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HomeMy WebLinkAboutRESPONSE - RFP - 7438 MEDICAL PROVIDER - WORKERS COMPENSATION & DOT MEDICAL EXAMS1 EXECUTIVE SUMMARY University of Colorado Health System is committed to its vision of providing World Class Health Care to our patients and to the communities we serve. That commitment in the area of Workers’ Compensation extends to community employers designating our Colorado Health Medical Group (CHMG) Occupational Health Clinics as their medical provider. Our focus is on partnering with employers to provide optimal health care in the most expedient manner possible with the goal of returning the injured worker to the job. Occupational Health would like the opportunity to continue our partnership with the City of Fort Collins as one of its designated medical providers for workers’ compensation injuries, post offer employment testing, medical surveillance, drug testing and preventive services and DOT exams. Occupational Health represents a strong commitment to high quality, cost-effective, and innovative occupational health services for your employees. Key points addressed in the content of the RFP include: • Provider staffing under the direction of an Occupational Medicine Board Certified physician with in depth experience in Workers’ Compensation issues worldwide. Our physicians practice only in the area of Occupational Medicine, are Board Certified, and Level II accredited. • Occupational Health currently offers four clinic locations; Fort Collins, Loveland, Greeley and Cheyenne. A new, centrally located Fort Collins clinic will be opening in 2014 near the CSU campus. • A ten percent (10%) payment discount off the Colorado Medical Fee schedule for Occupational Health Clinic and Rehabilitation charges and a five (5%) discount off of physicals and medical surveillance services for prompt payment. • Staff and procedures dedicated to assure consistent and timely communication with the injured employee, the employer, the claims administrator and all persons necessary to resolve the claim. • Immediate access to information systems and documentation of services provided within the University of Colorado Health System and all points of entry for medical decision making. • Access to iSYSTOC, an internet based computerized management program which allows designated City Risk Management staff to track appointments, view work status (M164 form) reports, and create reports for trending. • Thorough and timely physician narratives from first visit to closure, with appropriate impairment assessment (as indicated.) • Adherence to the use and implementation in treatment planning of the Colorado Medical Treatment Guidelines and evidence based medicine to assure quality of care and contain costs. • Average less than 0.9 lost days per claim in 2011-2012 Colorado Health Medical Group Occupational Health 2 Colorado Health Medical Group Occupational Health 1. Qualifications of firm Dedicated to the delivery of world-class integrated healthcare with measurable quality and outcomes, Colorado Health Medical Group (CHMG) is the largest and most comprehensive medical group in northern Colorado. The multi-specialty group, formerly known as Poudre Valley Medical Group, is part of University of Colorado Health, which provides health care, wellness services and health promotion in Colorado, Wyoming and Nebraska. The hospitals of University of Colorado Health include Poudre Valley Hospital in Fort Collins, Medical Center of the Rockies in Loveland, University of Colorado in Denver and Memorial Hospital in Colorado Springs. With over 180 employed medical providers, Colorado Health Medical Group offers clinics throughout the region representing 26 specialties, including Occupational Health. Our service has provided area employers dedicated Occupational Health services since 1987. Over the years our program has grown in response to the needs of Northern Colorado area businesses to cover a large part of the northern Colorado and Southern Wyoming region. Under the direction of John Charbonneau M.D., a Board Certified Occupational Medicine Physician, the program is designated as preferred provider by a number of Workers’ Compensation insurance carriers. Membership in these preferred provider networks is based on our ability to demonstrate quality care, to provide cost effective treatment, and to manage the case effectively to closure. CHMG Occupational Health offers a comprehensive occupational health program designed to assist the employer with the treatment, management, and prevention of work-related injuries. Our physician directed program assures an aggressive and highly managed treatment approach. Collaboration with the employer to assure an understanding of the work setting, job requirements and ability to place individuals in a modified duty position, if indicated, is essential to assuring a rapid and productive return to duty for the injured worker. Communication is a key element in any workers’ compensation case. Occupational Health prides itself on the accessibility of our providers and case managers and of the consistent and timely open communication we establish with both injured workers and our client companies. Our physicians are working diligently to continually improve on causality determination, and subsequent use of the Colorado Medical Treatment Guidelines in determining the course of the treatment to bring each case to Maximum Medical Improvement. The State form is completed electronically and emailed to the City Risk Management staff after each visit. All categories are addressed on the form at each visit including: work status, restrictions for physical demands, treatment plan, determination of work relatedness, and anticipated MMI and impairment consideration. Should the physician recommend a referral to a specialist or for diagnostic testing the Risk Management team will be called the following day for authorization. STAT or immediate referrals for medical necessity will be made without authorization. We assist in the prevention of work related injuries through education, on site familiarity with the work settings, and review of injury trends. We work as a collaborative team with Risk Management and the claims administrator to ensure claims are managed from initial determination of work relatedness to early return to productive employment and Colorado Health Medical Group Occupational Health 3 case closure. Our daily goals are: 1.) to deliver prompt, customer focused quality care to injured workers, 2.) to communicate with our client companies so that they are informed at each stage of the treatment process, 3.) to return injured employees as quickly as possible to their pre-injury work status, and 4.) to provide employers with additional assistance in the areas of prevention and pre-placement services. Our business is exclusive to medical management of Workers’ Compensation injuries and services designed to assist the employer with medical surveillance and prevention to assure a safe work environment. Our quality assurance program monitors return to work days and patient understanding of their work restrictions as described on the M-164 form. In the last year we returned 99.1% of our initial injury patients to work within three days or less, resulting in decreased lost time costs for employers. In addition our 2011* patient satisfactions surveys indicate 97.4% of our patients state that they understood their work restrictions as written and reviewed by the physician. (* CHMG changed venders for patient satisfaction survey data in 2012, and will have updated reporting shortly.) 2. Staff Qualifications : (Attachment A and B) Medical Director: John Charbonneau, M.D. Staff Physicians: Michael Holthouser, M.D. Kevin O’Connell, M.D. ( Kevin O’Toole, D.O. Tracey Stefanon, D.O. Ann Yanagi, M.D. University Of Colorado Health System, as a JCAHO accredited institution, must verify employee credentials upon hire, and assume responsibility to assure ongoing competency for all staff. Yearly standards are established for life safety training as well as job specific professional competencies for essential functions and critical job skills for all job categories. All Occupational Health physicians must be Board Certified in their area of specialty and attain Level II accreditation within one year of employment. Working solely with the industrial population, our rehabilitation staff provides services including: work-injury rehabilitation, employment testing, job-site analysis and injury prevention training. Our rehabilitation staff is a top-notch team of ergonomic specialists, physical, occupational, and massage therapists, who work closely with the physician, patient, and the employer to assure treatment is progressing rapidly and addressing the essential physical demands of the individual’s job description. They have expertise in evaluating work-injuries, assessing the job site based on the Colorado Cumulative Trauma Medical Treatment Guidelines, and in recommending and providing treatment to allow the worker to be responsible for his/her own exercise program, body mechanics and preventive knowledge. Colorado Health Medical Group Occupational Health 4 3. Copy of Fee schedule (Attachment C and D) CHMG-Occupational Health fees for injury management, testimony, impairment, etc., are billed at the rate outlined in Rule 18 of the Workers’ Compensation Rules of Procedure. Included in (Attachment C) are the current 2012 fees for injury treatment billing and copies of letters outlining fees and payment requirements for deposition, testimony and DIMES. Typically each January, there is an increase in the fee schedule as determined by the Colorado Legislature; this increase has averaged two percent (2%) annually. Our services will be discounted to the City of Fort Collins at a rate of 10% off the State fee schedule as amended annually by the Division of Workers’ Compensation. The fees will be automatically adjusted to the set rate in Rule 18 on January 1 of each year of the contract with the City. Client billed fees, not covered under the fee schedule for non injury service such as post offer testing, Fit for Duty testing, DOT physicals, etc are included in (Attachment D I) and are listed at 2012 rates. A five (5%) prompt payment discount will be given for payment received within two weeks of the billing date. These rates are reviewed annually and any rate increase will be sent to the City for review prior to implementation. 4. Description of Facilities (Attachment E) Snow Mesa Clinic: Monday-Friday Apts 6:30AM-6:00PM Walk-ins 8:00AM-5:00PM Located at 4674 Snow Mesa Drive, Suite 200 on the Harmony Campus of University of Colorado Health in Fort Collins. Physical, Occupational and Massage therapy are provided on site, as well as Post offer testing, Fit for Duty testing and Functional Capacity Evaluations. Dr. Bruns, will offer psychology evaluation and treatment at this facility one day each week. Patients are referred on campus for radiology, laboratory and other diagnostic services. Drug Collection and Breath Alcohol Testing certified staff is available for injury and employment screening. Loveland Clinic: Monday-Friday 8:00AM-5:00PM Located in the Medical Center of the Rockies campus, at 2500 Rocky Mountain Ave, Suite 330 this new facility offers a comprehensive array of state of the art diagnostic and treatment services including all radiology, imaging and laboratory services. Physical therapy is offered onsite. Greeley Clinic: Monday-Friday 8:00AM-5:00PM Located at 1900 16th Street in Greeley in the Greeley Medical Clinic, this facility offers Urgent care, full radiology and laboratory services. Therapy services are offered at our Peakview clinic. Cheyenne Clinic: Monday-Friday 8:00AM-5:00PM : Located at 5050 Powerhouse Rd in the Cheyenne Medical Specialist Clinic this is our newest site. This clinic also has a full range of diagnostic services including radiology, and laboratory. Currently, the focus of our Cheyenne clinic is on Medical Surveillance, Physicals and Drug Testing. Colorado Health Medical Group Occupational Health 5 Each of our clinics are able to address urgent care walk-in situations such as; laceration repairs, eye injuries requiring irrigation and slit lamp examination. Our clinics are equipped with an Audiology testing booth, Spirometry for Pulmonary Function testing, EKG, and Titmus Vision screener to evaluate the occupational vision testing requirements for DOT and other medical surveillance tests. Each clinic is a collection site for Drug and Breath Alcohol testing. Pharmacy services are not provides by our clinics; we work with the client company to assure employees are directed to the insurers or employer’s selected pharmacy. All sites provide immunizations, such as Hepatitis A and B, rabies, MMR, tetanus and PPD testing. An essential element of our ability to provide rapid, coordinated and comprehensive services is the fact that we are able to view electronically, any report, physician dictation or study completed within the University of Colorado Health System. This connectivity assures ready access to all aspects of a patient’s care. Conversely, should an Occupational Health patient require emergency treatment or hospitalization the medical record is readily available. We adhere to the HIPAA Privacy Rule and we follow these guidelines for release of information. 5. Scope of Work At CHMG Occupational Health we deliver World Class Healthcare to each of our patients. For injured workers this starts with a thorough determination of causality and medical probability that the mechanism of injury is work related or work aggravated. In the treatment of the injured worker this means early and ongoing aggressive management of the injury or illness with a determined focus on returning the worker to the job in a productive capacity as soon as possible. Working closely with the City Risk Management department is critical to assuring the individual has modified duty placement if necessary and that the supervisor is aware of any restricted duty. In addition to injury management we offer a full range of Medical Surveillance and annual physicals for corporate wellness in addition to focused physicals for Fit for Duty evaluations, DOT, Asbestos, Respirator and Haz-Mat physicals. For each of these specific physicals, the requesting party (Human Resources or Risk Management) will receive a report or Physician Written Opinion indicating findings and recommendations. These reports are typically available next day. We require our physician providers to complete the Federal Motor Carriers Safety Administration (FMCSA) medical examiner certification credential by January 2013 to assure continued compliance with the Federal requirements. Documentation of medical findings for DOT exams are provided to the City within 24 hours. Other physicals may require laboratory reports, stress tests, etc and documentation will be provided as soon as the physician has reviewed all findings and completed the Physician Written Opinion; generally within 3 working days. City employees may complete a release of information at the time of the visit to request copies of their records as well. All clinics are available for walk-in new injury visits from 8:00AM-5:00PM, Monday- Friday. Recheck appointments are scheduled per the physician and vary from 20 minutes to 40 minutes, based on physician preference. Colorado Health Medical Group Occupational Health 6 Our job begins with the most complete history possible, a thorough understanding of the mechanism of injury, the job requirements, diagnostic testing and frequently a job site assessment to obtain the information needed to determine work relatedness, establish a diagnosis, and treatment plan. We value the information we glean from the patient, the employer and the carrier in assuring complete and accurate data is available in the management of the case. Adherence to the Division of Workers’ Compensation Rule 16 and 18 and the Medical Treatment Guidelines (Rule 17) for injuries provides a structure for decision making. Our physicians will contact the City Risk Management staff after the first visit to report on causality, diagnosis and treatment plan. The physician or case management staff will also call to notify the Risk Management department if admission to another facility is required or if there is a request for a specialist visit. CHMG-OH physicians feel that the injured worker’s care and potential for improvement is significantly improved when the employer is able to provide modified duty options to ensure rapid return to work. Our physicians educate the patient from the first visit on the value of remaining productive and on the job. Our experience indicates the injured worker feels valued and will recover quicker when he/she is a productive member of the work group. We believe it is essential the injured worker understand that prescribed work restrictions are inclusive of all activities of daily living, including home and recreation, and are not just limited to the workplace. Work restrictions are reviewed with the patient by the provider, and then again by the scheduler during our check-out process. We feel this offers the patient opportunity to question and clarify his/her restrictions. We also encourage an active rather than passive role in treatment and in rehabilitation. Our intent is to provide the injured worker with a home program that he/she will do independently and that we will monitor for progression needs allowing us to advance work restrictions in conjunction with the home program. We believe the injured worker is not unlike an injured athlete. The focus must be on individual’s responsibility for adhering to modified duty requirements and in advancing the treatment program to meet the goals of performance and essential functions of the job. When the goal is to return to the job in a productive capacity and the increments are measurable in specific job tasks the individual has greater ownership in his/her outcomes. . Patients are always given two copies of the M-164 work status prior to leaving our clinics. They are instructed that one copy is theirs and the second copy is to be returned immediately to the supervisor. Our physicians and case management staff will meet monthly or as needed with the Risk Management staff, claims administrator, and other individuals as requested to review specific cases and discuss treatment plans. As indicated, the physician will be available to discuss or provide in writing rational for care outside the Medical Treatment Guidelines in the rare instances this occurs. When requested, these reports will be available within fourteen days. Site visits to the employer’s job site are also helpful to our physicians to assist in understanding specific job concerns. These visits are arranged on an as needed basis. The physician is the primary case manager for each Workers’ Compensation claim. Our case management staff works collaboratively with the physicians by reviewing charts daily for authorization needs, communication needs and “red flags.” The case managers assure the physician has the information required and authorizations in place Colorado Health Medical Group Occupational Health 7 to provide the patient the optimal care required in a timely manner. Our case managers are responsible for assisting the physicians and Risk Management with the detail of keeping cases “on track.” The case manager is both the employer’s and the employee’s resource when questions arise and additional information is needed to move a case along and bring it to closure. Our clinics utilize an electronic case management program (SYSTOC) which tracks each individual employee from initial visit until the employee reaches Maximum Medical Improvement (MMI). The written Work Status Report (M-164) outlining the employee’s functional gains or losses, changes in work status and/or work restrictions, and prognosis for return to work, will be provided to the employee and the Risk Management office via email at the time of the visit. The physicians’ dictation, detailing the medical treatment plan will be available within twenty-four (24) hours of the office visit or the next business day. An Internet based version of our data base is available to the Risk Management department. This service will give Risk Management authorized staff access to view patient specific injury and treatment information. The data is presented in a real time, interactive, on-line environment over a secure and encrypted connection. Each of our physicians encourage phone calls from the employer at any time to question, clarify, or provide additional information. Our case managers are available as well, to meet your needs, and want to be certain we address any concerns or needs of the Risk Management department. 6. References Occupational Health has been the designated provider of the majority of large Fort Collins employers over the last twenty years. We are proud to be the current primary designated provider for the City of Fort Collins, Poudre School District, Columbine Healthcare, Poudre Fire Authority, Colorado State University, Anheuser-Busch, Avago Technologies, WalMart Distribution Center, and the University of Colorado Health System, among others. The client companies listed below have been chosen as references due to the variety of services they require of our program, and because they have similar occupational health management needs to those of the City. These companies are particularly concerned that they receive cost effective health care, and that the emphasis remain on safety and injury/illness prevention services for their employees and business. Kenda Weigang, Risk Manger Betty Greenberg or Kat Rossman Colorado State University City of Loveland 970-491-4832 970-962-3314 Cindy Comer, RN, COHN Dawn Filsinger, Risk Manager Centers for Disease Control Columbine Health System 970-225-4269 970-492-6233 Colorado Health Medical Group Occupational Health 8 7. Referral Specialists: description of use and time frames. (Attachment F) Occupational Health is a SelectNET provider with Pinnacol Assurance and uses the resources of this preferred provider network and our own Colorado Health Medical Group in making Workers’ Compensation referrals when the employer does not have a specific provider group requirement. Should the City or its third party payor choose to designate certain specialty providers or groups, we will work within those requests. As the designated Primary Provider, the CHMG Occupational Health physicians will restrict the referral provider or specialist from making subsequent referrals. This referral control is assured via the referral process and ongoing OH case management communications by our case managers and the specialist’s office.. The majority of our specialty referrals are for Orthopaedic consults, and our physicians utilize primarily the Orthopaedic Center of the Rockies and the Orthopaedic physicians of Colorado Health Medical Group (CHMG.) Our physicians refer primarily to Daniel Bruns, PhD or Ron Carbaugh, PhD for psychological evaluations. For patient convenience, Dr. Bruns will come on site to our Fort Collins office weekly beginning in November. John Zimmerman and Scott Parker are the providers of choice for chiropractic. Scott Primak, Rebekah Martin (both Physiatrists) and David Columbus, M.D. are our choice for referral specialists in delayed recovery and pain management. 8. Mental Disability Protocol: A routine element of each physician’s initial examination of a patient includes a review the individual’s psychosocial functioning. Notation of pre-existing diagnosis, treatment and medications are included in the initial assessment, if relevant. This information provides valuable base line data in cases where mental heath concerns are raised. Assessment of psychosocial function continues throughout the course of treatment and includes routine visit questions re: eating, sleeping and digestive habits that can be indications of psychosocial dysfunction. When these symptoms are noted, or when a patient claims a mental disability as a result of a physical injury a psychological consult referral is made to Dr. Daniel Bruns, PHD for evaluation of the patient. Dr. Bruns has been very active in the area of medical guidelines and the passage of biopsychosocial legislation, particularly in Colorado, but these efforts have had impact nationwide. Through Dr. Bruns efforts, Colorado became the first state to have regulations that mandated a biopsychosocial medical treatment model in the worker compensation system. Dr. Bruns took a leadership role in the development of the Workers’ Compensation Medical Treatment guidelines, including the Chronic Pain Disorder Medical Treatment Guidelines, just recently revised. Colorado Health Medical Group Occupational Health 9 Based on an evaluation by Dr. Bruns , our physician will determine a treatment plan, and if appropriate and may utilize Dr. Bruns for short term treatment. Addressing work related psychological issues is important to assure the case is on track and the patient understands the issues and receives necessary treatment and support in a timely manner. Rarely is a claim regarding mental disability, considered for mental impairment, as the State has a narrow definition of what might constitute a legitimate claim. Only psychologically traumatic events that are outside an employee’s usual work experience and would evoke significant symptoms of distress to workers in similar circumstance are considered for impairment rating. Stress, job changes, employer /employee differences are not considered ratable. 9. Percent of Business pertaining to occupational injures: Our services are dedicated solely to the provision of occupational health and injury prevention services. An estimated 80% of our clinics’ volume is management of work- related injuries. The remaining 20% of our business is in the provision of other occupational specialty services such as DOT physicals, employment testing, immunizations, drug testing, and annual surveillance testing. 10. Maintaining Control of specialist referrals: (Attachment G) When indicated, our physician will determine which specialist to refer an injured worker to, and will schedule the appointment prior to the patient leaving the clinic to promote follow through and to assure the appointment is set within five days. Return Occupational Health follow up visits are scheduled within three to five days of a specialist appointment to assure we have received the documentation from the specialist and are able to act on findings rapidly. Any change to the work status or work restrictions is made only by the Occupational Health provider. Failure to follow these procedures by a referral provider risks their exclusion from our referral list. Our Occupational Health physicians meet routinely with our primary specialist to assure open communication and the ability to request “urgent” referral access when acuity of a case requires more immediate access. When a referral is made the specialist receives case records, medication history, and a referral letter which reinforces the requirement the specialist must work within re: case control. 11. After hours care options and Emergency care: (Attachment H) Harmony Urgent Care Center (HUCC), 2127 E. Harmony Road, Fort Collins is available for urgent care needs when the Occupational Health clinics are closed. HUCC is open to OHS patients from 5PM-9PM Monday-Friday and on weekends 8:00 to 8:00PM. Full imaging and laboratory services on site. Poudre Valley Hospital Emergency Department 1024 Lemay Ave, Fort Collins. Full service hospital, diagnostic and imaging services on site. Colorado Health Medical Group Occupational Health 10 Medical Center of the Rockies Emergency Department, Level II Trauma Center 2500 Rocky Mountain Ave, Loveland. Full service trauma hospital, state of the art diagnostic and imaging services on site. 12. Time allotted for office visits: (Attachment I) Initial injury visits are scheduled for 40 minutes. When a case is transferred to our service or is a reopen of an injury more than six months old the initial appointment is determined by the MD, but is generally 60 minutes. New injuries seen on a walk in basis are triaged and based on severity, may be seen ahead of a scheduled visit. The clinics each “block” four walk-in appointment times into each physician’s daily schedule, to allow a buffer to the scheduled appointments, so wait times are not generally longer than 15-20 minutes when required. Revisit or follow up appointments are scheduled for 20 minutes unless the physician requests additional time for the appointment or when an interpreter is required. Missed appointments are not well tolerated. The injured employee is informed at the start of treatment and at the start of any therapy that it is essential to his/her recovery to attend all appointment. Patients are required to sign a form (Attachment I) that indicates they are aware they must take and active role in their care and attend all treatment sessions and appointments. Repeat cancellations and rescheduling will be brought to the attention of the Risk Management dept. 13. Impairment ratings: All permanent impairment ratings are based on the American Medical Association Guidelines to the Evaluation of Permanent Impairment, Third Edition (Revised.) This rule implements the Division’s permanent impairment rating guidelines on how to appropriately utilize and report permanent impairment. When the authorized treating physician has determined that the injured worker is at maximum medical improvement (MMI) and has not returned to his/her pre injury status, physically and/or mentally, the physician determines a permanent medical impairment in accordance with Rule 12. Any apportionment of permanent impairment rating of a pre-existing permanent medical impairment form a work-related injury or occupational disease will be explained in the dictation of the visit. Our case manager will work with the claims administrator to secure all previous medical records to assure adequate information is available at the time of the rating. Our physicians understand the tremendous financial implications of impairment ratings and continually review the regulations and work diligently to assure accurate measurement, and reporting to the employer and adjustor. Most impairment ratings and reports are available the following day. Colorado Health Medical Group Occupational Health 11 Colorado Health Medical Group Occupational Health SUMMARY NOTE Occupational Health has delivered locally-controlled and responsive injury management services from a not-for-profit community hospital setting for more than two decades. We appreciate the opportunity to respond to the RFP for the City of Fort Collins for selection of one of your preferred medical providers for Workers’ Compensation injuries and DOT Medical examinations. We feel strongly that our proposal meets the requirements and intent of the RFP, and our relationship with your company as one of your current preferred providers demonstrates our expertise, customer focus and sincere interest in working as a partner to improve the safety and productivity of your workforce. We thank you for the opportunity to address your questions and highlight our services. University of Colorado Health Formerly Poudre Valley Health System CHMG CEO and President Russ Branzell CHMG VP Operations Donna Lankford OH Case Managers Mike Asmus, R.N. Stephanie Johnson OH Medical Director John Charbonneau, M.D. Service Line Administrator Jill Fitzgerald . Loveland Clinic Michael Holthouser, M.D. Kevin O’Connell, M.D. Stuart Peterson, LPT Medical Assistant staff (2) Secretary/ Receptionist (2) Snow Mesa, Fort Collins John Charbonneau, M.D Tracey Stefanon, D.O. Ann Yangai, M.D. Kevin O’Toole, D.O.. Paul Braunlin, LPT Barbara Walden, LPT Krisitne VonNeida, LPT Kathy Lindsay, LPT Dianne Holland, OTR Joy Tandberg, OTR, CHT Workplace and Ergo (2) Medical Assistant staff (6) Secretary / Scheduling (3) Medical Records (1) Greeley Clinic John Charbonneau, M.D Kevin O’Connell, M.D. Mike Deitz, P.A. Medical Assistant staff (2) Secretary/Receptionist (1) Cheyenne Medical Specialists –Occupational Health John D. Charbonneau, M.D., MPH, FACOEM COLORADO HEALTH MEDICAL GROUP OCCUPATIONAL HEALTH 1900 16TH STREET GREELEY, CO 80631 PHONE: 970.350.2471 FAX: 970.350.2418 Board Certification American Board of Preventive Medicine in Occupational Medicine, 1986 Fellowship Status Fellow, American College of Occupational and Environmental Medicine, 1995 Professional Experience COLORADO HEALTH MEDICAL GROUP OCCUPATIONAL HEALTH 2012 – PRESENT Medical Director for CHMG . Providing leadership and direction of 4 Occupational Medicine clinics. Active patient practice. CHAMPS, INC (CORPORATE HEALTH AND MEDICAL PROGRAMS) 1990-2012 Medical Director since 1994. Vice-President. Director, Occupational Medicine. Full-time practice of Occupational Health within a multi-disciplinary group practice. Greeley, Colorado. OCCU-CARE, INC ® (THE RAMAZZINI CENTER ®) 1994 – PRESENT Founder and President. Consulting services. HEWLETT PACKARD COMPANY 1991 -PRESENT Regional Physician Consultant to Hewlett Packard facilities. UNION PACIFIC RAILROAD 1990-PRESENT Regional Consulting Physician since 1989. Regional Medical Director since 1999. Associate Medical Director since 2004. Consulting Corporate Medical Director, developing policy and procedures for a nationwide hazardous disposal company, 1990-1994. STATE FARM INSURANCE 1986-PRESENT Regional Medical Director for Colorado, Wyoming, and Utah since 1994. Designated Treating Physician. BENCHMARK WORKER REHABILITAION SERVICES 1990-2000 Medical Director. State of the art work conditioning program. Full-time practice of Occupational Medicine including direct in- jury/illness patient care, case management, medical surveillance examinations, independent medical examinations and impairment ratings and corporate level consultation services to companies such as Monfort of Colorado (Red Meat Division of Con Agra), Tele- dyn Waterpik, Anheuser Busch, Hewlett Packard Company, State Farm Insurance, Colorado Compensation Insurance Authority, and many others. KODAK COLORADO DIVISION 1997-PRESENT On-site physician consultant. Designated Treating Physician. UNITED STATES POLLUTION CONTROL, INC (USPCI) 1990-1994 Consulting Corporate Medical Director, developing policy and procedures for a nationwide hazardous waste disposal company. WORKCARE CLINIC, SALT LAKE CITY, UTAH 1986-1990 Established a full-service ambulatory care Occupational Medicine practice with one practice partner. Provided screening exams, injury and illness care, rehabilitation services, case management and Occupational Health Consultation services to hundreds of companies in Salt Lake City and suburbs. WORKERS’ COMPENSATION FUND OF UTAH, SALT LAKE CITY, UTAH 1986-1990 Physician consultant for Case Management and lectures to adjustors and management. MILNE TRUCK LINES, INC, PLEASANTON, CA 1983-1987 Consultant Corporate Medical Director for a large interstate trucking company. Established and maintained corporate policies and procedures. Medical liaison between company and various health care providers in nine western states. Independent medical ex- ams/impairment ratings. Performs IMES and Impairment Rating for employers, insurance companies and attorneys. Occupational Medicine Consultant Services. SALT LAKE CITY WORKMED OCCUPATIONAL CLINIC 1983-1986 Ensure that appropriate medical care is rendered to all clinic patients with occupational injuries and illnesses. Direct the activities of physicians, physician assistants, medical technicians, physical therapists, x-ray technicians employed at the clinic. Responsible for establishing appropriate protocols for each client company based on the hazards and potential exposures at the work site and the needs of the company, and to ensure that protocols were followed. John Charbonneau, MD, page 2 INTERMOUNTAIN POWER PROKECT – FIRST AID FACILITY 1983-1986 Establish and maintain policies and procedures for the facility. Supervision of the activities of the facility physician assistant - man- ager and staff. Weekly visits to site to see patients and review all charts. DEFENSE DEPOT OGDEN – U.S. ARMY HEALTH CLINIC 1983-1986 Administrative, technical and medical support to site medical officer DECKER LAKE YOUTH DETENTION CENTER 1983-1986 Establish and maintain policies and procedures for the facility medical station. Supervision of facility medical station. Supervision of facility registered nurse. U.S. STEEL – GENEVA WORKS 1982-1983 Medical Director. Responsible for Medical Department at U.S.S. – Geneva Works – a plant of 3500 to 5000 employees. Chief duties included: care for all occupational injuries and illnesses and non-occupational emergencies, supervised all dispensary activities and personnel and review all s-rays taken in plant. Supervised and conducted health surveillance programs for coke oven facility, open hearth and foundry, benzol works, and hearing conversation program. Made daily contact with department heads in Employee Rela- tions, Safety, Security, Personnel and Benefits, Legal Department and Operating Units. Performed all final disability/impairment examinations in cases where patients claimed permanent loss due to industrial injuries, all disability pension examinations and all management physicals exams (including sigmoidoscopy). Served as Medical Advisor to U.S.S. Open Pit Ore Mine in Atlantic City, Wyoming, and U.S.S. Coal Mine Operations located in East Carbon, Utah and Somerset, Colorado. U.S. STEEL – SOUTH WORKS 1979-1982 Works Physician. Charged with responsibility for the dispensary portion of the Medical Department at U.S.S. – South Works – a plant of 9000 employees. Chief duties encompassed providing initial and follow-up care, including rehabilitation planning for all in-plant injuries and medical emergencies. Supervised dispensary activities of three nurses and an x-ray technician. Responsible for medical activities including interpretation of all audiograms performed in the plant and reading all x-rays (approximately 20 chest films per day in routine surveillance and those ordered in the work-up of injuries). Maintained close contact and active communication with the Safety and Security Departments including attending in emergency ambulance calls with EMTs/Paramedics on major trauma/medical runs and frequent instructions periods and critiques. Performed final disability/impairment examination on patients claiming perma- nent loss due to industrial injuries. Made daily contact with the Insurance/Compensation Department, Legal Department, Plant Super- vision and operating units. BETHLEHM STEEL, BURNS HARBOR, INDIANA MARCH 1978- JULY 1978 Plant Physician. Education University of Utah – Master of Public Health (MPH), 1989 University of Utah Medical Center, Rocky Mountain Center for Occupational & Environmental Health – Resident in Occupational Medicine, 1982-1984 University of Colorado Health Sciences Center, Denver, CO – Surgical Internship, 1979 Indiana University School of Medicine, Indianapolis, Indiana – MD, 1978 Valparaiso University, Valparasio, Indiana – Bachelor of Science (BS) Biology & Chemistry, with distinction, 1974 Andrean Catholic High School, Merrillville, Indiana – Salutatorian, 1970 Professional Activities & Licensure American College of Occupational and Environmental Medicine – Member and Fellow, Member since 1980 American Medical Association – Member Colorado State Medical Society – Member Weld County Medical Society – Member Utah State Medical Association, House of Delegates – Delegate representing physicians not affiliated with a hospital, 1988-1990 Utah State Medical Association, Physician Assistant Committee (Rules and Regulations Sub-Committee) – Member, 1984-1989 University of Utah School of Medicine, Department of Family and Preventative Medicine – Clinical Faculty, 1982-1990 Page 2 John Charbonneau, MD, page 3 University of Utah School of Medicine, Residency Advisory Committee, Occupational Medicine Residency – Member, 1985-1990 Chairman, 1988-1990 University of Utah School of Medicine, Resident Selection Committee, Occupational Medicine Residency – Member, 1988-1990 University of Utah, Medex (Physician Assistant) Training Program Advisory Committee – Member, 1988-1990 Licensed to practice medicine in Colorado, Wyoming, and Idaho Taught EMT-A, 20-hour refresher course in Illinois 1979, 1980, 1982 and in Utah 1983 Author and Lecturer - Colorado Division of Worker’s Compensation Level II Accreditation Course, Sections on Lower Extremity and Spinal Impairment Rating Rocky Mountain Academy of Occupational and Environmental Medicine – Member since 1990 Board of Directors, 1992-1997, 2006-2009 Vice President, July 1994- January 1996 Program Chair for Annual Meeting, 1995 President, 1996 Page 3 MICHAEL G. HOLTHOUSER, M.D., M.P.H. 1017 Elbert Ave, Loveland, Colorado 80537, Telephones: Work 970-495-8450, Cell 502-727-2851, Fax 970-495-7620 EXPERIENCE COLORADO HEALTH MEDICAL GROUP Jan 2012 – present OCCUPATIONAL HEALTH , Formerly, Poudre Valley Health System Occupational Medicine Physician OCCUPATIONAL HEALTH SERVICES, POUDRE VALLEY HEALTH SYSTEM, Fort Collins, Colorado. June 2003 – Jan 2012 Medical Director CONCENTRA HEALTH CENTERS, Denver, Colorado July 2002 - May 2003 Medical Director for Thornton Clinic. CONCENTRA HEALTH CENTERS, Louisville, Kentucky Jan 2001 - May 2002 Center Medical Director CARITAS OCCUPATIONAL HEALTH CENTER, Louisville, Kentucky August 2001- Jan 2002 NORTON HEALTHCARE, Louisville, Kentucky 1996 - July 2001 Medical Director GENERAL ELECTRIC COMPANY, Pittsfield, Massachusetts 1994 - 1996 Medical Director WEYERHAEUSER COMPANY, Tacoma, Washington 1991 - 1994 Corporate Medical Director OWENS-CORNING FIBERGLAS, Toledo, Ohio 1988 - 1991 Corporate Medical Director Page 4 MICHAEL G. HOLTHOUSER, M.D., M.P.H., page 2 IBM CORPORATION, White Plains, New York, Los Angeles, California, Dallas, Texas, Sydney, Australia, Tokyo, Japan, and Harrison, New York 1982 - 1988 Cross Group Medical Director 1987 - 1988 Medical Director 1985 - 1987 Senior Managing Physician 1983 - 1985 Physician Specialist 1982 - 1983 HEWLETT-PACKARD CORPORATION, Loveland, Fort Collins and Greeley, CO 1977 - 1980 Company Physician 1978 - 1980 Contract Physician 1976 - 1978 MOUNTAIN VIEW MEDICAL CENTER, Berthoud, Colorado 1976 - 1978 Family Physician, Owner NORTH FORK MEDICAL CLINICS, Paonia and Hotchkiss, Colorado 1975 - 1976 Staff Physician . ATSUGI NAVAL AIR FACILITY, Atsugi, Japan 1972 - 1975 General Medical Officer EDUCATION ROCKY MOUNTAIN CENTER FOR OCCUPATIONAL AND ENVIRONMENTAL HEALTH, DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE, UNIVER- SITY OF UTAH, Salt Lake City, Utah 1980 - 1982 The Rocky Mountain Center for Occupational and Environmental Health was a National Institute of Occupational Safety and Health (NIOSH) Educational Resource Center. It trained occupa- tional medicine residents, industrial hygienists and occupational health nurses. Most of the fac- ulty were highly experienced occupational physicians, epidemiologists, biostatisticians and in- dustrial hygienists. Page 5 MICHAEL G. HOLTHOUSER, M.D., M.P.H., page 3 Medical Resident and Master of Public Health Degree Candidate • Completed occupational medicine residency in a National Institute of Safety and Health (NIOSH) Educational Resource Center, awarded Residency Certificate • Performed several Health Hazard Evaluations for NIOSH • Completed the full industrial hygiene program, receiving Master of Public Health (MPH) degree • Performed a pathology externship at St. Mary’s Hospital, Grand Junction Colorado learning sputum cytology from Dr. Geno Saccomanno • Performed preceptorship with Occupational Safety and Health Administration (OSHA) National Health Response Team, in Salt Lake City • Worked in a large HMO for pay in the Internal Medicine Walk-in Clinic and stood call evenings for the Salt Lake Valley • Worked as Clinic Physician one day per week at the Kenocott Copper Smelter and Mine Clinic performing general occupational health duties UNIVERSITY of LOUISVILLE AFFILIATED HOSPITALS, Straight Medicine Intern, 1971 - 1972 Straight internal medicine internship performed in a large inner city hospital, Louisville General Hospital, and a Veterans Administration Hospital. Internal Medicine Intern • Completed Internal Medicine PG-1 and was awarded an Internship Certificate UNIVERSITY OF KENTUCKY COLLEGE OF MEDICINE, Lexington, Kentucky, 1967 - 1971 The University of Kentucky College of Medicine was founded in 1960. As a relatively new medi- cal school, the faculty was recruited from around the world. Many professors were from the Brit- ish Isles. A fresh approach to medical curriculum, and teaching methods was undertaken. The mission of the College was to train physicians for practice in a largely rural and agricultural state with severe pockets of poverty and under-served communities. Prevention and innovative methods of caring for poorly educated populations without access to sophisticated medical tech- nology through strong skills development in physical diagnosis, direct clinical care and public health were stressed. Since its opening, the University of Kentucky has become recognized as the best U.S. medical college form training family practice residents Medical Student • Completed the prescribed courses and was awarded the Doctor of Medicine degree (MD) • Served as acting intern in general surgery during senior year • Completed cardiology rotation at the University of Edinburgh, Western General Hospi- tal, Edinburgh, Scotland • Completed a Urology rotation at the Royal College of Surgeons, Trinity College, Jarvis Street Hospital, Dublin Ireland Page 6 MICHAEL G. HOLTHOUSER, M.D., M.P.H., page 4 • Completed a community medicine rotation in Sandy Hook, Kentucky, in Family Prac- tice • Completed a preceptorship with the U.S. Navy Neuropsychiatric Research Unit, Point Loma, San Diego, California and Balboa Naval Hospital, also in San Diego, as an En- sign in the Navy Reserve, Ensign 1915 Program UNIVERSITY OF LOUISVILLE, Louisville, Kentucky 1964 - 1967 The University of Louisville is a large metropolitan research university with colleges of engineer- ing, law, business, medicine, dentistry and many others. It is the second largest university in Ken- tucky, but has the largest college of medicine. Premedical Student • Completed courses required in the premedical curriculum while working a full-time job. Was on Dean’s list most of the time • Accepted into medical school after only three years of pre-medical coursework thus, no undergraduate degree PROFESSIONAL CERTIFICATIONS/APPOINTMENTS/AFFILIATIONS Medical Licenses Active: Kentucky, Indiana and California Inactive: Massachusetts, Ohio, Wyoming, Washington and Colorado Certifications • Certified by the American Board of Preventive Medicine, in Occupational Medicine • Certified by the Medical Review Officer Certification Council as a Certified Medical Review Officer • Level Two Accredited with the Colorado Division of Workers Compensation Appointments • Formerly University of Louisville School of Medicine, Industrial Toxicology Section, Department of Medicine as Clinical Associate Professor • Former Member of the Council for Accreditation in Occupational Hearing Conserva- tion representing the American College of Occupational and Environmental Medicine. Affiliations • American College of Occupational and Environmental Medicine – Master • Former Chairman of the Noise and Hearing Scientific Committee • Member of the Publications Committee • Member of the Scientific Affairs Council • Member of the Corporate Medical Directors Section Page 7 MICHAEL G. HOLTHOUSER, M.D., M.P.H., page 5 • Member of the International Occupational Medicine Section • Instructor in “The role of the Professional Supervisor of an Occupational Hearing Conservation Program” course cosponsored by CAOHC and ACOEM given annually at the American Occupational Health Conference • Instructor in “How to improve your Hearing Conservation Program” course cosponsored by CAOHC and the American Academy of Occupational Health Nurses given annually at the American Occupational Health Conference • American College of Preventive Medicine – Fellow • American Medical Association – Member. • Kentucky Occupational and Environmental Medicine Association – Past President • Kentucky Medical Association – Past Member and Specialty Component Representa- tive • Jefferson County Medical Association – Member • American Industrial Hygiene Association – Member. Languages, written and spoken • German • Japanese • Spanish Recent Publications • Holthouser, M.G. The Role of the Professional Supervisor in an Occupational Hearing Conser- vation Program. Council for Accreditation in Occupational Hearing Conservation, Cable 2000 • Holthouser, M.G. Noise Measurement. Council for Accreditation in Occupational Hearing Conservation, Cable 2001 • Holthouser, M.G. Workers Compensation Reform. Workers Compensation Reform 15(2):14-16 Feb 2001 • Guidotti, T.L., Rose, S.G., Holthouser, M.G. Workers Compensation: An Overview. Science on the Witness Stand: Evaluating Scientific Evidence in Law, Adjudication and Policy, OEM Press, Beverly Farms, Massachusetts, 2001 Page 8 Kevin T. O’Connell, M.D., M.P.H. Education: Masters in Public Health, University of Minnesota School of Public Health 1985-1988 Environment Health Department Minneapolis, Minnesota Internal Medicine Internship and Residency 1979-1982 Sacred Heart Medical Center Spokane, Washington M.D. degree, University of South Dakota 1975-1979 Sanford School of Medicine Vermillion, South Dakota B.S., degree, St. John’s University 1969-1973 Collegeville, Minnesota Experience: Physician –Occupational Medicine 6/2012 – present Colorado Health Medical Group Occupational Health Ft Collins, CO Physician – Occupational Medicine 1985 – May 2012 Occupational and Aviation Medicine, Clinical Practice Airport Medical Clinic Minneapolis, Minnesota Physician – Internist 1979-1982 US Public Health Service/Indian Health Service Wind River reservation Fort Washakie, Wyoming Certifications: Diplomat of the American Board of Preventive Medicine Specialization in Occupational Medicine, 1988 Diplomat of the American Board of Internal Medicine, 1983 Diplomat of the National Board of Medical Examiners, 1980 Certified Medical Review Officer, November 1997-present Level II Accreditation DOLE –State of Colorado, April 2012 Professional Society Memberships: American College of Occupational and Environmental Medicine Central States Occupational Medical Assoc. Aerospace Medical Assoc. Minnesota Medical Assoc. Page 9 Kevin T. O’Connell, M.D., M.P.H., page 2 Corporate Affiliations: Medial consultant to: Film Tec /Dow Chemical, Edina, MN Cypress Semiconductor, Bloomington, MN Pepsi-cola, Burnsville, MN SYSCO-MN, Shoreview, MN Pinnacle Airlines, Mendota Heights, MN Ziegler/Caterpillar, Bloomington, MN Goodrich Aerospace, Burnsville, MN Federal Appointments: FAA - Senior Aviation Medical Examiner 1986- June 2012 FAA – Medical Review Officer 1990- June 2012 U.S. Public Health Service - INS /Homeland Security Administration Civil Surgeon, 1986-June 2012 U.S. Air Force Reserve Officer, 1990-1997 U.S. Public Health Service –Indian Health Service 1982-1984 Page 10 Kevin O’Toole, DO, MPH COLORADO HEALTH MEDICAL GROUP OCCUPATIONAL HEALTH TEL 970.495.8450 Profile Board certified in Occupational Medicine. Colorado Division of Worker Compensation Level II accredited. Medical Review Officer certified. Experience in Clinical Hyperbaric Therapy, Human Factors, Mishap Investigation and Alertness/Fatigue Management. Proficient in Osteopathic Manual Therapy. Wellness exemplar. 5-time Hawaii Ironman finisher. Experience OCCUPATIONAL MEDICINE PHYSICIAN, UNIVERSITY OF COLORADO HEALTH, FORT COLLINS, CO 2008 - PRESENT Responsible for treatment of worker’s compensation injuries and illnesses; performing DOT, pre-placement and periodic employment physicals; fit-for-duty and return to work examinations and impairment ratings. OCCUPATIONAL MEDICINE PHYSICIAN, PRESBYTERIAN OCCUPATIONAL MEDICINE, ALBUQUERQUE,NM 2006 - 2008 Responsible for treatment of worker’s compensation injuries and illnesses; performing DOT, pre-placement and periodic employment physicals; fit-for-duty and return to work examinations, impairment ratings and reviewing drug testing program laboratory results. CHIEF OF HUMAN FACTORS, AIR FORCE SAFETY CENTER, ALBUQUERQUE, NM 2003 - 2006 Responsible for advising Air Force Chief of Safety and Safety Center staff on issues involving the human - machine interface and interactions between individuals and systems. Advised medical team members performing aircraft mishap investigations. Provided mishap investigation and aviation human factors instruction to flight surgeons in training at U.S. Air Force School of Aerospace Medicine. Maintained proficiency as C-21A (Lear 35) pilot. Responsible for outpatient treatment of injuries and illnesses, periodic physical examinations and aeromedical waiver requests for Air Force flight personnel. CHIEF OF COCKPIT HUMAN FACTORS, AIR FORCE FLIGHT STANDARDS AGENCY, MD 1999 - 2003 Responsible for advising Flight Standards Agency Commander and staff on issues involving cockpit human factors. Spearheaded major update to Hours-of-Service regulation for Air Force flying personnel. Maintained proficiency as C-21A (Lear 35) pilot. Re- sponsible for outpatient treatment of injuries and illnesses, periodic physical examinations and aeromedical waiver requests for Air Force flight personnel. Responsible for medical surveillance and fit-for-duty examinations for civilian employees at U.S. Naval Academy. Education United States Air Force School of Aerospace Medicine, San Antonio, Texas - Occupational Medicine Residency, 1999 United States Air Force School of Aerospace Medicine, San Antonio, Texas - Aerospace Medicine Residency, 1998 University of North Carolina, Chapel Hill, North Carolina - Masters in Public Health, 1997 Scott Air Force Base Medical Center, Scott Air Force Base, Illinois - Family Practice Internship Certificate, 1991 Des Moines University, Des Moines, Iowa - Doctor of Osteopathic Medicine, 1989 United States Air Force Academy, Colorado Springs, Colorado — Bachelor of Science, 1976 Certification Occupational Medicine, American Osteopathic Board of Preventive Medicine, 2009 - 2019 Medical Review Officer, American Association of Medical Review Officers, 2005 - 2015 Level II Accreditation, Colorado Division of Workers’ Compensation, 2009 - 2015 Medical Licensure State of Colorado, Board of Medical Examiners (31953) Publications Armentrout, J.J., Holland, D.A., O’Toole, K.J., Ercoline, W.R. Fatigue and Related Human Factors in the Near Crash of a Large Military Aircraft. Aviat Space Environ Med. 2006 Sep;77(9):963-70. Page 11 Kevin O’Toole, DO, MPH, page 2 Lyons, T.J., Ercoline, W., O’Toole, K., and Grayson, K. Aircraft and Related Factors in Crashes Involving Spatial Disorientation: 15 Years of U. S. Air Force Data. Aviat Space Environ Med. 2006 Sep;77(9):963-70. Luna, T., O’Toole, K., and Smith, E. USAF Human Factors Analyses: Fighter Aircraft Controlled Flight Into Terrain - A Fresh Look. (Abstract submitted for the 2004 Annual Meeting of the Aerospace Medical Association) O’Toole, K. U.S. Air Force Aircrew Fatigue Survey. (Abstract submitted for the 2004 Annual Meeting of the Aerospace Medical Association) O’Toole, K. You're the Flight Surgeon: Panic Disorder. Aviat Space Environ Med. 1999 Feb;70(2):191-2. Professional Memberships/Societies American Osteopathic Association American Osteopathic College of Occupational & Preventive Medicine Colorado Medical Society Sigma Sigma Phi Page 12 _________Tracey L. Stefanon__________ 642 Castle Ridge Ct., Ft Collins, CO 80525 (C) (970) 988-7440 traceyken@comcast.net Education: Occupational and Environmental Medicine Resident July 2006 – June 2009 University of Colorado at Denver Health Sciences Center, Denver, CO Master of Public Health July 2006 – May 2009 University of Colorado at Denver Health Sciences Center, Denver, CO Family Medicine Intern June 2000 – July 2001 Puget Sound Family Practice Residency, Bremerton Naval Hospital, Bremerton, WA Doctor of Osteopathy Aug 1996 – May 2000 Chicago College of Osteopathic Medicine-Midwestern University, Downers Grove, IL Master of Science in Kinesiology June 1991 – Aug 1992 University of Illinois, Champaign-Urbana, IL Bachelor of Arts in Kinesiology/bioscience June 1987 – June 1991 University of Illinois, Champaign-Urbana, IL Professional Experience: Occupational Medicine Physician August 2012 – present Colorado Health Medical Group Occupational Health, Ft Collins, CO Occupational Medicine Physician Sept 2009 – July 2011 GeneralCare Medical Clinic, Ft Collins, CO Delegate Jan 2012 – present American College of Occupational and Environmental Medicine Advisory Panel Member Sept 2012 Traumatic Brain Injury Medical Treatment Guidelines Colorado Division of Workers Compensation Member June 2011 – present Residency Advisory Committee University of Colorado Health Sciences Center Occupational and Environmental Medicine Residency Presenter Jan 2007 Malignant Mesothelioma Rocky Mountain Academy of Occupational and Environmental Medicine, Denver, CO Senior Medical Officer Jan 2004 – June 2005 Fisher Branch Medical Clinic, Naval Hospital Great Lakes, IL • Provided primary and acute care to an average monthly student and staff population of 5,000 • Supervise 5 general practitioners, 2 physician assistants and 2 advanced medical technicians in a busy primary care clinic serving over 67,000 patient visits annually • Preceptor for 2 physician assistants, one general medical officer and 2 independent duty corpsmen • Mentored 5 physician assistant students and over 25 medical technicians in training annually • Chairman of Quality Management meetings for Directorate of Fleet Medicine including 5 primary care and specialty clinics • Brig medical officer overseeing brig corpsmen and medical care for detainees • Revised provider appointment templates increasing appointment availability by 15% Page 13 Tracey Stefanon, DO, MPH, page 2 General Medical Officer Jun 2003 – Jan 2004 Fisher Branch Medical Clinic, Naval Hospital Great Lakes, IL • Provided primary and acute care to an average monthly student and staff population of 5,000 • Training Officer organizing continuing medical education lectures for medical staff General Medical Officer Nov 2002 – June 2003 2 nd Force Service Support Group, Camp Lejeune, NC • Provided primary and acute care to population of 6,000 active duty marines • Primary physician responsible for medical readiness of Maintenance Battalion consisting of 1,000 active duty marines during busy deployment rotation in support of Operation Iraqi Freedom General Medical Officer/Detachment Commander July 2001 – Oct 2002 MEU Service Support Group 22, 22 Marine Expeditionary Unit, Special Operations Capable, Camp Lejeune, NC • Provided primary and acute care to 700 active duty marines during busy 18 month work up and deployment schedule • Supervised medical detachment consisting of 2 dentists, 1 advanced medical technician and 19 medical assistants • Physician in charge of mass casualty unit • Physician in charge of 6 humanitarian assistant projects performed while deployed to Djibouti, Africa in support of Op- eration Enduring Freedom providing care to over 1,000 Djiboutian nationals Certifications BLS Honors/Awards: MPH May 2009 - Inducted into the Alpha Upsilon Chapter of Delta Omega of the Colorado School of Public Health, Na- tional Public Health Honorary Military Received highest rating of “Early Promote” on last 5 evaluation cycles Jan 2002 – June 2005 Operation Enduring Freedom Service Medal Mar 2005 Global War on Terrorism Expeditionary Medal Mar 2004 Meritorious Unit Citation for superior unit performance Jan 2004 Naval Achievement Medal for superior personal performance Oct 2002 Medical School Military Medical Student Association, Student Chapter Treasurer – 1998-1999 Health Professions Scholarship Program, United States Navy Recipient – 3-year scholarship Student Osteopathic Medicine Association, student mentor program Chairman of student mentor program – 1998 Professional Memberships: Apr 07 – present American College of Occupational and Environmental Medicine Apr 07 – present Rocky Mountain Academy of Occupational and Environmental Medicine Sep 96 – Sep 06 American Academy of Family Physicians Apr 99 – Feb 04 American Osteopathic Association Sep 96 – June 00 American Medical Association Sep 96 – June 00 Student Osteopathic Medical Association Aug 97 – June 00 Military Medicine Student Association Page 14 Page 15 _________Ann K. Yanagi__________ 8277 Spinnaker Bay Drive Windsor, CO 80528 Education: Emergency Medicine Residency, Valley Medical Center 1986-1988 Fresno, California (affiliate of University of California, San Francisco) Transitional Internship, Valley Medical Center 1985-1986 Fresno, California M.D., George Washington University School of Medicine 1985 Hayward, California Medical Technology, California State University 1977-1978 Hayward, California Bacteriology, University of California 1976 Berkeley, California Experience: Physician 12/2005 – present Colorado Health Medical Group Occupational Health, Ft Collins, CO Physician 12/2005 - present Wound Healing Clinic – Poudre Valley Hospital, Ft Collins, CO Emergency Physician, Relief 1992 – present Emergency Physicians of the Rockies PC, Ft Collins, CO Emergency Physician 1988-1992 St. Joseph Hospital, Denver, CO St. Anthony Central, Denver, CO Aurora Presbyterian Hospital, Aurora, CO Longmont United Hospital, Longmont, CO McKee Medical Center, Loveland, CO Professional: Board Certified Emergency Medicine, American Board of Emergency Medicine, 1990, Diplomate Level II Accreditation for Workmen’s Compensation Injuries since 2007 pvhs.org/occhealth Meet our occupational health physicians Welcome to Colorado Health Medical Group Occupational Health. We are pleased to introduce our award-winning team of physicians. We offer a comprehensive team of skilled physical, occupational and massage therapists to help patients recover and return to work as quickly as possible. Contact us Phone: 970.495.8450 | Email: chmg.ohs@pvhs.org Dr. John Charbonneau A long-time practicing occupational health physician in Greeley, Dr. Charbonneau is no stranger to medicine. Dr. Charbonneau attended the Indiana University School of Medicine and holds a certification from the American Board of Preventative Medicine. He works at our Greeley location. Dr. Michael G. Holthouser Dr. Holthouser has been a working in occupational medicine for several years. He attended the University of Kentucky Medical School and completed his residency at the University of Utah. Dr. Holthouser holds certifications from the American Board of Preventative Medicine with an added qualification in occupational medicine. He works at our Fort Collins location. Dr. Kevin J. O’Toole Dr. O’Toole enjoys seeing patients at our Fort Collins office. He attended medical school at Des Moines University - Osteopathic Medical Center, and completed his residency at the Scott Air force Base School of Medicine. Dr. O’Toole is certified by the American Osteopathic Board of Preventive Medicine, with an added qualification in occupational medicine. Dr. Kevin O’Connell Dr. O’Connell received his medical degree from the University of South Dakota School of Medicine and completed his internal medicine residency at Sacred Heart Hospital in Washington. He holds a Master’s degree in Public Health and is board-certified by the American Board of Preventive Medicine with a specialization in occupational medicine. Dr. Tracey L. Stefanon Dr. Stefanon joined our Fort Collins office in recent years. She attended medical school at the Chicago shared/hmc/admin/ohs/ohsforms/ohsphysicalpricesheet 8/03 COLORADO HEALTH MEDICAL GROUP OCCUPATIONAL HEALTH 2012 Client Services Fee Schedule REVISED 9/2012 PHYSICALS FEE DRUG SCREENS FEE Basic 99450-01 $70.00 Collection, Lab Analysis, & MRO $45.00 History & Physical Collection Only $25.00 Height Weight Vital Signs (included) On-site Drug Screen (rapid test) $40.00 Whisper Test (included) Hair testing collection $40..00 Snellen Eye Chart (included) Alcohol Testing Basic Exam and written opinion 99402-02 $80.00 Breath Alcohol Testing $30.00 DOT 99450-02 $68.00 Confirmation of positive BAT $30.00 History and Physical Height Weight Vital Signs (included) Snellen Eye Chart (included) Immunizations Whisper Test (included) TB Skin Test $20.00 Dip Urinalysis (included) Hepatitis A $70.00 Recheck for card restrictions or for addition To a corporate physical $35.00 Hepatitis B per injection (series of 3) $70.50 Corporate /HazMat 99396-02 $145.00 Tetanus Toxoid (TD) $25.00 Comprehensive History & Physical Diphtheria/ Pertusis/ Tetanus (ADAPT) $67.00 Height, Weight, Vital Signs (included) Administration fee for all injections (excluding TB Skin test.) * Effective Jan 2013 $25.00 Snellen Eye Chart (included) (current TB 9/2012 to 12/2012 $18.00) Whisper Test (included) Other Charges Dip Urinalysis (included) Dipstick Urinalysis $ 10.00 Lab draw and handling $64.00 Titmus Vision $15.00 Asbestos 99450-05 $75.00 Pulmonary Function Test $40.00 Includes: Basic Exam + written opinion EKG $100.00 Asbestos OSHA Questionnaire Base line Annual/periodic $25.00 $15.00 EKG no interp EKG with interp at OHS site $100.00 $150.00 Other if indicated: EKG and Interpretation (MCR ) $150.00 Pulmonary Function Test $40.00 Chest X-Ray (PA & Lat) (w interp) $105.00 Chest X-ray (PA & Lat) with interp $105.00 Chest X-ray (PA one view only) (w interp) $105.00 Laboratory testing per PVH Hearing Screen (w/audiometrics) $35.00 Occupational Exposure History Review $30.00 shared/hmc/admin/ohs/ohsforms/ohsphysicalpricesheet 8/03 Lead 99450-06 $75.00 WorkSteps Includes: Basic Exam + written opinion Set up and program education N/C Other if indicated: Post Offer Comprehensive Testing $130.00 Lead/ZZP Panel (OCH-1Panel) per Per PVH Carpal Tunnel Testing (only) $120.00 Per PVHS Lab Quote required from lab Post Offer Basic & Carpal Tunnel Testing $150.00 UA Microscopic per PVHS Lab Quote required from lab Job site analysis (per hour) $150.00 Range of Motion test $75.00 Ergonomic Training (per hour) $150.00 Back Safety Training (per hour) $75.00 Respiratory Physical 99402-01 $65.00 Job Site Analysis (per hour) $150.00 Includes: OSHA Questionnaire with Dynamic Lift Test 2504-DLT $50.00 Medical Exam Workcare back test and form $35.00 Other if Indicated: Professional supervision of Audiometric Program (included annual review of overall results of testing, annual program review and recommendations: typically 1-3 hours/year) $150.00/hr Pulmonary Function Test (additional) $40.00 Fit for Duty Exam (non work related, includes: Medical Record review and exam up to one hour, as well as Completion of ADA or FMLA documentation and recommendation for duty.) $230.00 (each add’l ½ hour $115.00) Physician on site education (per hour) $150.00 Respiratory Clearance Physician Medical Review /Oversite (per hour) $200.00 OSHA Questionnaire, no physical exam $25.00 Administrative Review 99900-01 $25.00 Coordination of Blood Borne Pathogen exposures: 11-20 minutes $46.26 21-30 min: $69.39 ALL BLOOD DRAW and COLLECTIONS to be packaged and sent to external lab of clients choice require Collection and handling fees of $64.00. All work comp billing is per the State of CO fee schedule and is updated by the State annually effective Jan 1 of each year. Locations: Main line 970-495-8450 Scheduling for physicals 970-297-6566 Fort Collins, CO 4674 Snow Mesa Dr. STE 200 Loveland , CO 2500 Rocky Mtn Ave, South Medical Office Bldg, STE 330 Greeley, CO 1900 16th St, Greeley Medical Center, STE 300 Cheyenne ,WY Cheyenne Medical Specialists 5050 Powderhouse Road shared/hmc/admin/ohs/ohsforms/ohsphysicalpricesheet 8/03 pvhs.org/occhealth Occupational Health locations With locations throughout northern Colorado and Wyoming, we are available for appointments and walk-ins. For your convenience, we offer urgent care daily, after-hours and on weekends at our urgent care centers. Emergency care is provided at our hospitals 24/7. PRIMARY CLINICS Occupational health clinics 1 South - Fort Collins 4674 Snow Mesa Drive, Suite 200 Fort Collins, CO 80525 Phone: 970.495.8450 Fax: 970.297.6599 Hours: M- F, 6:30 a.m. to 6:30 p.m. by appointment, 8 a.m. to 5 p.m. walk-ins. 2 Loveland Clinic Medical Center of the Rockies South Medical Office Building 2500 Rocky Mtn. Ave., Suite 330 Loveland, CO 80538 Phone: 970.495.8450 Fax: 970.297.6599 Hours: M - F, 8 a.m. to 5 p.m. 3 Greeley Medical Clinic 1900 16th St. Greeley, CO 80631 970.495.8450 Fax: 970.350.2418 Hours: M - F, 7 a.m. to 5 p.m. 4 Cheyenne Medical Specialists 5050 Powderhouse Road Cheyenne, WY 82009 Phone: 307.634.1311, ext. 153 Fax: 307.432.7546 Hours: M - F, 8 a.m. to 4 p.m. 1 2 3 4 South Timberline Rd. I-25 23rd Ave. 16th St. Prairie Ave. 14th Ave. Powerhouse Rd. Dell Range Blvd. 18th Ave. Rocky Mountain Ave. Snow Mesa Dr. East Harmony Rd. US-34 McWhinney Blvd. FORT COLLINS LOVELAND GREELEY CHEYENNE pvhs.org/occhealth 4 23rd Ave. 16th St. 18th Ave. EMERGENCY CARE SERVICES 1 Poudre Valley Hospital 1024 S. Lemay Ave. Fort Collins, CO 80524 2 Medical Center of the Rockies 2500 Rocky Mtn. Ave. Loveland, CO 80538 URGENT CARE CLINICS 1 Harmony Urgent Care – Fort Collins 2127 East Harmony Road Fort Collins, CO 80525 Phone: 970.297.6250 Fax: 970.297.6260 Hours: Daily, 8 a.m. to 8 p.m. 2 Family Medical Center Urgent Care – Fort Collins 1025 Pennock Place, Suite 121 Phone: 970.495.8980 Fax: 970.495.8988 Hours: M - F, 8 a.m. to 7 p.m., Sat. & Sun., 9 a.m. to 4 p.m. 3 Loveland Urgent Care 3850 North Grant Ave., Suite 100 Phone: 970.624.5150 Fax: 970.669.7750 Hours: M - F, 8 a.m. to 6: p.m., Sat., 9 a.m. to 5 p.m., Sun., 9 a.m. to 3 p.m. 4 Greeley Urgent Care 1900 16th St. Phone: 970.350.2454 Fax: 970.350.2447 Hours: M - S, 7 a.m. to 7 p.m., Sun., 10 a.m. to 5 p.m. 1 2 3 2 1 South Timberline Rd. S. Lemay Ave. Hwy. 287 I-25 Riverside Ave. Rocky Mountain Ave. S. Lemay Ave. Elizabeth St. Elizabeth St. 37th St. N. Grant Ave. East Harmony Rd. Pennock Pl. Prospect Rd. US-34 McWhinney Blvd. FORT COLLINS FORT COLLINS LOVELAND GREELEY FORT COLLINS LOVELAND Colorado Health Medical Group Occupational Health Referral List Orthopaedics Orthopaedic and Spine Colorado Health Medical Group Center of the Rockies Orthopaedics Robert Baer, MD Mark Grossnicle, M.D. David Beard, MD Brett Hunter, M.D. Robert Benz, MD Joshua Snyder, M.D. William Biggs, MD Satoru Chamberlain, MD C. Dana Clark, MD Kenneth Duncan, MD Mark Durbin, MD Sean Grey, MD Ryan L. Hartman, MD Michael Houghton, MD Wesley Jackson, MD Kirk Kindsfater, MD Dale Martin, MD Mark McFerran, MD Michael Rusnak, MD Steven J. Seiler, MD Rocci Trumper, MD Chiropractic Pain Management Scott Parker, DC David Columbus, DO John Zimmerman, DC Physiatry Psychology Scott Primack, DO Daniel Bruns, PhD Rebekah Martin, MD Ron Carbaugh, PhD Greg Reichart, MD College of Osteopathic Medicine and performed her residency at the University of Colorado Health Science Center. She is certified by the American Board of Preventive Medicine, with an added qualification in occupational medicine. Dr. Ann Yanagi Dr. Yanagi has been with our Fort Collins clinic for several years. She attended George Washington University’s School of Medicine and completed her residency at the Valley Medical Center in Fresno, California. Dr. Yanagi holds a board certification from the American Board of Emergency Medicine.