Health Care Administration in Athletic Training Chapter 2 Health Care Administration in Athletic Training

Planning an Athletic Training Facility Most important thing is maximum use of facility and equipment Size of facility is dependant on: Size and number of teams What sports are offered It must serve as a health care center

The Athletic Training Room: Must be at least 1,000 square feet in size Should be located immediately adjacent to the locker rooms Should have an outside entrance to fields or courts

Athletic Training Room Areas Taping First Aid or Wound Care Hydrotherapy or Wet Room = GFI’s Treatment = Tables and Modalities Rehabilitation Storage Offices List 3 athletic training room areas

Athletic Training Room Policies No Cleats No Game Equipment No Shoes on Treatment Tables No Food No Roughhousing SHOULD NOT BE A GATHERING AREA Name two policies you would have for your athletic training room

Keeping Facilities Clean The prevention of Infectious diseases is the direct responsibility of the coach Must make sure everything is clean and that the athlete is practicing safe health habits Must be aware of OSHA Guidelines (Occupational Safety and Health Administration)

Cleanliness Procedures Have clean H2O fountains, toilets, showers Air out lockers Clean Mats Wash Towels Clean Water Bottles and Jugs Clean floors List 3 cleanliness procedures

Factors Regarding Health Care Coverage When there are no health care professionals, the responsibility falls on a coach Wherever you are working make sure that there is a policy established describing a plan of care for injured athletes Emergency Action Plan (EAP) Who gets covered first? PREPARE

Pre-participation Health Exams Is Athlete at Risk before they start playing? PPE involves: Complete Medical History, Physical Examination and Orthopedic Screening Could warrant disqualification from certain sports Because of ADA a physician cannot legally disqualify athletes from competing because of an existing problem They can recommend that the athlete voluntarily choose not to participate One eye, kidney etc are cautioned against playing collision sports Another name for pre-participation health exams

Record Keeping In a time where lawsuits are the rule rather than the exception, record keeping is a must Coach/ATC should have: Insurance forms Injury reports Treatment logs Personal information cards Injury progress notes Supply and equipment records How often should injury reports be made?

Injury Reports For future reference Injury reports should be in triplicate going to: Physician School Health office One for personal records What acronyms do we use for writing injury reports? HOPS and SOAP

Treatment Logs Do not write in pencil!!! Should say what treatment athlete received Can serve as legal document and can be used in: Civil litigation Insurance action Criminal Action following Injury

Medical Records A coach/ATC must NOT release an athlete’s medical records or information to anyone without written consent by the athlete (if a minor, parents must give permission) If athlete wants medical records released they must sign a waiver with specifics such as who, when, what etc.

Developing a Budget Know what you need Keep accurate records for following year Expendable vs Non-Expendable Expendable items are used once (band aids) Non-expendable items are used multiple times (ice machine) Other Budget Concerns Phone Postage Professional Liability Insurance Travel expenses Memberships to Professional Organizations Clothing Contracts with Physicians

Progress Notes SOAP Subjective- what the athlete tells you about the injury Objective- what info the athletic trainer gathers from the evaluation that is measurable or observable Assessment- opinion on injury and athlete’s status Plan- how will the injury be managed

Legal Concerns and Insurance Issues Chapter 3 Legal Concerns and Insurance Issues

What is Liability? The state of being legally responsible for the harm one causes another person Assumes that an ATC would act according to the standards of care of any individual with similar educational background or training **Remember reasonable care**

Negligence Failure to use ordinary or reasonable care An individual does something that a reasonably prudent person would not do An individual fails to do something that a reasonably prudent person would do under circumstances similar to those shown by the evidence Athletic Trainers employed by an institution have a duty to provide health care to athletes at that institution A court will uphold waivers and releases of liability as long as there is no evidence of fraud, misrepresentation or duress

Torts Legal wrongs committed against a person Wrongs may emanate from an act of omission where a person fails to perform a legal duty(refer an athlete to a doctor) OR from an act of commission which is when one performs an act that is legally not his or hers to perform

Failure to Perform An AT who fails to provide an acceptable standard of care has committed a breach of duty ***An athlete must prove that this breach caused the injury or made the injury worse

Additional Terms Injury- An act that damages or hurts Accident: an act that occurs by chance or without intentions Assumption of risk: The individual, through expressed or implied agreement, assumes that some risk or danger will be involved in a particular endeavor . In other words, a person makes his or her own chances. Is subject to many interpretations especially with minors because they are not considered to be able to make a mature decisions Why are athletes required to sign a waiver?

Statute of Limitations A specific amount of time that an individual may sue for damages from negligence These limitations vary from state to state It is usually between 1-3 years

How Do You Avoid Litigation? Supervise constantly Proper instruction of skills Ensure that proper and safe equip is used Establish specific policies and guidelines Develop and carefully follow an emergency plan Keep good records that document the injury List 4 ways to avoid litigation

Avoiding Litigation (cont) Document efforts to create a safe learning environment Obtain written consent for providing health care, especially when minor are involved Maintain confidentiality of medical records Don’t dispense prescription drugs Don’t let injured players play without the written consent of a doctor

Avoiding Litigation (cont) Work cooperatively with the team doctor to insist top care for your athletes Purchase liability insurance Know the limitations of what you know as well as state restrictions Use common sense when making decisions

Product Liability The manufacturers must make sure that equipment is made safe All athletes must read NOCSAE National Operating Committee on Standards for Athletic Equipment

What Insurance is Necessary to Protect the Athlete? Medical Insurance is a contract between an insurance company and a policy holder in which the insurance company agrees to reimburse a portion of the total medical bill after some deductible has been paid General Health Insurance, Catastrophic Insurance, Accident Insurance, Liability Insurance

General Health Insurance Should cover illness, hospitalization, emergency care Some institutions offer primary care insurance but most offer secondary insurance Should send a form letter with insurance form to make sure that the paperwork is filled out appropriately What is secondary insurance?

Third Party Reimbursement This is the primary mechanism of payment for medical services in the US Health care professionals are reimbursed for services performed by the policyholders insurance company To cut health care costs many companies pay for PREVENTITIVE CARE Managed care: involves a prearranged system for delivering health care that is designed to control cost while also providing good care.

Health Care Providers HMO-Health Maintenance Organization must be pre-approved and is usually 100% covered as long as you go to a HMO facility PPO-Preferred Provider Organization Provide Discount Health but limit where a person can go for treatment Are paid on a fee for service basis Added services such as Physical Therapy may be obtained easier

Additional Information Point of Service Plan This is a combination of HMO and PPO plans It is based on a HMO structure, yet it allows members to go outside of the HMO structure or service. This is allowed only under certain circumstances Definitions Fee for service- Most traditional. Provider charges that patient or third party for services rendered. Charges are based on a set fee schedule Capitation- Form of reimbursement used by managed care providers in which members make a standard payment each month regardless of how much service is rendered to the member by the provider

Accidental Insurance Additional insurance that a student can take out It is limited in its payments and one does not have to acknowledge fault

Personal Liability Insurance This will protect against damages that may arise from injuries occurring on school property Will cover claims of negligence on the part of the individuals **Its concern is if supervision was reasonable Will cover you in a civil case but not a criminal case

Catastrophic Insurance NCAA and NAIA have policies that deal with permanent harm If cost is more than $25,000 and costs continue for a lifetime NFSHSA(National Federation of State High School Associations) covers costs over $10,000

Insurance Billing A coach/ATC must file insurance claims immediately and correctly Done by having insurance on hand Must stress that the parents insurance is first and the schools policy is second