We have got to do better

February 14, 2014

As an athletic trainer I know that I am valuable and that every single youth athlete needs to have access to the skills that I can provide. I can not only be there to counsel about health issues, treat acute injuries, solve the chronic issues, but I can also save their life.

I sometimes joke (although it is wholeheartedly true) when I do something remotely remarkable that I save people’s lives. I do in fact save lives. I have done so on the field and in indirect ways routinely. I can claim to be a life saver.

I want more people to know my value. More than that. I want everyone to know the value that an athletic trainer brings. There are some that wish that the NATA did more to promote us. I know that they do a great job of doing so, but at the same time I wish that there was a way to do more. I understand that ‘I’ am the NATA. What each AT does is a voice for the NATA.

My rub is that there are some that want to claim to be able to do what ATs do well. It is like the pastry chef claiming to be able to make excellent steaks. You make great pastries, but I am never going to trust you with my steak. Some professionals are great at what they do and I will respect them for that. They should not try to claim to be the solution for protecting youth athletes. Athletic trainers have the knowledge and understanding to do this. Keep your cake. We’ll take care of the steak.

It is my hope that each state organization will make a push to promote athletic training more. I hope that each district will make strides to support an AT in every high school and middle school in a reasonable amount of time. I do hope that the NATA will lead this and make it a concerted effort to do everything that they can to educate and inform. To lead the charge to make every school safer.

My hope is that every athletic trainer will push for House Resolution 72 to be passed so that there is support for our young athletes. We need to be focused on passing legislation that is intended to protect our youth. Join with me. Be active and be heard.

Open up your facility

July 30, 2013

If you have not already started preseason practices you soon will. That means a lot of long hours and work for many ATs. Did you know that it also presents an excellent opportunity?

As the year is ramping up for athletic trainers the work of Congress is on hold. They go on “vacation.” They are no longer in Washington, D.C. and are in their home districts. This does not mean that they are not working. What does this mean for you and I? We have a great opportunity to showcase what we do and our value in protecting the student-athletes.

House Resolution 72 is the Seconday School Student Athletes’ Bill of Rights. If you are not familiar with it then take a momment after you read this to go to (www.athletictrainers.org). The premise is that student-athletes and their parents should be able to have certain minimum expectations met when participating in secondary school athletics.

Would you be willing to invite your Congressman/woman to your athletic training facility for a visit in the month of August? All it takes is an email to their district office to invite them and let them know you would like to discuss House Resolution 72. If you would rather, give them a call and invite the Congressman. If you don’t know who it is then go to http://www.house.gov/representatives/find/.

When they come give them information about athletic trainers, about the bill of rights, about your program, and about HRes 72. Your NATA District Governmental Affairs Representative can provide you with information if you need or you can contact the NATA. Give your Representative a tour of your facility, your football practice, a ride on your Gator, and show them what you do. Ask them to co-sponsor House Resolution 72 to protect student-athletes. Get a picture with them and post it, along with a thank you, on twitter or facebook (tag them in the post). Then follow up with a thank you note to your Congressman/woman.

I hope to hear of hundreds of Congressional visits to AT facilities all across the country in the next month. I hope to share with you mine. We can show Congress why this is important and they will be interested. All it takes is a little time and effort on your part. Are you willing to take that step for the profession?

Have you ever taken a job for experience? That job that is simply a foot in the door or a step in the right direction. Perhaps it is simply resume fodder. I will admit it, I have. That job that is available and seems like the best choice at the time. Maybe we get desperate. After all, we do need to eat.

As I look through the Career Center I wonder how many of these jobs are actually worthwhile. How many of these jobs actually value the worth of the athletic trainer? How many of these internship positions are looking for a cheap certified with the promise of “experience?”
There are companies out there that do “outreach” to schools. Many times this is nothing but ‘pimping’ the athletic trainer to a school for presumed profit. There is no value to the school that does not pay for a service or pays so little that the service is essentially given. If I am selling shoes and give you a pair of shoes for $1 are you going to value them as much as one that I sell you for $75? Which would you presume to have more worth? The shoes do the same thing and provide the same functions. Would you expect that both are of equal quality?

Physical therapists have taken issue with physician-owned physical therapy practices because they put the physical therapist at a disadvantage. Athletic trainers need to stop accepting that physical therapists are the best or preferred employment means. We should take a stand against physical therapists devaluing the services that athletic trainers provide. They tell others and us that we should not be doing rehabilitation. They take this important skill away from so many ATs. At the same time they determine our salaries and tell us what they think we are worth.

This has to end. We need to stop taking jobs that do not show value for our profession. I have taken a job that I hoped I would be able to prove my worth once I got in. Three years later nothing has changed and I was stuck in a position that continued to not respect the athletic training profession. We all make mistakes.

Unfortunately you already have the answer for not taking these jobs. Someone else will take it. We, as a profession, need to stop taking jobs that devalue our profession. It’s simple, but it only works when more than one of us actually does it. Our new graduates need to know what they are worth and understand that some jobs are not helpful for the profession. Until we have more opportunities that understand our value we will have difficulty doing this.

The solution is to create a position that does value your skill set. That private school that only wants an athletic trainer for 20 hours a week at $20/hour is not a good position. But that physician office that can use you as a physician extender full time at a competitive salary because of the cost-savings that you can demonstrate may be a better position. That college that wants to pay you $25,000 is not valuing the work that you do. But maybe the school district that recognizes the need is a responsible fit.

Not all positions are equal and it is difficult sometimes to weigh that out. It would be my desire to see athletic trainers open their own clinics and demonstrate their value to the patient. It will be the day when athletic trainers no longer work for physical therapists and simply put money back into their pockets without being valued. The madness needs to end. We are a valuable profession that is driving talented professionals out of it because our profession believes that it is okay to give away services. Stop giving it away.

Reimbursement

March 25, 2013

An interesting topic that has come up is that of athletic training third party reimbursement. This is a topic that I am interested in, as well. Should we seek legislation for third party reimbursement?

You might know that a few years ago the NATA was seeking different forms of legislation to be recognized by Medicare. This was to reverse the CMS decision that athletic trainers could not provide rehabilitation services incident-to. While it is important nationally for athletic trainers to be recognized by CMS for Medicare and Medicaid, it is certainly not the easiest path.

What states have found is that they are willing to recognize and reimburse athletic trainers for the important services that they provide to their customers. Other states have passed legislation requiring insurance companies to not discriminate against ATs if they reimburse the services to other providers.

The challenge is in educating the insurance company decision makers, just like we have needed to educate the legislators who have passed our licensure bills. Many of these decision makers do not know about athletic training and some have never heard of athletic trainers. This does not mean that they will not support reimbursement for ATs, just that they need information and a clear case.

So what is the case for AT reimbursement? Athletic trainers have been providing the services that are reimbursed by other providers for decades. Rehabilitation is not owned by any profession, but is shared by athletic trainers with several professions. Athletic trainers have specific AT evaluation and re-evaluation codes for reimbursement. All of the other codes are non provider-specific. While many ATs practice in professional sports, colleges and universities, and high schools, there are also many who practice in physicians’ offices, hosptials, and rehabilitation clinics. Athletic trainers are not asking for a new category or for insurance companies to begin paying for services that they do not currently reimburse.

This conversation needs to take place with insurance companies. There are ways that states require insurance companies to pay, but that can only happen after there has been a demonstrated effort to gain reimbursement without legislation. Some states have laws, but this is not something that needs to happen in each state necessarily.

For the sake of the profession we should pursue third-party reimbursement. This is not to say that secondary schools should be neglected. We absolutely should continue to work on this. Why only put one iron in the fire? Should we not support the irons that have interest and skills in this area? We should support all of our practice settings and ensure that we are providing the necessary support legislatively when needed.

Concussion Laws

March 11, 2013

There are 43 states with concussion laws on the books. Four states (West Virginia, Tennessee, South Carolina, and Arkansas) have legislation pending. Many of them have similiar components, but none are exactly the same because no two states are the same.

Parents, coaches, school administrators, athletic administrators, athletic trainers, and physicians should all be familiar with the concussion laws that are in place in their state. The laws provide guidance for how, when, and by whom a student-athlete exhibiting concussion symptoms may resume participation. Some states require schools to have a protocol in place, while others simply require education of coaches and clearance by a qualified health care professional.

These laws could, and some argue should, go much further. The laws should be in place for all youth sports and require education by any coach of a youth athlete. The law should require a physician clear the athlete. There should also be a mandate that school districts have protocol in place for middle and high schools, in addition to youth leagues. Penalties would ensure that schools actually follow the law, but only if there is a way to report if the law is not followed. In addition, athletic trainers should be able to use their discretion if a physician clears an athlete and there are indications that concussion still exists.

I have heard it suggested that there should be support and advocacy for athletes with head injuries. The education surrounding concussions has improved, but continues to be insufficient. Parents are not getting the information that they need in order to fully understand. Coaches get around the education requirement by having one coach take the test and put in the name of each coach. Coaches are not interested, but the responsibility is on them by the state.

Which brings me to, why are the states putting the responsibility on coaches? Is it because they know that the coaches are qualified? Clearly not or else they would not require education every year. Is it because coaches make the best decisions? Certainly not! Is it because every school has a coaching staff, but not every school has medical staff in place? Precisely!!!

Coaches need to have the responsibility to know not to put an athlete back in the game, but they don’t have the ability, interest, or understanding to evaluate and determine if a concussion is present. Athletic trainers have this abililty and understanding and should be in place in every school to make sure that students are safe. It was reported that more concussions are diagnosed in schools with athletic trainers. Why? Because athletic trainers have the ability to evaluate and diagnose this injury. Those schools that do not have athletic trainers are not diagnosing all of these injuries and are returning them back to the field earlier. This is dangerous for their future health.

Everyone should be familiar with their concussion law. You can make a difference by talking with your elected officials about athlete safety laws and how they affect our children.

Licensure for Kentucky

March 8, 2013

Kentucky will become the 40th state to have licensure, as the legislature has passed a bill  to change “certification” in the practice act to “licensure.”  The governor still needs to sign the bill, but this is expected this month.

Kentucky Athletic Trainers’ Society has worked very hard to achieve this. They join a growing list of states that recognize athletic trainers and athletic training. And this list is set to grow longer in the future.

There are just three states with certification: Louisiana, New York, and South Carolina.  It is the hope of the NATA that all states that are not recognized with licensing will do so in the coming years. It is important for athletic trainers to have this recognition and to be held to the same standard as all other health care professionals.

Join with me in congratulating Kentucky on this most recent achievement!

Misinformation

March 7, 2013

Some professions do not agree with the athletic training scope. They believe that we are not qualified to do the things that are do well everyday. They would like to relegate athletic trainers to ancillary staff in clinics and not use the skills off of a football sideline.

In health care the people that we treat are patients, but athletic trainers are not supposed to refer to them as such. Athletic trainers treat patients in a number of settings, including settings where student-athletes are treated. Military, industrial, clinical, hospital, and performing arts are all settings that athletic trainers provide treatment of injury and illness. When someone seeks the care of an athletic trainer they are a patient.

Even though athletic trainers perform a clinical evaluation, it is not supposed to be called that. The clincial evaluation that is included in athletic training education is on par with any other allied health care professional treating musculoskeletal injuries and neurological conditions. The evaluation is a clincal evaluation because it fits the definition of what we do:

An evaluation of whether a patient has symptoms of a disease, is responding to treatment, or is having adverse reactions to therapy

For some reason athletic trainers do not provide “treatment of injury or illness.” I am honestly not sure where to start with this. What do athletic trainers do? Not treat injury and illness? Treat something other than injury or illness? The statement that athletic trainers do anything other than treatment of injury or illness is preposterous. Every single day athletic trainers do exactly that. For another health care professional organization to submit that it should not be in practice act language is unfortunate.

And lastly, and the most telling, is that athletic trainers providing “rehabilitation” is not appropriate. This is within the scope of athletic training practice. It is a crucial part of the education of athletic trainers. Rehabilitation, as some believe, is not owned by anyone. It is well within the athletic trainer’s scope to provide rehabilitation services to their patients in the course of treatment for their injury after a clinical evaluation has taken place.

Do not believe that others will provide anything but misinformation in targeting the athletic training profession. If they perceive a the potential for a threat to what they believe they own misinformation is just one way that they will do it. It is sad, unfortunate, and true.

This is why athletic trainers, students, and patients need to strongly support proper regulation that will allow ATs to practice within their scope. Legislators need to be educated on accurate information from athletic trainers. Otherwise they will rely on the information that others are more than willing to feed them. Understand, legislators may not know what an athletic trainer is and may not realize that this is misinformation. All that they know is that they need to make the best decision for the public. They may not be experts in health care. Take the time to educate your legislators, it will pay dividends in the future.

Case for AT Regulation

March 3, 2013

Why do athletic trainers need to be licensed? ATs already have national certification, isn’t that good enough? Does it really help at all?

Athletic trainers are certified nationally be the BOC (www.bocatc.org). There are requirements for taking the certification exam, including completing a CAATE accredited program in Athletic Training. The certification exam is grueling – ask anyone who has completed it. This certification (ATC) is the standard for most states for licensing, certification, or registration. The BOC requires continuing education to maintain the credential and has been leading the way in regards to certification.

The ATC does allow someone to be recognized as qualified and is the route for becoming an athletic trainer in the United States. This does not, however, prevent someone from calling themself an athletic trainer. The credential cannot be used without the BOC, but “athletic trainer” is not protected by the BOC.

In 39 states Athletic trainers are licensed. Four states have certification. Five states have registration. California, Alaska, and the District of Columbia are not regulated.

Regulation of a profession is for the protection of the public. It prohibits someone unqualified (without proper credential) from practicing or calling themself an athletic trainer. Unfortunately, not all regulation is equal. Licensing is the most protective. Certification provides greater protection than registration, but does not provide the public with adequate protection. Registration is essentially being listed with the state as an athletic trainer. There is not a great amount of protection under registration. The states that lack regulation have not taken the steps to protect the public from a parent, a coach, or even a janitor from practicing athletic training.

In states where regulation has been standard for years it might seem strange to think that someone could come in off the street and call themself an athletic trainer. A coach that has been around might try to fill the shoes, but they lack the knowledge and skills that are gained in athletic training education.

There are states attempting to improve regulation, including introducing regulation (California and Alaska). It is important for the public to know that they have someone qualified when someone calls themself an athletic trainer. A recent post on twitter talked about a chiropractor and students calling themselves athletic trainers. While the chiropractor has training, the qualifications are not the same and the skills should not be confused.

Athletic trainers have extensive training in evaluation, diagnosis, management, treatment and rehabilitation, and knowledge of return to play. Concussions and athlete safety are areas of expertise. Athletic trainers understand emergency management, especially of the equiped athlete.

While some might assume that athletic trainers are like personal trainers, it could not be further. Personal trainers are not required to have education, even though some have education, and there is no standard certification. In fact, some personal trainers become certified in a weekend. On the other hand, athletic trainers are health care professionals with a minimum of a bachelors degree and have the ATC as the standard.

Athletic trainers and the public should demand the highest regulation in each state. It is for the safety of those that athletic trainers treat. It is for the safety of all of the student-athletes in high schools who deserve the services of someone qualified. Parents need to know that when their child goes to school that, like knowing that the school nurse is qualified, that the “athletic trainer” is qualified through having a license.

Athlete safety

February 25, 2013

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Since the youth sports safety alliance met weeks ago there has been a push for greater attention on athlete safety. There is now an athlete bill of rights created by the youth sports safety alliance. This bill of rights creates a minimum standard for youth athlete safety. Simple steps like AED, first aid, CPR, emergency action plans, and safe facilities.

While it may come as a surprise to you that these things may be lacking in some places, it is the reality for about 60% schools in the US. Many of them do not have the necessary components in place.

There are 10 simple things all schools must do to protect their students. The NATA approached Congress today to ask for support of Represtative Gerlach’s resolution (H.R. 72). It seems like commonsense to support it. 

Your representative should learn about this resolution from you. Anyone can ask for their support and it is the most commonsense thing they can do in light of recent tragedies. We can’t force schools to provide the best care available, but they should be forced to provide basic things.

 

NPI

February 21, 2013

What is the NPI? You’ve heard it thrown around by the NATA possibly. What is it and why is it so important?

The NPI is the National Provider Identifier. It was part of the HIPAA that it be created and has been in place since 2005. It is a permanent number once someone registered. The number is to be used by all HIPAA  covered healthcare providers (which includes ATs) for HIPAA transactions.

While many ATs are not covered under HIPAA, it is important for us to have a number in case it is needed. Many ATs also practice in clinical settings where HIPAA transactions may be necessary. It does show strength in each AT possessing an NPI. While you may not use it daily, it may have a greater impact than you realize.

It takes less than 20 minutes to complete and costs nothing.

“NATA views having an NPI number like having a state license: it’s a professional requirement and adds credibility to both the individual and the profession,” says Cate Brennan Lisak, director of external affairs. “Once ATs get their NPI number, it will be theirs forever — no matter where they work. There’s no downside to having an NPI number.”

When filling out your application use: Provider Code 22 (Respiratory, Rehabilitative & Restorative Service Providers) and Taxonomy Code 2255A2300X (Athletic Trainer)

Go to this link https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart to apply for your NPI today.