Optimizing the Role
The Value of Certified ATs in a Physician Practice
This publication is based on a webinar conducted by ATPPS members about the value of certified athletic trainers in a physician practice.
DME Competitive Bidding
President Forrest Pecha MS, LAT, ATC and board member Tara Soprano MS, LAT, ATC host Justin Humphrey from DJO and Scott Milligan from Össur to discuss the DME competitive bidding process.
Justin and Scott welcome questions! You can email them at the addresses below
Justin Humphrey- Justin.Humphrey@DJOglobal.com
Scott Milligan- smilligan@ossur.com
Telemedicine Resources
Document containing resources for professional development regarding telehealth and telemedicine
Orthopedic Surgeons' Perceptions of Athletic Trainers as Physician Extenders
Steven Storch ATC, Susan W. Stevens EdD, ATC, Amanda M. Allen PhD, ATC
As physicians are experiencing increased workload, many are hiring more support personnel. A physician extender performs some of a physician's tasks under the direct supervision of the physician. Some orthopedic surgeons have employed certified athletic trainers (ATCs) to work in a physician extender role. The athletic trainer is a unique health care provider who can work with the physically active population, provide knowledge regarding sports injuries and rehabilitation, and provide outreach services to local schools. An ATC as a physician extender offers many benefits within an orthopedic setting, including an increased clinic throughput, improved clinic efficiency and increased revenue for a much lower cost compared that for NP-Cs and PA-Cs.
Enhancing Coordinated Care Delivery and the Healthcare Team: The Impact and Future of Athletic Trainers in Ambulatory Practice Settings
Christine L. Noller, JD, LLM, Forrest Q. Pecha, J.J. Wetherington,
and David C. Berry PhD, MHA
Although the ultimate fate of the Patient Protection and Affordable Care Act remains unclear, access to efficient, effective and high quality care persists as a priority for the U.S. healthcare system. No one disputes that the traditional fee-for-service model rewarded quantity over quality, driving costs with little concern for value. As lawmakers sought to reduce the national deficit, attention was focused upon Medicare cost savings in 2010. To meet the challenges of the next decade, athletic trainers can actively engage in physician practice settings enhancing patient throughput and satisfaction in orthopedic, sports medicine and primary care practices across urban, suburban and rural settings.
Athletic Trainers’ Role in Improving Efficiency in the Primary Care Setting
Forrest Q. Pecha, Reed L. Omdal, Sandra Ruben Koen and John M. Wick, MD
Athletic trainers (AT's) have been shown to improve clinical efficiency, enhance patient throughput, and provide high physician and patient satisfaction in various physician practice settings. Limited research exists on the value of AT's in the primary care setting. Our objective was to evaluate clinical efficiencies while utilizing AT's in a primary care clinic. Over a period of six weeks, ATs assisted within a primary care practice. Physician time for patient care was compared between ATs and medical assistants (MAs) as support staff. On average, ATs saved 5.5 minutes physician time per patient, including 7 minutes per orthopedic patient. Three additional patients were seen per day, with a mean of 37.5 minutes of physician documentation saved at the conclusion of clinic. We concluded that ATs improved clinical efficiency by increasing patient throughput and decreasing nonessential physician interaction and documentation time, while maintaining overall total time spent with the patient. ATs have been demonstrated to serve a beneficial role in the primary care practice.
Athletic Training Milestones Project
The Athletic Training Milestones Project Team has worked collaboratively since 2016 to develop the Athletic Training (AT) Milestones to enhance and facilitate assessment of student and resident learning. The AT Milestones are designed for use in evaluation of athletic trainers in the context of their participation in Commission on Accreditation of Athletic Training Education (CAATE) accredited professional education, residency, and fellowship programs.
Relative Value Unit for the Athletic Trainer
Burfeind SM, Wetherington JJ
What is a Relative Value Unit (RVU)?
Why are RVUs used?
Practice efficiency, cost accounting purposes/fee schedule
What is the difference between total, work and facility RVUs?
Why do physicians care about RVUws?
Why do athletic trainers care about RVUws?
Why do administrators/private practices care about RVUws?
Athletic Trainers in a Physician Practice: Concussion Clinic Model
Kitano J, Soprano T, Paturzo M
What role does an athletic trainer serve in a concussion clinic?
What type of testing can an AT administer in a Concussion clinic?
In what other ways can an athletic trainer function within a Concussion Clinic?
How can an athletic trainer affect efficiency in a Concussion Clinic?
How does increased throughput generate increased revenue for physicians?
Patient Throughput in a Sports Medicine Clinic With the Implementation of an Athletic Trainer
Nicolello TS, Pecha FQ, Omdal RL, Nilsson KJ, Homaechevarria AA
Orthopaedic clinics have acquired a multitude of health professionals to improve clinic efficiency. More recently, athletic trainers (ATs) have been utilized to improve clinical efficiency and patient care because of their extensive background in musculoskeletal injuries and anatomy. Improved clinical efficiency allows for increased patient visits, potentially enhancing patient access and downstream revenue via relative value units (RVUs).
Hypothesis: The addition of an AT into a sports medicine physician’s clinic will increase total patient throughput and overall RVU production
Conclusion: Clinical efficiency was improved with the addition of an AT. Total physician RVUs improved, thereby raising the potential revenue of both the physician and health care institution. Employing ATs in a sports medicine clinic may improve clinical productivity and financial stability, thereby validating the incorporation of ATs into the established clinical model
Patient Perception of Athletic Trainers and Orthopaedic Residents as Primary Clinical Support Staff
Pecha FQ, Nicolello TS, Xerogeanes JW, Karas S, Labib SA
Orthopaedic sports medicine practices utilize a variety of healthcare professionals to assist physicians in the clinic. The purpose of this study was to investigate patients' perception of orthopaedic knowledge and clinical care provided by orthopaedic medical residents and athletic trainers (ATs).
Hypothesis: ATs will be perceived similarly to orthopaedic medical residents in overall patient care and perceived education level.
Conclusion: There is no evidence that patients' perception is different when comparing ATs and orthopaedic medical residents in orthopaedic knowledge and clinical care. Although a statistically significant difference was found in the perceived highest level of education attained, orthopaedic medical residents and ATs were each perceived to have a master's degree level of education. Physicians should continue to use ATs in their practices.
The Financial Impact of an Athletic Trainer Working as a Physician Extender in Orthopedic Practice
Hajart AF, Pecha F, Hasty M, Burfeind SM, Greene J
The provision of care and business of musculoskeletal medicine have evolved signifncalty over the last two decades. It has become ever more important that those who are leading muskuloskeletal medicine practices evolve with the changing healthcare landscape and find new ways to provide higher quliaty and more cost-effetive care. To meet these new challenges, many orthopedic physicians are choosing to hire athletic trainers as a part of their office staff. Athletic trainers provide value to a medical practice through their skills in triage, taking patient histories, performing musculoskeletal evaluations, providing instruction on exercise prescription, rehabilitation, and general patient education. If a practice can become more efficient by narroworring staff to a single ancillary provider that encompasses several skills at a high level, this is where patient throughput and patient satisfaction scores can be improved by the athletic trainer as a physician extender.
Education Continues to Evolve: Post-Professional Work Expands
An editorial by Valerie Hunt
Physician Satisfaction With Residency-Trained Athletic Trainers as Physician Extenders
Pecha FQ, Bahnmaier LA, Hasty ML, Greene JJ
Athletic trainers (ATs) have historically functioned in a physician extender role when managing the health of competitive athletes in high school, collegiate, and professional settings. A high level of expertise in the prevention and management of musculoskeletal disorders among physically active individuals has been recognized by physicians who have chosen to utilize ATs as physician extenders in orthopedic and sports medicine clinical operations. The development of postprofessional residency programs that provide specialized education and clinical experiences to prepare ATs to effectively function as orthopedic physician extenders has greatly facilitated physician acceptance of the role, which has dramatically increased the number of ATs working in the orthopedic clinical setting. Such residency programs provide ATs with experience in taking detailed patient histories, performing thorough patient exams, and presenting the findings to the attending physician for delivery of efficient and patient-centered care. The physician can focus on making the diagnosis and developing a plan of care, while relying on the AT to provide appropriate therapeutic exercise instructions, educate the patient about the plan of care, and complete specific components of the clinical documentation.
Previous studies have demonstrated that utilization of the residency-trained AT physician extender (AT-PE) has increased clinical efficiency (i.e., patient volume and revenue generation) and improved patient outcomes. Physician satisfaction with this approach to delivery of orthopedic clinical services has not been previously documented. Thus, the purpose of this study was to assess physician satisfaction with the performance of residency-trained AT-PEs in the delivery of orthopedic clinical services.
The Value of Athletic Trainers in Ambulatory Settings
Frogner BK, Westerman B, DiPietro L
Athletic trainers (ATs) are increasingly used in ambulatory care settings. This study piloted a new survey instrument to assess the value that ATs add to these settings. The survey collected data on six domains: 1) general facility characteristics, 2) AT staffing characteristics, 3) other staffing characteristics, 4) patient characteristics, 5) billing practices, and 6) participation in innovations. A national sample of physician practices using ATs was recruited to participate in a web-based survey. The study found that ATs were among the most common clinical occupations in the practice. Practices were almost all "very satisfied" with the services provided by ATs with equal expectations to either maintain or increase the number of ATs. While most practices invested in training and continuing education units, the larger practices were more likely to do so. Practices were more likely to bill for AT services if ATs had a national provider identifier. The mean number of clinical visits, rate of billing, patient scheduling, wait times, and participation in innovations did not vary significantly by the number of ATs employed. Overall, the study found evidence that ambulatory care practices see value in hiring ATs.
Comparison of the Effect of Medical Assistants Versus Certified Athletic Trainers on Patient Volumes
Pecha FQ, Xerogeanes JW, Karas SG, Himes ME, Mines BA
Research has shown increases in efficiency and productivity by using physician extenders (PEs) in medical practices. Certified athletic trainers (ATCs) that work as PEs in primary care sports medicine and orthopaedic practices improve clinic efficiency.
Hypothesis: When compared with a medical assistant (MA), the use of an ATC as a PE in a primary care sports medicine practice will result in an increase in patient volume, charges, and collections.
Conclusion: ATCs can optimize orthopaedic sports medicine practice by increasing patient encounters, charges, and collections.
Athletic Trainers in an Orthopedic Practice
Greene JJ
Athletic Trainers at the University of Wisconsin Hospital have assisted orthopedic and primary-care sports-medicine physicians in the clinic since 1981. At the core of our success is the long-standing relationship of the certified athletic trainer and the team physician. We have extended the traditional on-the-field athletic training room model to the sports-medicine orthopedic clinic. This model has produced excellent clinic efficiency and flow and increased revenue for our hospital and physicians. Presently, the UW Health Sports Medicine Clinic has eight sportsmedicine-fellowship-trained physicians. Four of these have specialties in orthopedics, two in family medicine, and two in pediatrics. They are also the team physicians for the University of Wisconsin Athletic Department. A total of a 4.0 FTE equivalent of athletic trainers staff these clinics along with nurses, physician assistants, medical assistant, residents, and fellows. The athletic trainers are all hospital employees and are not employed by the physician group. The responsibilities of the various support staff are described in the sidebar.
Athletic Trainers in the Physician Practice Setting: A Business Case
Pecha FQ, Kitano J, Nicolello TS, Greene JJ, Hajart AF
The following document is a business case for certified athletic trainers (AT) in a physician office or hospital clinic setting. It is not intended to serve as a complete business plan for any specific organization. This business case serves as core information to develop a customized business plan and
strategy for the creation of such a position.
In order to use this document as a business plan or proposal, you will need to gather information, such
as type and needs of the practice, geographic location, patient demographics, individual athletic training state practice act, financial projections and/or assumptions and justifications.
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