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Chapter 1: The Sports Medicine Team

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Title: Chapter 1: The Sports Medicine Team


1
Chapter 1 The Sports Medicine Team

2
Sports Medicine
  • Where Have We Been?
  • Where Are We Now?
  • Where Are We Going?

3
Where Have We Been?
  • Trainers associated with Greek Roman Periods.
  • Increase in sports activities during the
    Renaissance.
  • Late 19th century ATs involved with
    intercollegiate athletics in the US.
  • Rub downs, home remedies, lack of technical
    knowledge.
  • After WWI ATs viewed as specialized in
    preventing and managing athletic injuries.
  • 1950 NATA founded in Kansas City
  • 1980s Athletic Training Program content for
    bachelors degree.
  • 1980s development of NATABOC for board
    certification, ATCs.
  • Recognized by the AMA as a allied health care
    provider.

4
Where Are We Now?
  • 40 of ATCs work outside of school athletic
    settings.
  • JRC-AT/CAAHEP programs developed
  • ATCs allowed to bill insurance companies using
    CPT codes in 2002.
  • 2004 End of internship programs
  • ATCs regulated and licensed healthcare
    providers
  • ATCs provide the same or better outcomes as
    others, including PTs.
  • ATCs demonstrate high patient satisfaction
    ratings.
  • 30,000 NATA members

5
Where Are We Going?
  • 2005 17,110 projected ATC jobs
  • 2010 21,525 projected ATC jobs
  • Continued research to develop new techniques for
    injury prevention, management, and
    rehabilitation.

6
What Is Sports Medicine ?

7
Human Performance
Injury Management
Practice of Medicine
Exercise Physiology
Biomechanics
Sports Physical Therapy
Sport Psychology
Athletic Training
Sports Nutrition
Sports Massage
8
Goals of Professional Sports Medicine
Organizations
  • Develop professional standards code of ethics
  • Exchange of professional knowledge, stimulate
    research, promote critical thinking.
  • Ability to work as a group with a singleness of
    purpose to achieve objectives that could not be
    accomplished separately.

9
The Players on the Sports Medicine Team
  • Physicians
  • Dentist
  • Podiatrist
  • Nurse
  • Physicians Assistant
  • Physical Therapist
  • Athletic Trainer
  • Massage Therapist
  • Exercise Physiologist
  • Biomechanist
  • Nutritionist
  • Sport Psychologist
  • Coaches
  • Strength Conditioning Specialist
  • Social Worker

10
The Primary Players on the Sports Medicine Team

11
(No Transcript)
12
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)

13
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)

14
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)

15
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)

16
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

17
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

18
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

19
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)

20
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

21
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

22
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

23
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

24
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

25
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

26
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)

27
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

28
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

29
National Athletic Trainers Association Board 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

30
Role Delineation Study Performance 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

31
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

32
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

33
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

34
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

35
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

36
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

37
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

38
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 ATCs to be
    employed in all high school athletic programs
  • 30,000 public high schools in U.S.
  • Between 20-25 of high schools have ATCs
  • School Districts
  • ATC floats between several schools in same
    district

39
Employment Settings for Athletic Trainers
  • College and Universities
  • Number of ATCs 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 ATCs

40
Employment Settings for Athletic Trainers
  • Sports Medicine Clinics
  • The largest of employed ATCs found in this
    setting
  • Work in the clinic in AM and in high school in
    PM
  • Industrial and Corporate Settings
  • ATCs oversee fitness, injury rehabilitation, and
    work-hardening programs
  • Understanding of workplace ergonomics is
    essential

41
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

42
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

43
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

44
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

45
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

46
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)

47
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 1990s 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

48
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

49
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

50
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

51
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

52
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

53
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

54
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

55
Future Directions
  • Increase efforts to create job opportunities
    particularly in secondary schools, colleges and
    universities, and corporate and industrial
    settings
  • Increase effort in seeking third-party
    reimbursement for services provided
  • Continue efforts in injury prevention and in
    providing appropriate, high-quality health care
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