Chapter 1: The Sports Medicine Team

Chapter 1: The Sports Medicine Team

Sports Medicine • Where Have We Been? • Where Are We Now? • Where Are We Going?

What Is Sports Medicine ?

Sports Medicine Human Performance Injury Management Exercise Physiology Practice of Medicine Biomechanics Sports Physical Therapy Sport Psychology Athletic Training Sports Nutrition Sports Massage

Physicians Dentist Podiatrist Nurse Physicians Assistant Physical Therapist Athletic Trainer Massage Therapist Exercise Physiologist Biomechanist Nutritionist Sport Psychologist Coaches Strength & Conditioning Specialist Social Worker The Players on the Sports Medicine Team

The Primary Players on the Sports Medicine Team

Physician Coach Athlete Athletic Trainer

Historical Development of Sports Medicine Organizations • International Federation of Sports Medicine (1928) • American Academy of Family Physicians (1947) • National Athletic Trainers Association (1950) • American College of Sports Medicine (1954) • American Orthopaedic Society for Sports Medicine (1972) • National Strength and Conditioning Association (1978) • American Academy of Pediatrics, Sports Committee (1979) • Sports Physical Therapy Section of APTA (1981) • NCAA Committee on Competitive Safeguards and Medical Aspects of Sports (1985)

International Federation of Sports Medicine (FIMS) • Federation Internationale de Medecine Sportive (FIMS) • Principal purpose to promote the study and development of sports medicine throughout the world • Made up of national sports medicine associations of over 100 countries • Organization is multidisciplinary, including many disciplines that are concerned with physically active individuals

American Academy of Family Physicians (AAFP) • To promote and maintain high quality standards for family doctors who are providing continuing comprehensive health care to the public • It is a medical association of more than 93,000 members • Many team physicians are members of this organization

American Orthopaedic Society for Sports Medicine (AOSSM) • To encourage and support scientific research in orthopaedic sports medicine and to develop methods for safer, more productive and enjoyable fitness programs and sports participation • Members receive specialized training in sports medicine, surgical procedures, injury prevention and rehabilitation • 1,200 members are orthopaedic surgeons and allied health professionals

National Strength and Conditioning Association (NSCA) • To facilitate a professional exchange of ideas in strength development as it relates to the improvement of athletic performance and fitness and to enhance, enlighten, and advance the field of strength and conditioning • 14,500 strength and conditioning coaches, personal trainers, exercise physiologists, athletic trainers, researchers, educators, sport coaches, physical therapists, business owners, exercise instructors and fitness directors • Accredited certification programs • Certified Strength and Conditioning Specialist, (CSCS) • NSCA Certified Personal Trainer (NSCA-CPT)

American Academy of Pediatrics, Sports Committee • Dedicated to providing the general pediatrician and pediatric subspecialist with an understanding of the basic principles of sports medicine and fitness and providing a forum for the discussion of related issues • To educate all physicians, especially pediatricians, about the special needs of children who participate in sports

NCAA Committee on Competitive Safeguards and Medical Aspects of Sports • Collects and develops pertinent information regarding desirable training methods, prevention and treatment of sports injuries, and utilization of sound safety measures • Disseminates information and adopts recommended policies and guidelines designed to further the above objectives • Supervises drug-education and drug-testing programs

American College of Sports Medicine (ACSM) • Patterned after FIMS (Umbrella Organization) • Interested in the study of all aspects of sports • Membership composed of medical doctors, doctors of philosophy, physical educators, athletic trainers, coaches, exercise physiologists, biomechanists, and others interested in sports • 18,000 members

Sports Physical Therapy Section of APTA • To provide a forum to establish collegial relations between physical therapists, physical therapist assistants, and physical therapy students interested in sports physical therapy • Promotes prevention, recognition, treatment and rehabilitation of injuries in an athletic and physically active population • Provides educational opportunities through sponsorship of continuing education programs and publications

Sports Physical Therapy Section of APTA • Promotes the role of the sports physical therapist to other health professionals • Supports research to further establish the scientific basis for sports physical therapy • Offers certification as a sports physical therapist (SCS) • Approximately 9,000 members • Many sports physical therapists are also certified athletic trainers

National Athletic Trainers Association(NATA) • To enhance the quality of health care for athletes and those engaged in physical activity, and to advance the profession of athletic training through education and research in the prevention, evaluation, management and rehabilitation of injuries • The NATA now has 28,000 members

AMA Recognition of Athletic Training • June 1991- AMA officially recognized athletic training as an allied health profession • Committee on Allied Health Education and Accreditation (CAHEA) was charged with responsibility of developing essentials and guidelines for academic programs to use in preparation of individuals for entry into profession through the Joint Review Committee on Athletic Training (JRC-AT)

AMA Recognition of Athletic Training • June 1994-CAHEA dissolved and replaced immediately by Commission on Accreditation of Allied Health Education Programs (CAAHEP) • Recognized as an accreditation agency for allied health education programs by the U.S. Department of Education • Entry level college and university athletic training education programs at both undergraduate and graduate levels are now accredited by CAAHEP

AMA Recognition of Athletic Training • Effects of CAAHEP accreditation are not limited to educational aspects • In the future, this recognition may potentially affect regulatory legislation, the practice of athletic training in nontraditional settings, and insurance considerations • Recognition will continue to be a positive step in the development of the athletic training profession

National Athletic Trainers AssociationBoard of Certification (NATABOC) • In 1999 the NATABOC completed the latest Role Delineation Study, which redefined the profession of athletic training • Study designed to examine the primary tasks performed by the entry level athletic trainer and the knowledge and skills required to perform each task

Role Delineation StudyPerformance Domains • Prevention of athletic injuries • Recognition, evaluation and assessment of injuries • Immediate care of injuries • Treatment, rehabilitation and reconditioning of athletic injuries • Health care administration • Professional development and responsibility

Education Council • In 1998 the Education Council was established to dictate the course of the educational preparation for the student athletic trainer • Focus has shifted to competency based education at the entry level • Education Council has significantly expanded and reorganized the clinical competencies and proficiencies

Athletic Training Educational Competencies (1999) • Twelve Content Areas • Acute care of injury and illness • Assessment and evaluation • General medical conditions and disabilities • Health care administration • Nutritional aspects of injury and illnesses • Pathology of illness and injuries

Athletic Training Educational Competencies (1999) • Pharmacological aspects of injury and illnesses • Professional development and responsibility • Psychosocial intervention and referral • Risk management and injury prevention • Therapeutic exercise • Therapeutic modalities

NATABOC vs. Education Council • The NATABOC defines the minimum knowledge base that an entry level athletic trainer should possess to be able to work in the profession while the Education Council was charged with determining the competencies that should be taught in accredited educational programs • There is overlap between Performance Domains and Competencies

Certification Requirements • Candidates for certification must meet NATABOC established requirements • For students graduating in 2003 and beyond, NATABOC no longer requires clinical hours • CAAHEP accredited programs must develop and implement a clinical instruction plan according to 2001 Standards and Guidelines to ensure that students meet all AT educational competencies and clinical proficiencies in academic courses with measurable outcomes

Certification Requirements • Accreditation process will be concerned with the quality of experiences and student outcomes and knowledge rather the number of hours accrued • As of January, 2004 the internship route to certification will no longer be accepted • All candidates for certification will have to meet CAAHEP requirements • Successful completion of all parts of the certification exam will earn the credential of ATC

CAAHEP Accredited Programs • Currently 134 institutions offer entry level athletic training education programs accredited by CAAHEP • 174 are in the process of seeking CAAHEP accreditation • 13 graduate programs in athletic training approved by the Education Council Post-Certification Graduate Education Committee

Employment Settings for Athletic Trainers • Secondary Schools • 1995 NATA adopted a position statement supporting hiring athletic trainers in secondary schools • 1998 AMA adopted policy calling for ATC’s to be employed in all high school athletic programs • ~ 30,000 public high schools in U.S. • Between 20-25% of high schools have ATC’s • School Districts • ATC floats between several schools in same district

Employment Settings for Athletic Trainers • College and Universities • Number of ATC’s varies considerably • Extent of coverage varies • 2000 Task Force published Recommendations and Guidelines for Appropriate Medical Coverage for Intercollegiate Athletics • Based on a mathematical model created by a number of variables • Professional Teams • ~ 5% of employed ATC’s

Employment Settings for Athletic Trainers • Sports Medicine Clinics • The largest % of employed ATC’s found in this setting • Work in the clinic in AM and in high school in PM • Industrial and Corporate Settings • ATC’s oversee fitness, injury rehabilitation, and work-hardening programs • Understanding of workplace ergonomics is essential

State Regulation of the Athletic Trainer • During the early-1970s NATA realized the necessity of obtaining some type of official recognition by other medical allied health organizations of the athletic trainer as a health care professional • Laws and statutes specifically governing the practice of athletic training were nonexistent in virtually every state

State Regulation of the Athletic Trainer • Athletic trainers in many individual states organized efforts to secure recognition by seeking some type of regulation of the athletic trainer by state licensing agencies • To date 40 of the 50 states have enacted some type of regulatory statute governing the practice of athletic training • Rules and regulations governing the practice of athletic training vary tremendously from state to state

State Regulation of the Athletic Trainer • Regulation may be in the form of: • Licensure • Limits practice of athletic training to those who have met minimal requirements established by a state licensing board • Limits the number of individuals who can perform functions related to athletic training as dictated by the practice act • Most restrictive of all forms of regulation

State Regulation of the Athletic Trainer • Certification • Does not restrict using the title of athletic trainer to those certified by the state • Can restrict performance of athletic training functions to only those individuals who are certified • Registration • Before an individual can practice athletic training he or she must register in that state • Individual has paid a fee for being placed on an existing list of practitioners but says nothing about competency

State Regulation of the Athletic Trainer • Exemption • State recognizes that an athletic trainer performs similar functions to other licensed professions(e.g. physical therapy), yet still allows them to practice athletic training despite the fact that they do not comply with the practice acts of other regulated professions • Legislation regulating the practice of athletic training has been positive and to some extent protects the athletic trainer from litigation

List of Regulated States • Alabama (L) Kansas (R) North Carolina (L) • Arkansas (L) Kentucky (C) North Dakota (L) • Arizona (E) Louisiana (C) Ohio (L) • Colorado (E) Massachusetts (L) Oklahoma (L) • Connecticut (E) Maine (L) Oregon (R) • Delaware (L) Minnesota (R) Pennsylvania (C) • Florida (L) Mississippi (L) Rhode Island (L) • Georgia (L) Missouri (R) South Carolina (C) • Hawaii (E) Nebraska (L) South Dakota (L) • Idaho (R) New Hampshire (C) Tennessee (C) • Illinois (L) New Jersey (R) Texas (L) • Indiana (L) New Mexico (L) Vermont (C) • Iowa (L) New York (C) Virginia (C) • Wisconsin (C)

Reimbursement for Athletic Training Services • During the past 40 years the insurance industry has undergone a significant evolutionary process • Health care reform initiated in the 1990’s has focused on the concept of managed care in which costs of a health care providers medical care are closely monitored and scrutinized by insurance carriers • Managed care involves a prearranged system for delivering health care that is designed to control cost while continuing to provide quality care

Reimbursement for Athletic Training Services • Third-party reimbursement - primary mechanism of payment for medical services in the United States • Health care professionals are reimbursed by the policy holder's insurance company for services performed • To cut pay-out costs, many insurance companies limit where and how often an individual can go for care and what services will be paid for

Reimbursement for Athletic Training Services • Unless ATC is also a licensed physical therapist, it is difficult to obtain third-party reimbursement for health care services provided • State regulation of the ATC has, to date, helped little with obtaining reimbursement • In general, insurance companies have not been willing to cover services provided by the ATC • Securing third-party reimbursement must be a priority, especially for the clinical ATC

Reimbursement for Athletic Training Services • 1995- NATA established Reimbursement Advisory Group to monitor managed care changes and to help ATC secure a place as a health care provider • 1996- NATA initiated the Athletic Training Outcomes Assessment project designed to present supporting data to measure results of interventions which involve athletic training procedures

Reimbursement for Athletic Training Services • Athletic Trainers must bill insurance companies according to the Current Procedural Terminology (CPT) codes published by AMA • In 1999, the American Hospital Association approved a new uniform billing code (UB Code) to be used specifically for provide athletic training services -- 951

Athletic Trainer vs. Physical Therapist Wars • It is not unusual to find a physical therapist interested in sports and athletics working toward certification as an athletic trainer • A certified athletic trainer interested in working with patients outside of the athletic population may work toward licensure as a physical therapist

Athletic Trainer vs. Physical Therapist Wars • Historically, the relationship between athletic trainers and physical therapists has been less than cooperative • There has been failure to clarify the roles of each group in injury rehabilitation • Academic preparation is similar • Individual who holds a dual credential is more marketable

Future Directions • Increase effort to enhance visibility • By making themselves available for local and community meetings to discuss athletic health care • Through research efforts and scholarly publication • Continue reorganize and refine educational programs for student athletic trainers • Continue to seek and strengthen state regulation of the practice of athletic training

Chapter 1: The Sports Medicine Team