Last week, we published a piece on the structural crisis hiding inside large health system occupational health programs.

A program director at a major health system read it and sent us this:

"I think you hit the marks well with what is written — and honestly, this has to be every blended model group out there dealing with the same issue."

He then described his current situation: an interim CMO on vacation, a new CMO he hasn't yet met, and a direct report line to a manager who only engages when there's a problem. Classic leadership vacuum. Classic blended model trap.

His conclusion: "I think the article is compelling, and I think the cost is a drop in the bucket."

The article makes the case in detail. Here's the short version:

Most health systems are running two programs under one roof — compliance-driven employee health work and revenue-generating occupational health services — with no separation in cost accounting. When leadership reads the financials, they see an underperforming department. What they're actually seeing is a blended model that was never properly structured.

When program directors try to make the staffing case, they hit a wall: there are no industry benchmarks for compliance-based occupational health work. MGMA doesn't publish productivity standards for respiratory protection programs serving tens of thousands of employees. So leadership asks for benchmarks, the program director can't produce them, and a productivity metric designed for something else entirely fills the vacuum.

The result: programs being asked to grow their obligations without growing their capacity, evaluated on metrics designed for a different kind of work.

The director we heard from put it plainly: "Any time we're allowed to come off the leash, we show them what we can do."

Capacity isn't the issue. Structure is — and structural problems require a different kind of intervention.

The Executive Diagnostic was built for exactly this situation.

It surfaces the cost allocation gaps that standard reporting never captures, models what a properly separated employee health and occupational health structure would show, and gives program directors the language and financial frameworks to make the case to administration.

Applied recently to a program serving more than 80,000 employees, it identified where the accounting was obscuring real performance — and what the program was actually worth.

If this describes your situation, the conversation is confidential and carries no obligation.

→ Request Your Executive Diagnostic
https://naohp.group.app/pages/occhealth-exec-diagnostic

Health system administrators are asking occ med programs to justify the footprint, demonstrate physician value, and tie compensation to outcomes. It's a reasonable ask — with one serious problem: the frameworks that exist weren't built for this specialty.

Press Ganey measures acute care patient experience. HEDIS tracks preventive care and chronic disease management. Standard scorecards reward volume, RVUs, and satisfaction scores. None of them capture what a great occupational medicine physician actually does.

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

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

After working through this challenge with 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.

Step 1: Measure Timeliness Report turnaround is a top employer satisfaction driver, and it's entirely within a physician's control. Set a clear target: 85% of reports delivered within 24 hours of exam completion. Track it by physician, by quarter, without exception.

Step 2: Assess Clinical Appropriateness Are your physicians practicing guideline-concordant care? Imaging referral rates — particularly early MRI for acute MSK complaints — are a reliable proxy for both cost stewardship and evidence-based practice. ACOEM and ODG provide the benchmarks. Use them.

Step 3: Track Return-to-Work Support Modified duty utilization is one of the strongest predictors of case duration and total workers' comp cost. The question to answer: is your physician documenting RTW options and communicating them to the employer? That behavior is measurable, and it should be measured.

Step 4: Collect Employer Experience Data This is the domain most programs skip — because it requires infrastructure. A five-question post-case-closure survey, sent to the employer contact within five days of closure, gives you the signal no EMR report can: did this employer feel like a partner, or a transaction? Build the survey. Send it consistently. It's the metric that correlates most directly with retention.

Step 5: Track Regulatory Compliance For programs performing DOT exams, FMCSA error rates are a clean, objective measure with real liability stakes. Easy to pull. Hard to argue with. If your physicians are doing federally regulated exams, this belongs in the scorecard.

Putting It Together

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 control — not payor mix or scheduling factors outside their hands.

The framework is the straightforward part. The harder part is collecting the data consistently, generating reports administration will trust, and keeping the employer survey program running quarter after quarter without it falling off someone's to-do list.

That's exactly why NAOHP is launching a supported implementation program — pairing the physician quality framework with dedicated data collection and reporting support, plus consulting from customer experience expert Barbara Khozam, to help member programs stand this up without building from scratch.

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 already asking you to show the data — or you want to be ready when they do — this is worth a conversation.

👉 Request a discovery call here

The virtual orthopedic curbside model we introduced two weeks ago has a simple clinical premise: get specialist input before the referral decision, not after.

The more honest reason MSK cases get referred out isn't that conservative management failed — it's that the clinician managing the case didn't have the orthopedic depth to manage it confidently in the first place. APPs and early-career physicians in occ med settings often lack the specialty training to assess, treat, and progress an acute MSK injury with any confidence. When clinical uncertainty hits, the default is referral. That's understandable. It's also where the case — and the employer relationship — walks out the door.

The Upswing Health virtual curbside model addresses that directly. A board-certified orthopedic specialist consults on the case alongside your clinician — guiding the clinical decision in real time, not waiting for the patient to stall out. In the Connecticut pilot, the majority of cases were managed conservatively to resolution inside the program. Outcomes: 35.9% reduction in MSK costs. Zero MSK-related ER visits.

That's not just a clinical win. It's a contract renewal conversation.

If you haven't run your own program's numbers yet, the calculator takes about 15 minutes.

👉 Schedule a brief call to 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 →

— 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