers are tempted simply to shift more costs to employees in the form of high-deductible plans that result in increased out-of-pocket costs. Experts agree that consumers need to share financial pain with employers and consumer-directed plans serve a valid role; however, cost shifting to employees does not address the root cause of the medical cost problem: The majority of the increase in healthcare spending during the past 15 years resulted from rising disease prevalence and new medical treatments (Thorpe, Health Affairs 24(6): 1436-1445). Employee morale is easily damaged when limited wage increases are consumed by higher medical plan contributions and out-of-pocket expenditures.

The Medical On-Site Center Option

There is no silver bullet to the healthcare cost dilemma. Plan sponsors of all types--private employers, federal, state and local governments, and Taft-Hartley funds--must try alternative healthcare approaches that offer cost relief. An increasing number of employers are exploring on-site medical centers and/or pharmacies as cost-management approaches.

An on-site medical center mimics a primary care (e.g., family practice) physician's office with one or more treatment rooms and basic diagnostic and laboratory equipment. It may be staffed with physicians and/or nurse practitioners and technicians. Centers serving a limited patient population may rely upon a nurse practitioner as the first-stage clinician. Patient demand and hours of operation dictate actual staffing levels. The typical on-site medical center offers:

1. Routine medical care

2. Immunizations

3. Basic radiology and laboratory testing

4. Physical examinations

5. Preventive screenings

6. Health education, consultation, and wellness (nutrition counseling, cholesterol screening, prenatal programs)

7. Basic adolescent and child care, including back-to-school and sports physicals...

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