Why physician quality metrics need to be built for this specialty — and how to do it right

Health system administrators are asking more of their occupational medicine programs. Justify the footprint. Demonstrate physician value. Tie compensation to outcomes. It's a reasonable ask — but it runs straight into a problem that most occ med medical directors know well: the quality frameworks that exist weren't built for us.

Press Ganey measures patient experience in acute care. HEDIS tracks preventive care and chronic disease management. Standard physician scorecards reward volume, RVUs, and patient satisfaction scores. None of those instruments capture what a great occupational medicine physician actually does — or the behaviors that drive real program value.

A physician who sees 30 patients a day but sends every acute low back pain case for an MRI on day one isn't delivering value. A physician with average volume who calls the employer back, documents modified duty options, and turns around the report the same day? That physician is the reason your employer clients renew.

The disconnect isn't new. But pressure to act on it is growing.

What occ med quality metrics should actually measure

After working through this challenge with several member programs — and inspired by a question raised by Laura Radke, MD, Medical Director at Froedtert and NAOHP board member — we've landed on five domains that hold up as meaningful, measurable, and fair for physician incentive comp:

Timeliness. Report turnaround is a top employer satisfaction driver, and it's entirely within a physician's control. The target: 85% of reports delivered within 24 hours of exam completion.

Clinical appropriateness. Are physicians practicing guideline-concordant care? Imaging referral rates — particularly early MRI for acute MSK complaints — are a proxy for both cost stewardship and evidence-based practice. ACOEM and ODG give you the benchmarks.

Return-to-work support. Modified duty utilization is one of the strongest predictors of case duration and total workers' comp cost. Is your physician documenting RTW options and communicating them to employers? That should be measured.

Employer experience. This is the one that gets skipped most often because it requires infrastructure to collect. A five-question post-case-closure survey, sent to the employer contact within five days, gives you the signal that no EMR report can: did this employer feel like a partner, or a transaction?

Regulatory compliance. For programs doing DOT exams, FMCSA error rates are a clean, objective measure with real liability stakes. Easy to track. Hard to argue with.

Each domain gets weighted in a composite score. Each physician gets a quarterly review. The scorecard is transparent, improvement-oriented, and built around behaviors physicians can actually control — not payor mix or scheduling factors outside their hands.

The infrastructure gap

Here's the part most programs get stuck on: the framework is the easy part. The hard part is collecting the data consistently, generating reports that administration will actually trust, and maintaining the employer survey program quarter after quarter without it falling off someone's to-do list.

That's exactly why NAOHP is launching a supported implementation program — pairing our physician quality framework with a dedicated data collection and reporting partner, and consulting support from (world famous!) Barbara Khozam, our customer service maven, to help member programs stand this up without building it from scratch.

This isn't a one-size-fits-all program. Every engagement starts with a discovery conversation to assess your program's current state, physician mix, and incentive comp goals. Member programs receive discounted pricing. Cohort size for 2026 is limited.

If your health system is asking you to show the data — or if you're asking yourself how you'd answer that question when they do — this is worth a conversation.

👉 Request a discovery call here

Last week's piece on acuity degradation and the Carbon Health bankruptcy generated more responses than most of our pieces. The short version of what it argued: urgent care drifted so far from clinical capability that when the COVID tailwind faded, there wasn't much of a practice left. MSK is where that drift is most visible — and most costly.

This week we want to move from diagnosis to tool.

Introducing the NAOHP Virtual Orthopedic Curbside Calculator

We've been working with Upswing Health on a virtual orthopedic curbside model — a structured referral pathway that keeps MSK cases inside your program rather than losing them to orthopedic urgent care chains marketing directly to your employer accounts.

The Connecticut pilot data behind this model is why we built a calculator around it: a 35.9% reduction in MSK costs. Zero MSK-related ER visits among participants. Those aren't marginal improvements. They're the kind of numbers that show up in a contract renewal conversation.

The NAOHP Virtual Ortho Calculator lets you run your own program's numbers — visits, sites, payer mix — and see what that opportunity looks like in real dollars.

What it looks like for a multi-site practice:

A multi-site occupational health program running this model stands to capture more than $2,000,000 in annual revenue that is currently walking out the door to orthopedic urgent care and direct-to-employer MSK vendors.

That figure isn't hypothetical. It's what the calculator produces when you input realistic visit volumes for a mid-size program with multiple clinic locations. The mechanism is straightforward: virtual orthopedic curbside reduces unnecessary specialist referrals, keeps cases clinically managed inside your program, and captures revenue that the current referral pathway forfeits entirely.

Why this matters right now

Orthopedic urgent care chains aren't waiting for occupational health programs to figure this out. They are actively marketing to the same employer accounts you serve, with MSK as the wedge. The virtual curbside model is how you close that gap — clinically and financially.

If you want to run your own numbers, the calculator is available through NAOHP. Meet with me briefly here, provide some basic info about your practice and referral patterns, then we’ll 👉 Run the Virtual Ortho Calculator

Provider Office Hours Kick Off April 15th — Here's What to Expect

If you enrolled in the NAOHP Occupational Medicine Provider Course — or you've been on the fence — this is the update that changes the calculus.

Starting April 15th, all enrolled providers get access to twice-monthly live office hours sessions, beginning at 9 AM Pacific. These aren't webinars. They're working sessions.

What the sessions look like

Each office hours session will open with highlights from the course — cases, concepts, or frameworks worth spending time on together. From there, it's open Q&A: bring a real injury case you're managing, a regulatory question you've been sitting on, an employer communication that went sideways. The format is designed for the kinds of clinical and operational questions that don't have a clear answer in a textbook.

Dr. John Koehler will anchor several of the sessions, providing OccDocOne support — which means you're getting experienced occupational medicine physician input on the questions that actually come up in practice.

We'll also be bringing in special guests periodically. Our first featured guest will be Dr. Jay Kimmel, who leads our virtual orthopedic program — timely, given everything we've been publishing lately on MSK and the acuity degradation problem in urgent care.

How to sign up

Office hours access is exclusive to enrolled providers. If you're already enrolled, sign up for the April 15th session here:

👉 Sign up for Provider Office Hours — enrolled providers only

If you're not yet enrolled and want in before April 15th:

👉 Enroll in the NAOHP OccMed Provider Course →

Group pricing is available for programs enrolling multiple providers. Reach out before registering. We just enrolled 200 providers from a well known urgent care group ready to level up their occmed game - they got a huge discount plus NAOHP membership for each.

👉 Enroll now or request group pricing →

A large health system reached out recently. Their occupational health program director was frustrated, exhausted, and running out of ways to explain to leadership why the program kept looking like it was underperforming.

From the outside, the numbers looked bad. Only about a third of visits were generating any revenue. Staffing requests kept getting denied. A new campus wanted them to expand. And leadership was asking for benchmark data that — as anyone in this field knows — simply doesn't exist for this kind of work.

Sound familiar?

Here's what we found when we looked closer: the program wasn't broken. It was misdiagnosed.

Employee health and occupational health were operating as a single cost center — meaning every dollar of compliance-driven work (fit testing, surveillance, immunizations, regulatory screenings) was being absorbed silently into the same budget as the revenue-generating clinic. No separation. No attribution. Just one blended number that made a profitable program look like a drag on the system.

When you run the real math — isolating occ health revenue against occ health costs — the picture flips completely.

But leadership wasn't looking at the real math. They were looking at productivity metrics designed for primary care and applying them to a compliance-driven workforce model. Leadership was evaluating the program using the wrong instrument entirely — and every conversation about staffing or resources was happening on top of that faulty foundation.

And it's more common than you think.

This is exactly what the Executive Diagnostic was built for.

It's a structured engagement designed for health system leaders who suspect their occupational health program is being evaluated unfairly — but don't yet have the financial model, the language, or the benchmarks to make that case to administration.

We've applied it to programs ranging from a few thousand to more than 80,000 covered employees. Every time, the same pattern surfaces: the program is stronger than the numbers suggest, and the path forward becomes clear once the cost structure is properly separated and the right performance framework is in place.

The full article drops tomorrow [or Wednesday]. It goes deep into the three structural traps — the blended cost model, the missing benchmarks, and the expansion paradox — and what program directors can do about each.

But if you're reading this and already thinking "this is my program" — don't wait for the article.

→ Learn about the Executive Diagnostic
https://naohp.group.app/pages/occhealth-exec-diagnostic

A confidential conversation. No obligation. Just clarity.

— Larry

Advanced biomarker testing has become an area of growing interest for me, particularly as it relates to employee health, long-term resiliency, and disease prevention. The opportunity is not simply to collect more data, but to use more precise data to identify emerging risk patterns earlier—cardiometabolic strain, inflammatory burden, and in some cases cancer-related signals—before they evolve into disability, career interruption, or preventable claims.

This topic comes up frequently in workforce discussions, and especially in conversations surrounding firefighter medical surveillance. Important questions remain. Which biomarkers are clinically meaningful in asymptomatic populations? Which tests are appropriate for higher-exposure or safety-sensitive groups? How should testing differ across employee populations? And once results are obtained, what constitutes responsible follow-up, monitoring, and intervention?

These are complex issues that deserve careful, evidence-based discussion. I am exploring them more deeply in my new publication, Elucidate, where I focus on biomarker science and its practical application to workforce health, prevention strategy, and long-term resiliency.

If this topic is of interest to you, I invite you to read and subscribe to Elucidate.

The first post is: A Physician Looks at His Own Biomarker Data