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The Value of Certified Athletic Trainers in the Ph ...
The Value of Certified Athletic Trainers in the Ph ...
The Value of Certified Athletic Trainers in the Physician Practice Setting
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All right, well, it is one o'clock, so we're going to go ahead and get started with our webinar. So thank you so much for joining us for the value of certified athletic trainers in the physician practice setting. I have a few housekeeping notes just to get us started here. All attendees are in listen only mode. We're going to be using the Q&A function today to gather questions for our panelists. We're not going to be using the raise hand function. So please do submit those questions through the Q&A, and you can also utilize the chat as well. When you're using the chat function, just make sure that you're selecting all panelists and attendees from the drop down above the message box, and that way everyone can see it. This webinar is being recorded, and we're going to be sending the recording to all registrants after the webinar is ready. So without further ado, I am going to introduce each of our speakers. Well, they'll introduce themselves actually, and so I'm going to go ahead and start with you, Jen. Sounds good. Thanks, Jessica. I am Jennifer Catano. I'm a certified athletic trainer currently working at Maine Health Orthopedics and Sports Medicine outside of Portland, Maine. I have been working in physician practice about 15 years and am a founding board member of ATPPS. I've served as a secretary in the past. I'm currently an at-large member for the past six and a half years. Great. Thank you. I'll move to you next, Allison. My name is Allison Hoops. I am a certified athletic trainer. I have been practicing for 15 years, been in a physician office for eight. I work for Gnomes Healthcare, Northern Ohio Medical Specialties out of Sandusky, Ohio. We are a large multi-specialty group, and I am the DME coordinator there. I have been a member of ATPPS for about five or six years now, and I am the chairman of the year-on-education board or committee. Wonderful. And finally, JJ. Yeah, I'm JJ Weatherington, a certified athletic trainer. I work here at St. Luke's Health System in Boise, Idaho. I work clinically with a sports medicine physician here, primarily seeing knees and shoulders. I am also a founding board member, along with Jen, of ATPPS and have served since the beginning as the vice president for ATPPS and have been practicing in this setting for almost 11 years now. Awesome. Well, thank you all so much for joining us today and participating on this panel so that we can talk about how to utilize the athletic trainer. So I'm going to start with you, Jen, with some questions. Could you get us started by discussing the keys to success in implementing an athletic trainer into the physician practice? Absolutely. So I think one thing from an executive or administrator's perspective is to really understand our state rules and regulations and state practice acts for athletic trainers. There are certain regulations that go along with an athletic trainer functioning within a physician practice. It's not a setting that is accessible in every state for an AT, unfortunately, due to how the restrictions within the state practice act and the regulations. For example, there are some states that just state that an athletic trainer can only work with athletes and give a very small scope of what an athlete is. Other states put regulations on whether we can help in the operating room, things of that nature. So I think if you're looking to implement an AT, understanding both of those is extremely important. Secondly, if you determine that you can have an athletic trainer in your practice and you want to, helping to serve as their administrative advocate. It's very difficult for an athletic trainer to speak to an executive VP to that level of justifying their role. So maybe just acting as a go-between, kind of speaking that language, understanding what we can and can't bring to the practice, and kind of speaking the language of what kind of value we can add. And also helping collaborate on the role. What kind of needs are there in the practice versus what can the AT bring, and helping this be a collaborative process of creating a successful role. Awesome. Thank you so much. To expand on that last piece a little bit, what are the various roles and responsibilities of an athletic trainer in the physician practice? I'm very proud to say that they are very varied at this point. Over the past few decades, especially, athletic trainers have been integrating into physician practice more and more. And I was just talking to someone about how it can start. It can start with a physician having experience with an AT at a school or something like that, wanting to bring them into the practice, and then just kind of seeing what the needs are. We can function within clinic in various roles. We can also function within surgery, which we'll talk about a little bit today. Do you need help with expediting patients through clinic? Do you need help optimizing physician templates? Do you need help with your staff, like with nurses and medical assistants, helping them understand more of the sports perspective of what your practice is about? So there's a lot of things that we can do within the physician practice. A lot of those have been studied and written about, and there's a lot of articles on our website, actually, that show that and go over that role. But it can be very varied. And I always tell athletic trainers, don't go into a practice saying, here's all the things I can do. Kind of take it in and see what the practice needs are to where you can fit in from a satisfaction perspective. Also, again, this role should be collaborative with other health care providers. We don't want to create any strife with nurses or medical assistants trying to take away from their scope. So how can we create a collaborative role where we're optimizing each health care professional within the team, I think is very important as well. Awesome. So I'm going to move on to JJ now to give us a little bit more background on that athletic trainer. So let's say your practice has identified they do want to bring on an athletic trainer. What should they understand about the trainer's education, certification, so that they know what to look for in a qualified candidate? So I know some of that is residency. So can you go through what is an athletic training residency and what skills does someone develop within that? Yeah, Jessica, for sure. And that's a pretty loaded question. As Jen and I have been doing this for a while now, and her and I have been a part of this work for, gosh, almost two decades now. From when we started, a lot of athletic trainers jumped into the physician practice role and were kind of feeling their way out and kind of, as Jen said, making it work with whatever the practice needed. As more of us have been in that role longer, we've realized that some athletic trainers need a little bit more education around developing their skill set, especially deepening their skill set in orthopedics. And athletic training residencies were kind of an evolution of that. This started about almost 15 years ago. We're the first couple that were started. Now there's almost 22 in the country now. These residencies have specific focuses around a specific skill set. Predominantly, most of the residencies are based around orthopedics, but there are some in pediatrics, there are some in primary care, and there are some in rehab. And they're continually growing. We've seen almost a threefold increase in the last five years. And the idea of a residency is a one-year postgraduate education that's focused around didactics and clinical education. And there's focus in that specific area of making an athletic trainer's skill set deeper in that area. Athletic training education, being a master's entry level now, is a very broad education and covers a lot of topics. And as we got into the physician practice, a lot of athletic trainers realized we needed to deepen our skill set. And so that's where the residency model kind of evolved. But there are still a lot of athletic trainers who have been doing this for a long time who didn't go through a residency or are able to go through a residency and really develop skill sets outside of that by continuing to be lifelong learners. Recently, the profession of athletic training just developed a specialty certification to kind of help identify those athletic trainers that have an advanced skill set. And that credential was created through the Board of Certification for Athletic Training. It's the only credential that is recognized by the athletic training profession. And currently, it is the what's the acronym is BCSO, Board Certified Specialist in Orthopedics. That is the only credential that is currently recognized by the athletic training profession as an advanced skill set. There are two pathways to get that certification. You can use an experience pathway with a you have to have at least five years of experience to sit for that exam that way. Or you could have gone through a residency, an athletic training residency program. Those are the two pathways to sit for that exam. So with that, outside of, you know, maybe that credential, is there any other way that you can differentiate an AT who has some of these specialized skills? Yeah, it gets a little bit, it's a little bit more difficult at that point. And that's one of the things the profession is really trying to evolve and especially with creating a specialized skill set so that you can identify which athletic trainers are ones that have an advanced skill set, because there's no other credential to really identify that we all have the one credential, which is an ATC. And that's where some of the failures in the past have happened when that ATs move into this setting, is they jump into the setting without really any experience, and they don't know what they don't know. And so that's where ATDPS was really created was to help athletic trainers to try and transition those skills. That's why we've created a lot of our education that we provide online and in person is to help athletic trainers develop those skills, also give them information they didn't know they needed. And administrators as well, our annual conference every year, we try and put on multiple tracks between administrator tracks and with entry-level athletic training tracks, trying to better their skill sets and better their scope and really get them operating at the best of their abilities. Awesome. So that specialty certification that the administrators are looking for, remind me one more time what that was. It was a BCOS, right? Board Certified Specialist in Orthopedics. So BCSO. And that can be found on the Board of Certification for Athletic Trainers website. There's a fair amount of information on there. And that credential is relatively new. It's only been around for about two, almost two and a half years now. Okay. Great. Awesome. Thank you so much. So now that we know a little bit more of that background, I wanted to move on to some of the opportunities that are opened up with having an athletic trainer within your practice. So one big area is durable medical equipment and Allison, with your experience, I think you could be a great one to dive deeper on that. Could you start by discussing when DME would be appropriate to add into your clinic and the different types of DME there are? Yeah. So when looking at DME, there's really two different types. So you can have like your medical device sales, which is your CPAPs, your CGMs, your glucometers. You're going to find those at a medical supply store. The DME that we can in orthopedics or a lot of other specialties that we can keep in our office is more the bracing side of things. So your knee braces, your back braces, your shoulder slings, your wrist braces, boots, those kinds of things. So basically anybody who sees musculoskeletal injuries, so that can be orthopedics, that can be sports medicine, podiatry, family medicine, any of those people can easily slide this into their model and open up a new revenue stream if that's not something that you are doing already. As being a physician supplier instead of just a supplier, so actually we are only allowed to, if you're a physician supplier, then you are only allowed to dispense to your patients who you are seeing. And with that is it's more of a service to your patients. And so there's a few things that you don't have to do. You don't have to get some extra credentialing and stuff like that when you're a physician supplier because of the fact that it's just a service to your patients. But that's a great way to kind of open up a new revenue stream. Awesome. And what type of role can an athletic trainer take to benefit a DME program in each setting? So an athletic trainer is the perfect person to run your DME program. I'm a DME coordinator. I've been a DME coordinator for eight years. And I would say that more often than not, that's who I run into that are the people that are running the programs. Basically we know orthopedics. We are comfortable talking to physicians where we can talk to vendors. And anytime that you have basically more than like four or five providers in one office, it would be smart to have a DME coordinator in your office. Just because there needs to be somebody that kind of keeps track of workflows and keeps track of rules and everything else. But so there could be that DME coordinator that's an athletic trainer. But if you already have a DME coordinator that's not an athletic trainer, which is completely fine. An athletic trainer is the perfect person to put in there just to fit your patients. So obviously they have a wealth. We have a wealth of knowledge when it comes to different orthopedic braces. And so that person, it's a good way to educate your patient and educate the provider on the different options that you have. Awesome. How exactly does that athletic trainer increase revenue within a DME program? So if DME has ran well, DME is very lucrative. The problem is, and you know, when I started doing this a while ago, this is kind of what I ran into is there was a lot of physicians that didn't really want to do it because of the fact that there's just so much to stay up on. So when you have somebody, when you have somebody that's in that role, that their job is to continue to make sure that they know the rules. And they know, they know, okay, if what is going to get denied and knowing if a denial is going to come, how do you get around that? And if you have a denial, how do you manage that on the backend? Before I, before I started doing this, I would, you know, when I first started, I would run denial reports and they were just absolutely astronomical because there wasn't somebody that was watching it. And so just to think about all of the, the just thousands and thousands and hundreds of thousands of dollars that we were writing off because nobody knew what the process was and nobody knew what we were supposed to be getting paid. But then also knowing what your contracts are. So if you have, if you have somebody that is an athletic trainer, that's in that role as the DME coordinator is, you know, the contracts, you know what you should be getting paid for every different product, depending on that payer. And so just somebody having that knowledge is really important to, to continue to run your DME program well. All right. And other than that increase in revenue, what other benefits will you obtain by having that dedicated person managing all DME in their office? So when, when you add a specialized person into an office for DME, the, you increase your usage significantly. And basically it's because you have one person that you know, that if you have, you know, three providers working in that office that day, and you have one person that, you know, hey, Allison's over there and she's, and she's here to fit braces and it's not Allison's over there and she's here to fit braces, but she's also rooming Dr. Smith's patient. But she's also answering the front desk calls or she's calling for, you know, calling patients back or refilling medications. So when you have that specialized person, then that will increase your usage. But also when it comes to provider satisfaction, so provider education there, you know, there's a lot of times that, that, you know, docs and providers that I work with that will go to different, you know, like meetings and stuff and then they will get shown a product and it's maybe it's not the right thing for that patient and so to be able to just educate them on what they should be using um is is really useful and then also patient satisfaction so anybody can go on amazon and anybody can buy a boot off of amazon um and but however sometimes it's being able to educate that patient on why are they using it if if this is you know if it's an issue with fitting then how what do we need to do to fix that um or why do they have to pay more more if they're getting it from us and if they're getting it from amazon and just making sure that the patient is in the correct product at the time of service is really important awesome so just moving on to other opportunities within your office jen i'm going to come back to you um could you share how the concepts of direct and indirect revenue relate to the athletic trainer in the physician practice yes absolutely um and i'll probably jj i'll probably bring you in on this too because we work very similarly um in this realm so you know a long time ago decades ago when uh this practice setting we started working in this practice setting there was a focus on direct revenue and we get questions in our society from physicians all the time how can i bill for this athletic trainer how can i justify their role with direct revenue so we had been billing like some incident to to the physician visit we've been billing for home exercise programs and crutch fitting and those things and it just came back that you know we were billing for all of these things but the reimbursement rate was very low so our value was kind of dipping a bit so we kind of changed our focus within physician practice to creating indirect revenue opportunities for a physician practice we understand that through cms guidelines we are not a billable provider so we can't look at direct rvus that we help with but however i have a very important role in my physician practice of creating indirect revenue an example is how i function within my surgical practice we have a surgeon and we have a physician assistant who have two full days of clinic and they run parallel i function on the physician assistant schedule to help with pre-operative patients and first post-operative patients so through our templates that we have i go through pre-operative teaching i also go through post-operative patient wound care go through their rehab answer any questions they have and and help run those visits our physician they're on their physician's assistant schedule so they can come in and introduce themselves go through kind of through the final thing but while i go through that 30 minute visit that physician assistant is seeing a new patient or is performing an injection or an established visit is pretty much creating an established visit within our practice we have a sir i work for a surgeon who does about 13 or 14 surgeries a week and they each has a pre and post-op patient a post-op appointment with this physician assistant so with his clinic schedule he would only be seeing pre and post-op patients during the week he would be a zero net provider unless the athletic trainer was helping to offload these conversations and teachings patients have also come back to us and said that they really enjoy this role because we can spend more time with them we can just sit down be more relaxed we're not in a rush to get to the next visit and it adds to the quality of their visit so i have looked and i've tracked since i've been with this team for almost three years it'll be in september and i've added just under 1300 billable visits to that physician's assistant schedule alone and that trickles down from the physician too right that offloads the physician schedule for so it really it works very well for our practice and patients seem to enjoy it very much so that's just an example i have i don't know if you have anything to add there jj but that's my experience yeah i mean for us it's very similar it's more about increasing patient physician efficiency and really being able to increase billable visits for the physician we oftentimes will be able to you know double book our pre-op patients with a new patient and oftentimes the pre-op conversation is a 20-minute conversation with me and then a five-minute conversation with the physician and while i'm having that 20-minute conversation he is then seeing a new patient that's a you know a billable a more billable visit and then most likely we'll turn in downstream revenue between an imaging or and or surgery it's typically how we try and stagger those appointments and then rpa has been taken out of the or one complete day of the week because of the role ret plays in the or so that's that's we really look at more as a patient efficiency and patient satisfaction encounter with the at to really help drive the indirect revenue that jim was talking about awesome thank you so much for going into that so jen could you discuss the manner in which an athletic trainer could positively affect surgical block time efficiency i know you kind of talked a little bit about that but going into a little more detail would be great yep um so i've worked in the operating room with um with several surgeons over over my career and each is each is different in terms of the surgery center or the hospital but just to kind of go through it real quick so uh when i am in the operating room with the surgeon i'm making sure that i'm there before he is i'm making sure that we have the proper trays in the room and things are being opened like appropriately that we need making sure that the dme equipment is in the room making sure that the images are up you know things just things that save time for him um sometimes i'm even going into the pre-op or post-operative area to answer any last minute questions that the patient or the family has again to optimize their time as well um so from a and from a scrubbing perspective you know we talked about this briefly but um from a scrubbing perspective i'm also uh scrubbing into cases a lot of times where a physician assistant can't be billed you know so there are cases where a physician assistant excuse me can be billed but will not gain reimbursement for their services so it is more advantageous uh for me to be in that role say i'm scrubbing into a shoulder scope or something like that um and the physician assistant can be seeing patients during that time that's how i functioned in my last practice the physician assistant would have a clinic we'd have certain surgeries where they couldn't be billed anyway and then we're making revenue in a parallel structure again the other role that i've actually functioned in uh in a teaching hospital was in a non-scrubbing role so again those conversations um i used we used to have residents and fellows i remember running up to clinic to grab a boot during a case and i'm like oh my gosh like you know it doesn't need to be like this so just kind of helping with those conversations and again that helps block efficiency especially in a patient or a provider who's in hand ankle you know those shorter cases you can even add another case a day because you're not wasting some of this time and you're optimizing the staff that you do all right and um i have one more question for you jen could an athletic trainer affect institutional benchmarks such as um efficiency satisfaction abandonment rates etc related to the physician practice and if so could you just explain a little bit more about how that can happen yeah absolutely uh and i saw some of the questions in the chat like specifically from dylan and kevin these are great questions about how are we separate from a medical assistant role i think um both of our roles can be rooming patients and creating efficiency that way when i room a patient for a physician i'm bringing the patient into the room and i'm trying to get the most um concise summary that i can i'm trying to get you know all the information but make it as concise as possible i'm performing a short physical exam for the physician so that way i can present to him we he he's going to go into that room knowing how long this has been going on the treatments that they tried what questions they have for him today what i found in my exam it's going to really hone in his exam a bit instead of just rooming a patient and going back and forth giving him making his time with the patient more efficient and effective um you know in terms of clinic efficiency i started with the surgeon that i was at at my last institution when i started with this practice he had 27 patients on his template and when i left he had 42 patients on his template and we saw them in the same amount of time but it was about optimizing our medical assistant roles myself he had a lot of residents and fellows because he was a well-liked physician so we had a lot of players in the game so for me kind of quarterbacking that situation to make this clinic efficient and saying the resident can go here the physician can go here let's room here uh created a lot of efficiency for our practice other ways are creating patient and provider satisfaction you know one way anecdotally i do that in my practice is my pa works a four at four day week he's off on fridays and it's a surgical day um so myself or the other athletic trainer trainer switch off we do our less complicated cases those days so again he's not a billable provider then anyway he gets a four-day work week and honestly if he's happy my provider's happy so we're creating satisfaction in that way also other things like um like phone abandonment rates you know seems you know silly but it's a small thing we have a real problem on our phones right now um with our front desk staff being pulled so thin but as athletic trainers we can jump on we can answer those questions and delegate so those are just a few ways i think we can add our clinical expertise to the situation um jj i don't know if you have anything else to add on that but those are just some areas we've touched on yeah i think one of the big things uh too is just being as you said the quarterback uh being able to have be the point of communication uh between surgery centers uh between reps between patients um and yeah being that clinical voice on the phone is one of the most uh satisfying thing i hear from patients is being able to have that long in-depth conversation to the level of knowledge that we have really helps to set you know satisfy patients but also it takes time away from physicians if they were to have that conversations or providers apps as well and since we kind of can function in an in-between role and do both of those that really does help with the patient satisfaction uh thing and then really i said the one question regarding you know bill you know trackable items you know those are all things we kind of track um and that's one of the things with atps we talk every year in our conference about what are some of those items that are you know things that our systems are looking for practices are looking for um to really measure our indirect value because as jen said it's really hard to measure our direct value but we make a significant impact on indirect value um and one thing i just want to add real quick um in terms of the ma role versus the atc role sometimes you know we're going back into the office after the physician and finishing up that visit jen can have this in-depth discussion with you about what your rehab is going to look like what your return to play might look like once you get to that point or even if it's you know making sure mri orders are pended ct scans x-rays you know pt scripts those kind of things do you need uh medications pended for the physician do you need a school note those are all things where our physician could be moving on to another billable visit so it's really looking more in depth at the visit of what kind of things there are needed to move this physician along and make things more efficient and ultimately make patients happy all right so we've gotten several questions in here i'm gonna go ahead and bring up each of them i know you both have um you know touched on a little bit but just if there's an opportunity to go deeper if you know allison or anybody else has more to say about it you know we can do that as well so um the first one that came in um is are you aware of states that have best practice acts scope practice to utilize ats and physician practices um and looking to assist in updating practice act um i i can speak to that a little bit i think the language in the state practice act that you're looking for is that um there is there are some states that specifically say that we can work in a clinic you want there to be a very um a broad definition of an athlete where it could be a recreational person or an athletic person that that kind of covers it um also there there's some stipulations i believe it was when i worked in colorado i worked in a lot of states i think it was in colorado there was actually a blurb in there that we can work outside the athletic setting at the discretion of a physician and it was very broad and i think that's where a lot of practice acts go anyway they leave it open to interpretation to not cut off a lot of opportunities um i think there's a couple states in particular i i think um pennsylvania louisiana i think are states where athletic trainers cannot function in the operating room there's just a stipulation there that's a hard stop uh but there's less of that there's more of you know working at the discretion of a physician working with an athletic population and that allows us to to function in this role yeah looking for language specific around skills um i pennsylvania is one of those states that specifically says athletic trainers can't perform invasive procedures um versus like my state that i live in in idaho it says that an athlete trainer can perform any skill that it's their directing physician approves of um so language around that is a little bit more inclusive and usually it's more broad definitions as jen said more vegas seems to be the best option and leaves it a little bit more gray and open to interpretation all right so next one i know you've kind of touched on this a little bit but does anyone else have things to add on how to advocate for at is not just fulfilling an ma role within the clinic i'll let you guys go if you want we have some we have some research actually on that on our on our at pps website and there's actually been studies that have shown with where a physician has either a medical assistant or an atc in the clinic it increases clinic throughput which increases revenue um so there's actually objective data to show that we can increase those benchmarks within a physician practice as well awesome um and as jen mentioned that if you haven't looked at the chat um my colleague megan has been dropping in links to the atpps website so um and everything that she's posted in there it's not behind a paywall or anything you can you can access that you know regardless of whether you're an atpps member and do utilize those resources that's what they're there for okay um i see a note from kevin um as well i think we covered through that um do you does anyone want to touch anything else on if you're not billing for atc's exam and documentation how do you justify the cost of an at no all right so we have a dme question here regarding dme service have you found that hospital-based clinics have to obtain an additional license to be able to bill for these supplies this is what we found in the past um so the biggest thing is uh you need to differentiate like again like what supplies that you want to dispense um so is it just like the braces are you looking at more the cgm glucose or glucometer cpeps those kinds of things um but there's a few things to to look at here because if it depends on who the who has the license so if the hospital itself has a license and it's not a physician then you're going to be more of a supplier because at that point like i was saying earlier at that point um it's not a it's not just a benefit to the patient because they're there because anybody could come in um so if you're if yeah if you are looking at a hospital-based clinic and doing a hospital-based dme then you're going to be looking more at a supplier license rather than a physician license if you're looking to dispense that stuff in a hospital you would what you would want to do is you would want to license all of your physicians um because like each like it goes down to like the suite number so it's if you are on floor three and the and you know two wing and you are suite a then that's what the license is going to be for and those patients that are going into that office are the people that can benefit from your dme license um so that it's it's important to to figure out exactly which license that you need um and then also is you know are you in the global fee so if you're in the global then everything is going to get dispensed as a supply and not a dme product that you can build to insurance um so all of these things that like i talked about today and we talked about and you know answering this question um all of these things we are going we at pps and aoe is going to be having a dme course um hopefully coming out in february that's going to cover all of these types of questions because it is it's very different state to state um but you can you know hopefully with having a full course and having a you know basically a year long to learn all of this stuff um will kind of allow us to dive a little bit deeper into your exact situation um but that might be that might be an idea if you're looking to get a license thanks allison um so there's a question here that someone came in a little bit late um asking if anyone commented on the boc osc test using the additional credential in the clinic so specifically asking from a pathway to route yeah i'm a little confused by that question but yeah the bcso uh Credential has two pathways, as I discussed. Pathway one is going through an athletic training residency program that's KD accredited. The second pathway is going through an experience pathway. And, you know, every, like I said, it's a relatively new certification, or specialty credential. And for us here at St. Luke's, we recently just got it approved through our health system, just like any other specialty credential, like our RNs or PTs get. So, you know, making sure that you can identify that within your system. And then we start the conversation around opening up scope for people who have that additional credential. And we're still, again, it's still relatively new, and anything in a health system takes a long time to kind of go through that process, but we're in the process of redefining scope based on credential. And so that is an external validation of that additional skillset and additional training. So that's one way that you can utilize that credential to start those conversations. All right. So next question we have here, what items are you tracking for indirect revenue? So tracking how many patients, diagnostics ordered, they're seeing 60 to 70 patients two times a week, and like to start tracking the value they're bringing. Yeah, so I'm specifically tracking, I track numbers of patients for my facility. So I basically help with either a pre-op patient or post-operative patient. So I track the numbers that I'm seeing, but then I track on the physician assistant schedule the number of new patients, the number of follow-ups, the number of injections. And also he sees some pre and post-ops as well, we have more. So what kind of those differentiated numbers are, and then our facility can put those with the RVUs and billing rates and things like that. So that's basically what I'm tracking. I do track surgical volume as well. I've scrubbed into almost 500 cases at our surgery center here, and what those cases are and kind of what I have the most experience in. I'm not sure that that directly relates to revenue, but I just keep those numbers anyway. So I think my clinic numbers are more impactful for our facility. Yeah, and for me, it's more of a, it's more, again, it depends, I think, what your practice is looking for and what your system might be looking for. For us, it's more around physician efficiency and surgical efficiency, and making sure that we can keep his surgery schedule as full as possible throughout the year. Here, especially in Idaho, people like to be active in the summers can be a little bit bare in the surgery area. And so making sure that we don't run into lulls and we can fully maximize our OR time and fully maximize our clinic time as well. So that's really one of the areas that I track is more raw numbers, but also efficiency and how full are we keeping our clinics and how full, especially with new patients and surgical patients that we do things. All right, so are there any states that allow intra-articular injections by an ATC? I don't, I'm not aware, Jen, correct me if I'm wrong, I'm not aware of any that call that out specifically. But again, like I said, some states are very vague, like here in Idaho, if directed by your physician and your physician's physician approves, then you can do it. So that's something I have and do in the OR all the time, because my physician has given me direction and has given me approval to do so. So I think that's how ATs get around that. And then a lot of times I work on a health system, the health system can be one of the areas where credentialing around those specific procedures can be a little bit difficult. But I do know there are plenty of ATs doing that, especially in states that have more vague practice acts. Yeah, and to piggyback on that, the way our practice acts and our rules and regulations are written, they're not written like a list of things we can do. They're written as, there's certain restrictions on them. So otherwise, at the discretion of a physician, we can do them. And inter-articular injections are also part of our new KD educational standards as well. So all athletic trainers will be trained in that manner. So with those two things, as long as it's not restricted, it should be allowed to be done. All right. Someone's in the process of hiring an athletic trainer. Could you share a little bit about onboarding process? Does anyone want to have anything specific that they want to call out on what they look at when they're onboarding a new AT? I think, you know, whether an AT has worked in a physician practice or not, I think making sure they're oriented to the rules of all the rest of the staff in the office, down to the front desk, surgery schedulers, radiologists, all those kinds of things I think is really important to see how we fit into this complex healthcare puzzle that we have here. Part of our onboarding process is a rotation through the practice. We have our athletic trainers who rotate not only with other ATCs in the practice, but rotate with practices that are run primarily by a medical assistant or by a nurse and seeing what their roles are and how they run their practices as well. Part of our onboarding is athletic trainers learning casting techniques so that we can jump in and do those things as well. You know, getting on the phones, the phone calls, all those kinds of things. So we do a pretty robust like two or three month rotation through the practice before they're specialized within one physician's practice. And I think that's really important again, to understand the whole system. We have a lot of physicians and APPs in our office. So instead of just learning one narrow scape of it, just understanding again, how we're part of everything. So we really take our time orienting our ATs. All right. So someone's looking to utilize an ATC and our ASC for assisting and need to develop a competency checklist. Does anyone know where they can find an example or can share any examples? Yeah, we mainly developed ours off of pre-existing first assist PA and PE checklist, our NFA checklist as well. So we developed ours based off of that. So we didn't recreate the wheel. So within your practice or ASC or health system, I'm sure they already have one of those already out there and you'd want them to kind of follow the same as any non-physician first assist, because that's the kind of category that we would fall into. And so we'd wanna be following the same exact guidelines and competencies that they are doing. All right. Good advice. What are best practices for integrating ATs in a clinic that go into schools in the afternoon to cover sporting events? They're trying to integrate into the clinic, but running into staffing issues and workflow efficiencies after they leave. I'll take this one because I do this. So I still function as the DME coordinator, but I also still function at a high school and I work in a clinic. So basically it does get hard. It does get hard. Like everyone is extremely excited right now because it's summer, I'm there all the time, but it does get very difficult when it gets to like those later days during the week. I had a very good conversation with my coaches, my athletic director, stuff like that, because there were some times that, I mean, obviously I was blocked out, but then things happen in clinic. I mean, sometimes you don't get out when you're supposed to. So there are some days that I have a hard stop where it's like, nope, I am leaving. I have to leave at three o'clock, just kind of depending on what is going on at the schools. And then there's also some days where it's like, okay, I'm supposed to leave at three, but if I can't get out until four, 4.30, and then I go to the school afterwards and kind of check in and do things like that. So if you really are trying to push to get your athletic trainer, like involved in the clinic and use them that way, I would really have a conversation with the school because those are the people that are probably going to notice it the most is if your person is not there. Obviously your office is too, but I would have a conversation with them and just kind of figure out what, okay, what can we do? Can she kind of roll in late or he roll in late and still be able to see all of the kids and do everything that they need to do? All right, so how would you justify the salary for ATs in the physician setting as well as pay raises? What obviously taking into consideration, cost of living would be a good, well, and we have to be careful here because of antitrust laws, but like maybe, are you aware of anywhere where you can find resources for benchmarking on salary that we can direct people to for an AT where they can find really good reliable information on that? It's a little dated now, unfortunately. We have an infographic we put together through APT-PPS and this is pre-COVID. So the salary data is a little bit low now given the changes in healthcare landscape and everything in finance since COVID. So the salary data is a little bit lower, but one of the key things on that infographic is around specialized skills and the amount of specialized skills that an AT performs. And what's really cool about that infographic is that it kind of correlates additional skill sets with increase in salary. And it calls out some of those specific roles and specific skill sets that ATs in those specialized skills perform. And that can show and validate the benchmark of where you would put the salary. And that's one of the key things that we utilize that infographic for. And that's the reason it's still on there. We haven't collected salary survey data in a number of years now, just because a lot of times going through HR and benchmarking, they oftentimes have their own set of rules and paradigms that they use to make those determinations. So it became less useful than what we used to use it for. But really that specialized skillset infographic is why it's still on our website because we do find that very, very valuable and it's still directly correlated and still pretty true with the new changes and new expansion of ATs in this role. Great, thank you. So in Virginia, our ATCs can give injections under supervision of PA or physician. That was just a tip there in response to that other injection question. How are you billing for injections performed by the AT versus an MD, PA or NP? Is there different codes or billing that you want to go into? No, okay. All right, last one I see coming through here. Allison, Jen and JJ could answer this too, but specific to you, Allison, who does your outreach coordination and how does a outreach director work in your specific clinic? So we're a large multi-specialty group and so we have a lot of different, so we have like the physician side and then we also have physical therapy side. So when we look at our athletic trainers, we have some that work on the physician side and then some that work in the PT side. So our outreach director, he works on the PT side. So he does all of the school, everything for all of our schools. And then he also kind of assists the therapy manager. So he is her assistant. So they will do, he does more of the payroll and more of the admin stuff. And then some of our other athletic trainers, like I do DME and I see patients. We have one that does strictly DME. We have one that strictly sees patients. We have one that's doing more performance enhancement, injury preventions. We have one that's a PTA, ATC. So like they see patients as well when they're there. And so that's, I mean, it kind of just depends on what works in your model. But our thing, like where I work, our big thing is we want to make sure, because obviously, I mean, it's a big conversation when you're doing clinic outreach and you have ATCs at schools. Sometimes it's a little bit hard. Okay, how do we make them make money? Like we need to make them earn their keep. And so that's one big thing that I pushed when we came back is like, okay, we're going to have all these schools, we're going to have all these ATCs, but where else can we put them to generate some revenue? And most of ours is indirect. I'm actually working with our payers right now to make it more direct. So that way we can do more of the home exercise programs and stuff like that. But what I ran into is it is per payer all the time. So yeah, so there's a combination of things, but that's how ours works. And Jessica, just going back real quick to the pay question, I did put a link in the chat from the U.S. Bureau of Labor Statistics, specifically for athletic trainers, pay medians statewide, because it varies state to state. So there's a good resource there as well. Thank you. Thank you so much for doing that. All right, so we're really at time here. One tip here from Cassie in the chat, so make sure to check that out to prove worth to outreach ATs. So as we close, I just wanna give a final opportunity to each of you, if you wanna give anything you wanna drive home or one piece of advice as somebody who's considering adding an AT into their practice. So Allison, I see you first. I think any time, and I will be just like JJ and Jen on this call. It is, we are the first people that are going to stand up for ourself and try to tell you what we can do. And so if you're thinking about it, I would do it because it is, I mean, any of the docs that I work with, any of my admins that I work with, I know they're going to tell you that it was not a bad idea because I was the first ATC that worked in physician office and did DME and now we just continue to grow. So it's a good idea if you're holding back, I would definitely do it. And there's a lot of resources on our website that obviously can help with that. All right, I see you next, JJ. Yeah, to expand on that even more, I think ATs are, we can, first with Army Knives, we can fit in a lot of places. And I think if you have a very specific mindset of what you're trying to do when you're implementing an AT into that role, being very clear with the definition of what you want them to perform, but then also being willing to modify that as you go, because ATs can perform so many different areas. I mean, within our health system alone, we've expanded from ATs just being outreach to being a clinic, to being in the OR, to changing into all of, just being in sports medicine, to being in all of orthopedics and now venturing outside of orthopedics into primary care and some of the other areas. And so I think ATs can fill a very big void in health systems and within private practices, but being willing to adapt your model and what you're planning to use them for and being open to continuing the education for them as well and letting them grow in their role because they're not stagnant. And if you let them be stagnant, your practice will become stagnant. And so I think that's one of the biggest things that the reason we started ATPPS and one of the things we're always advocating for is continuing to be lifelong learners within our practice. Great, and Jen, would you like to close us out here? Yeah, just my perspective in addition to both of those is to really understand what we can and can't do, understand those state practice acts when you bring an AT in. But I think the biggest thing, as JJ alluded to before, if a physician or an executive doesn't understand what an AT can do and the AT also doesn't understand, you will get an athletic trainer and you look and you say, they're similar to my MA. Why wouldn't I just hire an MA? But if the executive or administrator understands the scope of practice, as does the AT, you can be creative like we have within our practices and make this a very worthwhile experience. So I would highly recommend that to grow. All right, thank you all so much. As a reminder, this was recorded and we'll be sending this out to all of the registrants when it's available. Thank you all so much for your time and sharing all your wealth of information, Allison, JJ, and Jen, thank you. And again, please do utilize ATPBS for resources as you're continuing to build your business case to bring on an AT into your practice and feel free to reach out to us and we'll be able to, I can always facilitate questions to these folks to get additional input. You can reach out to us at AOE or I know ATPBS even has an info at ATPBS email. So thank you all, thanks for joining us and we'll see you the next time around. Thank you. Thanks.
Video Summary
In the video transcript, the speakers discussed the value of certified athletic trainers (ATs) in physician practices, focusing on topics such as onboarding processes, billing for AT services, indirect revenue tracking, integrating ATs into clinics, DME programs, and more. They emphasized the importance of understanding state practice acts, advocating for the unique skill set of ATs, and adapting and growing the role of ATs in healthcare settings. Tips included utilizing resources from ATPBS, benchmarking salary data from the U.S. Bureau of Labor Statistics, and adapting the AT role to fit the specific needs of the practice. Overall, the speakers highlighted the diverse skills and benefits that ATs can bring to physician practices and encouraged open communication and ongoing education to maximize their impact.
Keywords
certified athletic trainers
physician practices
onboarding processes
billing for AT services
indirect revenue tracking
integrating ATs into clinics
DME programs
state practice acts
ATPBS
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