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The Growing Role of Athletic Trainers in Orthopaedics

Posted in The Top Line | Jan 2013 | Comments (6)

Tags: orthopaedic servicesorthopaedic practice managementathletic trainer

Healthcare reform has forced orthopaedic surgeons to streamline office efficiency and search for new revenue streams. Adding certified athletic trainers is one option.

ORTHOPRENEUR spoke to Forrest Pecha, Director of Clinical Residency at St. Luke's Sports Medicine, on how orthopaedic practices might incorporate athletic trainers as mid-level providers.

“Athletic trainers can do everything from rooming a patient, entering data into electronic medical records, performing injury assessments, educating patients, drawing injections, prepping patients and assisting in procedures,” says Pecha. “It’s nearly all-encompassing, in that the athletic trainer can fulfill the roles of other more traditional health care professionals. Hiring an athletic trainer allows you to place a very versatile, multi-purpose professional in your practice, one with a deep background in musculoskeletal knowledge.”

A deeper discussion followed.

ORTHOPRENEUR: How do athletic trainers provide value to an orthopaedic practice?

Forrest Pecha: They increase patient throughput, improve clinic efficiency and flow and provide high patient satisfaction.

Athletic trainers have a very high musculoskeletal education level. It’s our foundation. When we’re working in an orthopaedic or sports medicine practice, we’re able to use our musculoskeletal knowledge to support injury assessments and diagnoses of our patients, presenting our findings to the physician. Following the patient's time with the physician, we can give the patient the necessary information about their injury and follow-up care. Taking these few steps for the physician allows his or her time with the patient to be spent more effectively. It allows the physician to focus on physician-necessary tasks – HPI, diagnosis and plan of care – and the remaining time to be spent developing patient relationships.

ORTHOPRENEUR: What revenue-generating value does an athletic trainer add to a practice?

Pecha: We see our services as both direct and indirect revenue changers. A number of U.S. studies indicate that athletic trainers are increasing patient throughput by 20% to 23% in any given physician practice setting. The increased patient throughput, increased billings and downstream revenue are quite significant when we’re increasing practice productivity on average 20%+. That is an indirect revenue share, and it’s important to remember that a 20% increase in office throughput should correlate to a 20% increase in other clinic ancillaries.

Athletic trainers can also bill directly, although success is variable across states, practices and insurance carriers. One direct revenue source can come from having athletic trainers perform services under the direction of the physician. Similar to cast techs, the physician is still billing for the application, but the athletic trainer may apply the cast. The same concept can be used to support home exercise programs, therapeutic exercise and crutch training. In those cases, the PM&R code is added to the physician E/M code. In some instances, a modifier may need to be applied to the E/M code.

In certain states, athletic trainers are working as first assists with surgeons in the OR and collecting first assist fees. For billing purposes, this may require a dual credential, such as Orthopaedic Technologist Certified (OTC) or Orthopaedic Physician Assistant (OPA-C).

A third source of revenue for the practice could be using the athletic trainer to develop a durable medical equipment business. In-housing your DME business may prove to be a profitable ancillary to the practice, and can be fully supported by an athletic trainer’s experience and training. They understand the bracing, prophylactic and durable medical equipment that will assist in the patient’s care.

ORTHOPRENEUR: How can hiring managers clarify varying state regulations regarding athletic trainers?

Pecha: State Practice Acts will vary. Most State Practice Acts allow athletic trainers to work under the supervision of directing physicians. In most cases, athletic trainers can perform most skills that the directing physician teaches them to do. However, some states do have regulations that indicate more specifically what the athletic trainer can do. We have a liaison from the National Athletic Trainers’ Association who works in governmental affairs. Her name is Judy Pulice, and part of her job is to help employers understand individual State Practice Acts. She’s available for questions at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

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Bob OMalley 03/20/2013 09:40 AM
My practice has 21 AT's on staff, only 7 of us are outreach. Three manage the DME business, one is Director of Process Engineering, a PT/ATC is Director of Rehab, the rest of us float among the patient care aspect of the practice. Our physician partnership has figured it out and our management team is embracing our value.
Robbe 03/20/2013 09:08 AM
I have been working in an orthopedic practice for almost two years now. Although it is an outreach position, the clinical role is that of a physician extender (patient evaluations & home rehabilitation programs mainly). I have found what the article says is true, wait time is decreased and the patient flow through the clinic is streamlined. Hopefully as this type of role becomes more common, we will have greater success billing for our services. Go ATC's!
Forrest 02/04/2013 12:31 PM
Thank you for the comment and would be happy to discuss how you are operating in your current role. Feel free to drop me an eamil
Brad Bushnell 02/03/2013 05:49 PM
Great Article Forrest! Keep preaching the ATC gospel!
Brad Bushnell
Harbin Clinic Orthopedics and Sports Medicine
Rome, GA
Steve Jessup MA ATC 02/03/2013 03:32 AM
Thanks for the great article Forrest.

Steve Jessup MA ATC/L
Benewah Community Hospital
St. Maries ID
Wellness/Outreach Program
Amy Roberts, MS ATC 01/29/2013 10:13 AM
Thank you for this article. I am a certified athletic trainer who has been working in an ortho private practice for 7 years. We have since hired 8-10 athletic trainers to work with our orthopedic surgeons. It is a wonderful fit and we look forward to the next several years.
Amy at Kansas City Bone & Joint Clinic, OP, KS