What ATs are allowed to do

January 27, 2013

I had a conversation with a respected colleague concerning what ATs are permitted to do in the clinical setting in Pennsylvania. This is someone who is very knowledgable and a quality educator. Her question was, based on the law, what are ATs allowed to do in the clinical setting?

This is an easy answer with a lot of complex ethical, legal, and professional discussions. Athletic trainers are permitted to perform within their scope of practice in the clinical setting. That includes AT evaluation, modalities, manual techniques (including “manipulations,” the caveat is that in some states PTs and ATs are not permitted to call grade 5 mobilizations “manipulations”), re-evaluations, and to BILL the patient. Here is where the problem exists: most ATs are not doing this and many are doing things improperly.

As an athletic trainer it is important to have direction from a physician. This includes a script when performing the things in your practice act. So here’s how it should work: Patient with a script from a physician who has deemed the patient appropriate and within the scope of the AT in the state (in some states it is “physically active,” in others it is an “athlete”) comes into the clinic and is evaluated by a licensed AT. An appropriate plan is documented and sent to the physician. The patient is treated much like any other clinician would treat the patient with (or possibly without) the use of modalities, manual techniques (including mobilization, stretching, and massage), and therapeutic exercises. The patient is billed for the services (either cash-based or through third-party payor).

Now here is how it currently works in many PT clinics: The athletic trainer brings back patients and sets them up on heat (or possibly applies the e-stim electrodes), interviews the PT patient on their current status, removes said modality(ies), takes the patient through PT stated therapeutic exercises (as an aide/ancillary staff), informs the PT how the patient is doing and then turns the patient over to the PT or PTA for manual techniques. What is the difference here? The patient is not an AT patient and so the AT is ancillary to the PT. Why??? Well, third party payment.

Athletic trainers should not be applying modalities, performing PT evaluation/re-evaluations, or manual techniques. The reason is two. The law does not allow them to treat them. PT evaluation and re-evaluation must be performed by a PT or PTA or else it is insurance fraud.

Nothing stops you, as an AT, from doing everything that your practice act states as long as you have physician direction (as your practice act requires). This applies to any setting. In professional, collegiate, or secondary school settings you must have physician direction. In order for it to be worth it to you (or your employer) there needs to be a way for the services to be reimbursed. Would you work a basketball tournament without compensation? Why see a patient in a clinic without expecting compensation for your valuable services?

So what can you do in the clinic? Anything! But only if you are covered by the law. Otherwise you are potentially in violation of the law. If you are performing PT re-evaluations and it is being billed then be prepared for you, the PT, and/or the business to come down on the wrong side of insurance fraud. We need to be careful to protect ourself ethically, legally, and professionally. This is why you need to know, understand, and work within your state’s practice act.

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