Current Topics in PPE Administration - NATA#3 · 7/1/2012 1 Institute for Collegiate Sports...

7/1/2012

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Institute for Collegiate Sports Medicine

CURRENT TOPICS IN PPE

ADMINISTRATION

PERSONAL INFORMATION

� Athletic Trainer:

� Doctors’ Hospital / University of Miami

� Nova Southeastern University – Head Athletic Trainer

� Florida Atlantic University – Head Athletic Trainer

� Founder / President of the Collegiate Sports Medicine Foundation – 2001 – 2012

� Founder / President of the Institute for Collegiate Sports Medicine

HIGHLIGHTS

� Authored / Co-authored various peer reviewed articles

� Principal Author in an Athletic Training Text Book Chapter – Administrative Topics in Athletic Training: Concepts to Practice,

� Directed 85+ Educational Seminars

� Approximate 750 presentations

� Most of which are round table discussions and town hall meeting formats

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MATERIALS

� Today

� BOC Forms

� Evaluation Forms

� Interest Forms

� Audience Response Clicker

� Future

� Copy of Presentations

ANNOUNCEMENTS

� Restrooms

� Cell Phone

� Feel free to get-up, use the

rest room, refresh coffee,

make a call, etc.,

� Have FUN and Learn

something different!

� Meet someone new!

CURRENT TOPICS IN PPE

ADMINISTRATION

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PRE-PARTICIPATION PHYSICAL

EXAMINATION – 4TH EDITION

� American Academy of Family Physicians

� American Academy of Pediatrics

� American College of Sports Medicine

� American Medical Society for Sports Medicine

� American OrthopaedicSociety for Sports Medicine

� American Osteopathic Academy of Sports Medicine

American Academy

of Pediatrics

DISCUSSION TOPICS

� Goals and Objectives

� Team Physician vs Family Physician

� Ethical and Legal Considerations

� Cardiac Screening Considerations

� Sickle Cell

� Governing Body Requirements

� Special Populations in Athletics

� Medical Disqualification Processes

� Central Nervous System / Brain

� Clearance and Referrals

� Minimizing Risk of Injury with PPE

GOALS AND OBJECTIVES

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WHAT IS THE “PRIMARY”

GOAL OF YOUR PHYSICALS?

18%

73%

9%

Screen for... Screen for... Promote He...

1. Screen for Life-

threatening

Conditions

2. Screen for

Conditions that

Predispose

Athletes to Injury

3. Promote Health &

Safety

GOALS

� Promote the health and safety of the

athlete in training and competition

� More Standardized Approach =

Provide a tool to facilitate care of the

athlete and set the stage for data

collection leading to future changes

based off of outcomes data.

� Effectiveness

� Identify diseases or processes that

will affect student athletes

� Sensitive and Accurate

� Practical and Affordable

FACTS ABOUT PPES

� Goal is not to exclude

participation

� 0.3% - 1.3% of athletes

are denied clearance to

participate

� 3.2% - 13.9% require

further evaluation

� 75% of medical and

orthopedic conditions are

detected by history alone

Just a Thought: If 100% of

SAs pass physical without

any further evaluation was

your physical detailed

enough?

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IN THE LAST 3 YEARS HOW MANY STUDENT ATHLETES

HAVE YOU DISQUALIFIED DUE TO THE PPE?

40%

50%

10%0%

0 1-2 3-4 5+

1. 0

2. 1-2

3. 3-4

4. 5+

YEAR IN REVIEW SURVEY

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Medical Disqualifications

All

PPE

PRIMARY OBJECTIVES OF PPE

� Screen for Life-Threatening Conditions

� Screen for Conditions that May Predispose to

Injury or Illness

� Of Athletes, 66% believed that the PPE was not

absolutely necessary to participate safely in

sports

� 90% believed that the PPE could prevent injury

Just a Thought: What do we do during the PPE that

could assist in preventing injury?

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ASK JEROME HARRISON

� Jerome Harrison’s failed physical turned up a brain tumor

� The Philadelphia Eagles and Detroit Lions agreed to a trade

on Tuesday that would've sent Harrison to Philadelphia. A day

later, however, the trade was voided when Harrison did not

pass a physical.

SECONDARY OBJECTIVES

� Determine Good Health

� Society for Adolescent Medicine: 5 -10% of adolescents have a chronic condition that requires ongoing care / monitoring

� Asthma, Anemia, ADD, ADHD, Apena,

� Serve as an Entry Pointing in Healthcare

� PPE is not intended to replace routine medical exams

� 1/3 of student athletes indicate that the PPE is their only contact with healthcare system

� Consequently follow-up becomes a critical component of PPE

� Provide an Opportunity for Discussion on Health and Lifestyle

� 70% of adolescents express more desire for additional information: risk behaviors, substance use, sexuality, weight, diet,

� Many times not possible in a station to station exam.

FOR WHAT % OF YOUR ATHLETES IS YOUR PPE

THE ONLY POINT OF CONTACT WITH THE

HEALTHCARE SYSTEM

0%0%0%0%0%0%

100% 75 – 99% 50 – 74%

25 – 49% 1 – 24% 0%

1. 100%

2. 75 – 99%

3. 50 – 74%

4. 25 – 49%

5. 1 – 24%

6. 0%

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LOGISTICS

WHO PERFORMS PPES OF YOUR SAS

ON ENTRANCE INTO YOUR PROGRAM?

50%50%

Family Phy... Team / Uni...

1. Family

Physician /

Student Is

Responsible

for getting PPE

2. Team / Univ.

Physician

LOGISTICS

� Time: At least 6 weeks prior to start of season

� Person: Ideally with Personal Physician / Information Obtained From

� Why?

� Established Relationship?

� Previous Documentation

� Continuity of Care

� Privacy and Time

� Then using that information with the Team Physician Evaluation

� NCAA Requirements: Beginning initial season, physician administered medical examination prior to start of activity and be conducted within six (6) months of the activity with subsequent annual follow-up.

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HOW FREQUENT DO YOU PROVIDE / REQUIRE A

COMPLETE PHYSICAL ON YOUR STUDENT ATHLETES?

31%

69%

0%

On Entranc... Every Year Every Othe...

1. On Entrance

Into Program

Only

2. Every Year

3. Every Other

Year

FREQUENCY CONSIDERATIONS

� American Academy of Pediatrics: Recommends

Annual Screening of Athletes from age 6 to 21

� PPE Consensus: Recommends PPE performed

every 2 years in “younger” student athletes and

every 2 to 3 years on “older athletes with

intermittent “Annual Updates”

� Annual Updates: Comprehensive History

Questionnaire and a problem-focused exam of

red flags

COMPLICATIONS OF ANNUAL PPES

ON ALL STUDENT ATHLETES

� Man Power

� Timing of Getting All PPEs done and follow-ups prior to start of activity (Thus 6 Week Recommendation When Possible)

� Possible Solution: Provide PPEs on All Returning Student Athletes at End of Previous Year (i.e. Spring)

� Could also serve as an exit physical on those that don’t return.

� Potentially eliminates 2/3 of PPEs that would need to be done at start of school.

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TIPS TO IMPROVE COORDINATED

MEDICAL TEAM APPROACH TO

PPE

� Preparation

� Early and Accurate Information

� Privacy

� Counseling / Discussion of Sensitive Issues

� Continuity of Care

� Referrals

� Protocol for Referral

� Financial Responsibility???

� Disqualification

� Typically Require Further Evaluation at Time of PPE

EXIT PHYSICALS

� Purpose

� Continuation of Care and Disclosure of Ongoing

Injuries

� Minimize risk of claims that may not be university

responsibility

� Responsibility

� Student Athlete Responsibility

DO YOU PERFORM EXIT

PHYSICALS / SCREENINGS?

23%

54%

23%

Yes No No, but co...

1. Yes

2. No

3. No, but

considering

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RECRUITING PHYSICALS

� Must be conducted on an official visit

� Must be performed in the presence of a physician

� May not include testing not normally conducted in a

physical (i.e bench press, 40 yard dash, etc.,)

� Should not be used to determine offer letter

� Purpose: Identify those at risk therefore after signing

day, acquisition of additional information or follow-up

may occur

� Underage considerations

ADMINISTRATIVE CONSIDERATIONS

PPE POLICY CONSIDERATIONS /

STATEMENTS

� All information contained within is complete and

correct to the best of my ability

� In the event that a student athlete leaves a team for

voluntary or involuntary reasons, it is the

responsibility and right of the student athlete to

report for exit physical

� Team physician has final authority over all medical

clearance processes

� In the event that additional test are warranted for

participation, financial responsibility falls upon the

student athlete and / or their health insurance

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ADDITIONAL ADMINISTRATIVE

CONSIDERATIONS

� Timely acquisition of information (Medical

History, Sickle Cell Results, etc.,)

� 17 Year Olds / Signature Forms

� Financial Responsibility Considerations

� Referral Processes

IF A STUDENT ATHLETE NEEDED A “CARDIAC WORK-UP”

WOULD YOUR UNIVERSITY PAY FOR IT?

31%

69%

Yes No

1. Yes

2. No

REFERRAL PROCESSES

� Student Athletes Primary Care Physician / Insurance

� Positive:

� Decreased Cost

� Negative:

� Time

� Opinion: PCP may not agree are allow for a cardiac work-up

� Limited to Specialist on Insurance Plan

� University Responsibility

� Positive:

� Decreased Time

� Consistency of Specialist

� Negative:

� Cost

� Fee for Service

� Retainer

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MEDICAL DISQUALIFICATION

PROCESS

� Role of “Team Physician”

� Reasonable Accommodations

� Knapp v. Northwestern

� Waivers

� Impact on Catastrophic Injury Claim

CLINICAL CONSIDERATIONS

CARDIAC SCREENING

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ROUTINE SCREENING TEST

� PPE Work Group: Doesn’t

Recommend Routine

Screening for

Asymptomatic Athletes

� Value of Screening Test

� Predictive Value

� Ability to Reduce

Morbidity and Mortality

by Identifying the

Condition

DO YOU PROVIDE ANY OF THE FOLLOWING

WITH “ROUTINE” SCREENING?

0%0%8%

92%

EKGs Echo Cardi... Both None of th...

1. EKGs

2. Echo

Cardiograms

3. Both

4. None of the

Above

CARDIAC SCREENING

DILEMMA

� Support for Not Routine Screening

� American Heart Association

� 36th Bethesda Conference

� PPE Work Group

� Support for Routine Screening

� Media / Parent Groups

� Italy Project

� Cardiovascular disorders account for 75% of sudden death in athletes

� 1:65,000 to 1:69,000

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AMERICAN HEART ASSOCIATION

RECOMMENDATIONS

� Medical History*

� Personal history

� 1. Exertional chest pain/discomfort

� 2. Unexplained syncope/near-syncope†

� 3. Excessive exertional and unexplained

dyspnea/fatigue, associated with exercise

� 4. Prior recognition of a heart murmur

� 5. Elevated systemic blood pressure


RECOMMENDATIONS

� Family history

� 6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in ≥1 relative

� 7. Disability from heart disease in a close relative <50 years of age

� 8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias


RECOMMENDATIONS

� Physical examination

� 9. Auscultation for Heart murmur

� 10. Palpation of Femoral pulses to exclude aortic

coarctation

� 11. Physical stigmata of Marfan syndrome

� 12. Brachial artery blood pressure (sitting

position)§

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DURING YOUR PHYSICAL ARE ALL 12 POINTS OF THE AHA

GUIDELINES COMPLETED?

0%

100

%

Yes No

1. Yes

2. No

SICKLE CELL SCREENING

DIVISION I / II & III?

� Student athletes present with SCT Result from

Birth

� School provides / requires SCT Result

� Student athlete waives right and signs release of

liability

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HOW DO YOU ANTICIPATE /

PAY FOR TESTING?

� Student Responsibility

� University Provide

� NCAA Lab Agreement

� Student Health

� Local Labs

� Self Draw

BIGGER PICTURE OF SICKLE

CELL “KNOWLEDGE”

� Who Knows?

� Student-Athlete Acknowledgment

� Athlete Education

� Genetic Counseling

� Participation Education / Awareness

� Acclimation Process

� Co-existing Conditions

� Air Quality, Asthma, Etc.,

BASELINE TESTING

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CONCUSSION BASELINE

TESTING

� Symptomalogy

� Balance

� Neuropsychological Testing

IDENTIFICATION OF ATHLETES

WITH SPECIAL CONDITIONS

� Mental Health

� Learning Disabilities

� Risk of Suicide

� Disordered Eating

� Single Paired Organ

� Nutritional and Supplementation

� Performance Enhancing Medications

MEDICATION AND

SUPPLEMENTATION

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MEDICATION CONSIDERATIONS

� Know Drug Allergies

� Other Allergies

� Football Player Allergic to Grass

� Bee Stings vs. Bees

� Current Medications and Reason

� Any Banned or Special Exemption Considerations

DO YOU OBTAIN A LISTING OF

SUPPLEMENTS?

69%

31%

0%

Yes No No, but co...

1. Yes

2. No

3. No, but

considering

IF YES?

� Do you obtain the information only at the PPE?

� Do you “Approve” the supplement?

� Consult with nutritionist / physician?

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DO YOU THINK A “DRUG TEST WOULD

BE OF VALUE ON A PPE?

31%

69%

Yes No

1. Yes

2. No

POTENTIAL BENEFITS OF

DRUG SCREENING

� Identification of

� Diuretics / Energy /

Weight Loss / Weight

Gain

� Depression Medication

� Banned Substances

� ADD / ADHD

Medications

MENTAL HEALTH CONSIDERATIONS

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MENTAL HEALTH

CONSIDERATIONS

� IMPORTANT: If your going to ask the question, be prepared to handle the answer.

� i.e. Have you ever attempted suicide

� Risk Behaviors?

� Sexual, Drug Use, Etc.,

� Disordered Eating

� Depression

� Performance

PPE Q&A

TIME FOR A BREAK!

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PREDICTIVE INJURY MODELING:

PRELUDE TO PREVENTION

GRADE HOW WELL YOUR PROGRAM DOES

WITH INJURY PREVENTION

0%

38%

46%

8%8%

A B C D F

1. A

2. B

3. C

4. D

5. F

PREDICATIVE INJURY

MODELING

� Objective #2: Screening for Conditions that May

Predispose Athletes to Injury

� Remember: 90% of athletes believe that the PPE

can help prevent injury. ??????

� Domain #1 of Athletic Training: Prevention

� How do you go about prevention in your

programs?

� How does your PPE assist you in prevention?

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WHAT DO YOU DO IN THE AREA OF

INJURY PREVENTION?

� ????

� Education

� Jump / Landing Training

� Strength and Conditioning?

� Brace and Tape

� Core Stability

� Flexibility Assessment and Enhancement

� Can it be validated that it works?

� Do you validate that it works?

WHO IS INVOLVED IN INJURY

PREVENTION?

� ????

� ????

� Coaches

� Strength and Conditioning

� Athletic Training Staff

� Team Physicians

� Where does your PPE fit into the process of injury prevention?

INJURY PREVENTION

�Do you and your athletic

training staff have time

for Injury Prevention for

ALL Student Athletes?

�Can we target athletes at

High Risk for Injury?

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PURPOSES OF PREDICTIVE

INJURY MODELING

� Identify Athletes at Risk of Injury

� Identify where the athlete is deficient

� Provide a basis / criteria for corrective exercise

programs.

� Improve performance while minimizing risk

INJURY PREVENTION

� High-force collisions make football injuries inevitable,

but some portion may be prevented

� Very little high-quality research evidence is available to

guide injury prevention

� Rapid fatigue of the core musculature may relate to

poor neuromuscular control of the core & LE joints

� Pre-season screening procedures can identify

individual players who have modifiable injury risk

EVIDENCE-BASED APPROACH TO INJURY

PREVENTION

Documentation of Injury Incidence Rate (Injuries/Exposures)

Identification of Injury Risk Factors (Predictive Model for Injury Occurrence)

Development and Implementation of Strategies to Reduce Injury Risk

Confirmation that Risk Reduction Program Decreases Injury Incidence Rate

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WHAT STANDARDIZED TEST WOULD

YOU PERFORM TO IDENTIFY ATHLETES

AT RISK FOR INJURY?

IDENTIFICATION OF INJURY

RISK FACTORS

� Foot & Ankle Assessment Measure

� Int. Knee Doc. Comm. (IKDC) Survey

� Oswestry Disability Questionnaire

� Body Mass Index

� Navicular Drop

� Q-Angle

� Hip ER & IR ROM

� Shoulder ER & IR ROM

� Sit & Reach

� 1.5 Mile Run Time

� Vertical Jump

� Triple Hop for Distance

� Functional Movement Screen

� Tuck Jump Assessment

� Balance Error Scoring System

� Cogsport Neurocognitive Test Score

� Back Extension Hold

� Side Bridge Hold

� Trunk Flexion Hold

� Wall Sit

� Isokinetic Peak Torque

� Hand-Held Dynamometer Force

71

TEST FOR INJURY PREDICTION

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OSWESTRY

D ISABIL ITY

INDEX(0 -100

SCORE)

Pain Intensity Standing

0 I have no low back pain at the moment. 0 I can stand as long as I want without pain.

1 My low back pain is very mild at the moment. 1 I can stand as long as I want, but it causes pain.

2 My low back pain is moderate at the moment. 2 Pain prevents me from standing for more than one hour.

3 My low back pain is fairly severe at the moment. 3 Pain prevents me from standing for more than 30 minutes.

4 My low back pain is very severe at the moment. 4 Pain prevents me from standing for more than 10 minutes.

5 My low back pain is the worst imaginable at the moment. 5 Pain prevents me from standing at all.

Personal Care (Washing, Dressing, etc.) Sleeping

0 I can take care of myself normally without pain. 0 Pain does not prevent me from sleeping well.

1 I can take care of myself normally, but it causes pain. 1 I can sleep well only by using pain medication.

2 It is painful to care for myself, and I am slow and careful. 2 Even when I take pain medication, I sleep less than 6 hours.

3 I need some help, but can manage most of my personal care. 3 Even when I take pain medication, I sleep less than 4 hours.

4 I need help every day in most aspects of personal care. 4 Even when I take pain medication, I sleep less than 2 hours.

5 I do not get dressed, wash with difficulty, and stay in bed. 5 Pain prevents me from sleeping at all.

Lifting Social Life

0 I can lift heavy weights without pain. 0 My social life is normal and does not cause pain.

1 I can lift heavy weights, but it causes pain. 1 My social like is normal, but it increases my level of pain.

2 Pain prevents me from lifting heavy weights off the floor. 2 Pain prevents me from participating in energetic activities.

3 I can lift light to medium weights if conveniently positioned. 3 Pain prevents me from going out very often.

4 I can lift only very light weights. 4 Pain has restricted my social life to my home.

5 I cannot lift or carry anything. 5 I have hardly any social life because of my pain.

Walking Travel

0 Pain does not prevent me from walking any distance. 0 I can travel anywhere without pain.

1 Pain prevents me from walking more than one mile. 1 I can travel anywhere, but it increases my pain.

2 Pain prevents me from walking more than 1/2 mile. 2 Pain is bad, but I can manage journeys of two hours or more.

3 Pain prevents me from walking more than 1/4 mile. 3 Pain restricts me to journeys of one hour or less.

4 I can only walk using a cane or crutches. 4 Pain restricts me to short necessary journeys under 30 minutes.

5 I am in bed most of the time. 5 Pain prevents me from travelling, except to receive treatments.

Sitting Sports & Work

0 I can sit in any chair as long as I like. 0 My normal activities do not cause pain.

1 I can only sit in my favorite chair as long as I like. 1 My normal activities increase pain, but I can still perform all.

2 Pain prevents me from sitting for more than one hour. 2 I can perform most activities, but pain prevents some of them.

3 Pain prevents me from sitting for more than 30 minutes. 3 Pain prevents me from doing anything but light activities.

4 Pain prevents me from sitting for more than 10 minutes. 4 Pain prevents me from doing even light activities.

5 Pain prevents me from sitting at all. 5 Pain prevents me from performing any work/sports activities.

COMBINED ANALYSIS

OSWESTRY DISABILITY INDEX N=171

Core + LE Strains & Sprains

Injury No Injury

≥ 6 points 28 13

< 6 points 50 80

Total 78 93

Fisher’s exact p = .001

Sensitivity: .36 Specificity: .86

95% CI: .26 - .47 95% CI: .78 -.92

+LR: 2.57 Odds Ratio: 3.45

95% CI: 1.43 - 4.61 95% CI: 1.63 - 7.27

−−−−LR: .75 Relative Risk: 1.78

95% CI: .62 - .90 95 % CI: 1.31 - 2.40

Scale using pain with: Sleeping, Travel,

Social, Lifting, Sitting, Personal Care,

Standing, Sports / Activities, Pain

Scale,

COMBINED ANALYSIS

WALL-SIT HOLD N=171

Injury No Injury

Z ≤ −0.58 30 22

Z > −0.58 48 71

Total 78 93

Fisher’s exact p = .031


95% CI: .28 - .50 95% CI: .67 -.84


95% CI: 1.03 - 2.58 95% CI: 1.06 - 8.50


95% CI: .65 - .99 95 % CI: 1.04 - 1.97

90°

90°

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COMBINED ANALYSIS

GAMES AS STARTER (N=171)

Core + LE Strains & Sprains

Injury No Injury

≥ 1 game 63 11

None 15 82

Total 78 93

Fisher’s exact p < .001


95% CI: .71 - .88 95% CI: .80 -.93


95% CI: 3.88 - 12.02 95% CI: 13.46 - 72.85


95% CI: .14 - .35 95 % CI: 3.42 - 8.85

Mostly interested in the number of reps

one would receive in both games and

practice.

Instead of starter, might use and

objective way of determining significant

playing time.

Additional other sports, starting one

game would not be very significant

unless they played significant minutes.

COMBINED ANALYSIS

3-FACTOR PREDICTION MODEL N=171

Core + LE Strains & Sprains (78)3-Factor Model

Injury No Injury

≥ 2 Factors 39 5

0 or 1 Factor 39 88

Total 78 93

Fisher’s Exact p < .001


95% CI: .27 - .57 95% CI: .86 -.99

+LR: 10.05 Odds Ratio: 17.60

95% CI: 2.46 - 41.11 95% CI: 3.46 - 77.20


95% CI: .47 - .80 95 % CI: 1.86 - 3.92

AUC = .8495% CI: .78 - .90

1) Starter (≥1 game) 2) Hi ODI (≥6) 3) Lo WSH-Z (≤−0.58)*

≥2

≥1

Sensitivity: .50

Specificity: .95

Relative Risk: 2.89

Sensitivity: .94

Specificity: .57

Relative Risk: 7.49

*Bilateral ≤60 sec & Unilateral Avg. ≤45 sec

COMBINED ANALYSIS

N=171

Starter ≥1 Game AND

Either Hi ODI* OR Lo WSH†

Injury No Injury

≥ 1 game 38 3

None 40 90

Total 78 93



95% CI: .38 - .60 95% CI: .91 - .99

+LR: 15. 10 Odds Ratio: 28.50

95% CI: 4.85 - 47.05 95% CI: 8.31 - 97.80


95% CI: .43 - .66 95 % CI: 2.29 - 3.95

*Hi ODI

≥6

†Lo WSH

≤60 sec Bilateral

≤45 sec Unilateral Avg.

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2009 + 2010 COMBINED ANALYSIS

N=17179

Starter ≥1 Game AND Hi ODI*

Injury No Injury

≥ 1 game 25 1

None 53 92

Total 78 93



95% CI: .23 - .43 95% CI: .94 -.99

+LR: 29.81 Odds Ratio: 43.40

95% CI: 4.13 - 215.03 95% CI: 5.72 - 329.48


95% CI: .59 - .80 95 % CI: 2.10 - 3.30

Starter ≥1 Game AND Lo WSH†

Injury No Injury

≥ 1 game 22 3

None 56 90

Total 78 93



95% CI: .19 - .39 95% CI: .91 -.99


95% CI: 2.72 - 28.12 95% CI: 3.37 - 41.20


95% CI: .64 - .86 95 % CI: 1.79 - 2.95

*Hi ODI ≥6 †Lo WSH ≤60 sec Bilateral; ≤45 sec Unilateral Avg.

KEEP IT SIMPLE

� Disability Survey

� Wall Sit

� Exposures

� Logistics

� Performed Multiple

Time Per Year

� PPE, Prior to “Off-

Season” and Prior to

End of School

� Note: This only identifies

athletes at high risk of

injury, once identified a

corrective exercise

program would need to be

developed and executed.

WHAT IF I WANTED TO

PARTICIPATE IN PROJECT?

� Do you keep track of injuries and exposures?

� Electronic Database

� Are you interested in reducing injuries to student athletes?

� Can you add a ODI questionnaire to your PPE?

� Can you add a single leg wall sit to your PPE?

� Note: We will perform the statistical analysis to determine risk.

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INTERESTED IN GETTING INVOLVED

WITH PREDICTIVE INJURY MODELING?

GENERATING REVENUE FROM PPES

OVERVIEW

� Note: For physicals performed by your team physicians as part of your PPE program.

� Generate $20,000 for every 100 physicals performed with valid health insurance

� No cost to the parent, student-athlete or school

� Little additional administrative work needed by school

� Could do billing and collections internally or outsource to a third party

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PROCESS

� Once Set-up

� School

� Agreement Forms Provided

� Tax Form

� Physician NPI #s

� Institute of Collegiate Sports Medicine

� Set-up school as provider with insurance companies

� School Provides

� Student Athlete Demographic Form

� Copy of Insurance Card

� Signed and Completed Copy of Physicals

INSTITUTE FOR COLLEGIATE

SPORTS MEDICINE SERVICE

� Billing and Collections, Follow-up, Coding,

Electronic Transmission, Account Reconciliation

� Checks made out to school are received in our

office and forwarded to school on a weekly basis

� Monthly school would receive an invoice for

billing and collections fees

� 20% of collected

SCHOOL RISK AND BENEFITS

� Time and effort taken to scan / fax forms to Institute for Collegiate Sports Medicine

� We only get paid after you collect insurance reimbursement checks

� Set-up

� 100% of First $3000 for Software Package

� One Registration on Cruise Meeting (Annually)

� iPad (Current Release)

� Software Allowance (ATS)

� 100% of First $2000 (Non Software Package)

� One Registration on Cruise Meeting (Annually)

� iPad (Current Release)

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INTEREST FORM

ATSEA 2013

� Date: June 1 – 8, 2013

� CEUs: 20

� Departure City: Miami

� Ports of Call: Cozumel, Mexico,

Belize, Mahogany Bay, Isla Roatan,

Grand Cayman

� Lodging / Meals / Taxes – Based

on Double Occupancy

� Inside: $868*

� Balcony: $1128*

� Includes $100 Ship Board Credit

INTEREST FORM

� Event Coverage and Staff Hours

� Predictive Injury Modeling

� Drug Testing

� Discussion Group

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GOLF SPORTS MEDICINE

MEETING

� Date: June 12 - 14

� Location: Cog Hill Country Club -

Chicago

� CEUs: 20

� Cost: $670

� Three Rounds of Afternoon Golf and

Three Mornings of Educational

Programing

PPE REIMBURSEMENT PROGRAM

VERIFICATION OF INSURANCE

� Valid Health Insurance (Yes / No)

� Description of Plan

� Deductible

� In vs Out of Network Benefits

� $2 per Verification

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PRIMARY INSURANCE

� International Student Athlete

� With Sports Coverage

� Medical Evacuation and Repatriation

� Domestic

� Variety of Programs that do cover intercollegiate

sports

� Varies by state

SECONDARY INSURANCE

STRATEGIC PLANNING

SERVICES

� Financial

� Cost-Containment Strategies

� Staffing

� Policy and Procedure

� …………………………

� …………………………

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STRATEGIC PLANNING /

WINTER MEETING

� Date: Jan 7 – 9

� Ft. Lauderdale, FL

� Highly Focused Meeting on

Strategic Planning in

Collegiate Sport Medicine

� Cost: $450 per person or

$800 per school

� Limited to 25 Schools

� ATCs and Administrators

INSURANCE STRATEGIST

CONFERENCE MEETINGS

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THANK YOU AND ENJOY ST. LOUIS

Current Topics in PPE Administration - NATA#3 · 7/1/2012 1 Institute for Collegiate Sports...

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Transcript of Current Topics in PPE Administration - NATA#3 · 7/1/2012 1 Institute for Collegiate Sports...