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Monitoring Worksite Clinic Performance Using a Cost-Benefit Tool

Tao, Xuguang MD, PhD; Chenoweth, David PhD, FAWHP; Alfriend, Amy S. RN, MPH, COHN-S/CM; Baron, David M. MBA, CISSP; Kirkland, Tracie W. MS, APRN/PNP; Scherb, Jill PAC; Bernacki, Edward J. MD, MPH

Journal of Occupational and Environmental Medicine: October 2009 - Volume 51 - Issue 10 - p 1151-1157
doi: 10.1097/JOM.0b013e3181b68d20
Original Articles

Objective: The purpose of this study was to explore the usefulness of continuously assessing the return on investment (ROI) of worksite medical clinics as a means of evaluating clinic performance.

Methods: Visit data from January 1, 2007, to December 31, 2008, were collected from all the on-site clinics operated for the Pepsi Bottling Group. An average system-wide ROI was calculated from the time of each clinic’s opening and throughout the study period. A multivariate linear regression model was used to determine the association of average ROI with penetration/utilization rate and plant size.

Results: A total of 26 on-site clinics were actively running as of December 2008. The average ROI at the time of start up was 0.4, which increased to 1.2 at ∼4 months and 1.6 at the end of the first year of operation. Overall, it seems that the cost of operating a clinic becomes equal to the cost of similar care purchased in the community (ROI = 1) at ∼3 months after a clinic’s opening and flattens out at the end of the first year. The magnitude of the ROI was closely related to the number of visits (a function of the penetration/utilization rate) and the size of the plant population served.

Conclusion: Serial monitoring of ROIs is a useful metric in assessing on-site clinic performance and quantifying the effect of new initiatives aimed at increasing a clinic’s cost effectiveness.

From the Division of Occupational and Environmental Medicine, Department of Medicine (Dr Tao, Ms Alfriend, Ms Kirkland, Ms Scherb, Dr Bernacki), Johns Hopkins University School of Medicine, Baltimore, Md.; Department of Health, Education and Promotion (Dr Chenoweth), East Carolina University, Greenville, N.C.; and Department of Health, Safety and Environment (Mr Baron), Johns Hopkins University School of Medicine, Baltimore, Md.

Address correspondence to: Edward J. Bernacki, MD, MPH, Director of Occupational and Environmental Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Billings Administration 129, Baltimore, MD 21287-1629; E-mail:

©2009The American College of Occupational and Environmental Medicine