NATA Now

August 9, 2018 by Beth Sitzler

Athletic training is not a stagnant profession. The people drawn into the profession are naturally movers, innovators and forward thinkers – so it’s no surprise that a profession full of people on the move is constantly moving. As athletic trainers become globally recognized health care providers, many settings want to capture the skills and expertise ATs bring. One of these settings is free-standing orthopedic urgent care clinics. These acute-care clinics, modeled after Saturday morning football injury clinics offered by orthopedic practices across the country, give patients easy access to quality care, without exposure to other illnesses or wait times seen in traditional emergency departments. Luke Bahnmaier, MS, LAT, ATC, with St. Luke’s Orthopedics in Boise, Idaho. He shares what it’s like to be an athletic trainer and site manager of the Orthopedic Urgent Care of St. Luke’s Clinic, which opened in May 2017.

 

Why is there a demand for orthopedic urgent care clinics?

Really this comes down to two factors: cost and convenience. In regard to convenience, when we look at health care as a whole, it appears that there has been a shift toward consumerism in the health care market.1 This means that patients are taking a more active role choosing who they see for their health care needs, and quick access has become a priority. When we think of patient-centered care, access to this care has become important. Patients desire being seen when and where it works for them, and they want scheduling to be simple and timely.2 Therefore, patients are driving the bus when it comes to how health care is delivered because of this trend in consumerism, particularly in the orthopedic markets, as it can be argued that orthopedic services are more “shoppable” due to its elective case mix and specialties.1 An orthopedic urgent care provides this quick and easy access to orthopedic specialists without the typical wait seen in an outpatient ambulatory clinic setting, which can push appointments out one to two weeks or even longer, depending on the situation. Hours of orthopedic urgent cares typically offer an opportunity to be seen after hours or on the weekends, which is important and convenient for patients in today’s market.

When it comes to cost, we can talk about a financial benefit for both patients and the health care system. As we all know, the health care system has been under the microscope the past three to five years with an emphasis on how the country can reduce wasteful health care spending, and be more efficient with the use of various health care resources. According to the CDC, there were 141.4 million ER visits in 2014.3 These numbers continue to grow. Of the total number of ER visits, only 7.9 percent of them resulted in hospital admission.3 When you look at data from 2014, 2.4 percent of the total number of visits were for fractures and 4 percent of these visits were for “sprains and strains.”4 Although the details of these visits are not available, it can be assumed – due to the low number of total hospital admissions – that a large percentage of these fracture, sprain or strain visits could have been triaged and treated outside of the emergency room in an outpatient orthopedic urgent care setting. Therefore, outpatient orthopedic urgent care clinics could save money and resources for the health care system by providing a more specialized walk-in access point for these acute musculoskeletal conditions. This also makes sense from a cost standpoint for patients, as co-pays and total visit cost would be less in an outpatient orthopedic urgent care versus an ER.

 

What is the typical staffing model for an orthopedic urgent care clinic?

In general, these clinics are staffed by either a physician or advanced practitioner (PA or NP), clinical support staff, front desk staff and an on-site imaging technician. Our specific model is led by primary care sports medicine fellowship trained physicians and one orthopedic surgeon. However, most models that I have been exposed to have been led by advanced practice providers. This is generally a financial decision made by the hospital or private practice developing the orthopedic urgent care clinic. Again, there are other models that are physician-led, with physicians fellowship trained in sports medicine, or even orthopedic surgeons. It is known that patients tend to prefer to be seen by a physician, but the hospital or orthopedics practice can save money by hiring advanced practice providers with orthopedics training. To my knowledge, the clinical support staff in most orthopedic urgent care clinics have historically been nurses or medical assistants, but I feel these clinics offer an exceptional opportunity to highlight the skillset of athletic trainers. In my clinic, we use athletic trainers exclusively as our clinical support staff.

 

What is the value of having an athletic trainer in this specific setting?

The value of having an AT in this clinic setting is simple. Orthopedic urgent care clinics are set up to deliver specialized acute care and injury triage for fractures or dislocations, sprains and strains, painful or swollen joints, sports-related injuries or any other minor injuries to the musculoskeletal system. These clinics typically have X-ray on site, and injuries can be treated and stabilized with various splinting, casting, or DME equipment. Comprehensive patient education is provided, and the patient is directed to the appropriate provider for streamlined and efficient follow up care. The skillset and education of athletic trainers make them a natural fit in an orthopedic urgent care, as this is what we do on a daily basis.

We are experts in injury triage, and this expertise becomes critical in prioritizing and managing patient care in a busy environment. The athletic trainer works seamlessly with the physician or advanced practice provider to examine patients, order imaging if indicated, present cases to the provider and provide differential diagnoses, educate patients on their condition and instruct them on appropriate therapeutic exercise programs, and stabilize injured joints or body parts with proper splinting or casting techniques, or durable medical equipment fitting. Additionally, the knowledge of musculoskeletal injuries and the appropriate surgical or non-surgical treatment they require allows the athletic trainer to coordinate patient care effectively and efficiently once discharged from the orthopedic urgent care. The athletic trainer in this setting truly becomes a patient advocate, ensuring the patient is scheduled with the appropriate provider for definitive care. At times, the athletic trainer can assist in providing the necessary patient education and therapeutic exercise program to avoid a referral to a sub-specialty physician or physical therapist. This potentially saves the patient time and money because of the comprehensive care provided at the clinic.

Essentially, athletic trainers in an orthopedic urgent care function as athletic trainers in the traditional physician practice setting. That being said, the way in which athletic trainers objectively demonstrate value in an orthopedic urgent care does not necessarily mirror the physician practice value model recently released by the NATA Council on Practice Advancement. The biggest difference is in the ability of the athletic trainer to increase clinic efficiency and volume, and therefore increasing clinic revenue. As with any urgent care, volume is on a walk-in, first come, first served basis. Therefore, patient volume can be feast or famine at times. An appropriate value-based model within this subset of the physician practice setting is currently being discussed within the NATA Council on Practice Advancement to explore the specific worth of ATs in orthopedic urgent cares.

 

For those interested in approaching a clinic or hospital system for opportunities in the emergency department or orthopedic urgent care, what would be the biggest selling point?

This is a tricky question and will vary considerably depending on the market or hospital system. What you really need to figure out is the system’s goals and how they measure success. You know why you would be an asset to their clinic or hospital, but health care leaders and administrators typically speak a different language. It is critical that you understand this language. Questions you should consider answering before approaching a hospital or clinic for a position like this would include the following:

  • Is it a for-profit or not-for-profit hospital?
  • Has the hospital taken any steps towards the goals of the Affordable Care Act?
  • Are they concerned about revenue production, cost savings, or both?
  • What metrics drive their strategic decisions on health care delivery?
  • Do they currently have any athletic trainers in the physician practice?
  • Do they have plans to pursue an orthopedic urgent care or is there any opportunity in the emergency department to apply your skillset in orthopedic examination, patient education and therapeutic exercise instruction?

Once you have figured these things out, then you can come up with a game plan on how to approach them about an opportunity.

    Leverage the relationships you might have within the organization to glean as much information as possible. Don’t oversell yourself. Educate yourself on the health care market and the terminology used in health care administration to build a business case that supports the role of an athletic trainer in the emergency department or orthopedic urgent care. There are tons of resources out there, and the NATA Council on Practice Advancement is a great place to start.

     

    What have been some unexpected hurdles you experienced in the day-to-day operations of an orthopedic urgent care?

    There have been a couple hurdles for our clinic within the first year. The most challenging has been establishing relationships with various provider groups in the immediate area. Our orthopedic urgent care clinic was the first of its kind in our hospital system, which is the largest in our state, with more than 10,000 employees. Our orthopedics group alone has grown to be a very large and comprehensive sub-specialty group. I had to get my feet on the ground and meet with all of these provider groups to establish good relationships, emphasizing a collaborative and financially responsible approach to patient care. Looking at referral rates and patterns became important to be seen as not only a valuable branch of our system, but a true driver of patients into their offices. Our early success has been built on these relationships and collaboration, both with patients as well as other primary care, internal medicine and pediatrician offices within our hospital system.

     

    References

    1. Sanju Pratap S. How consumerism is driving orthopedic groups to improve patient access. Beckersspine.com. 2017. Available at: https://www.beckersspine.com/orthopedic/item/37116-how-consumerism-is-driving-orthopedic-groups-to-improve-patient-access.html. Accessed February 14, 2018.
    2. Picker Principles of Patient Centered Care | Graduate Medical Education Challenge Grant Program. Cgppickerinstituteorg. Available at: http://cgp.pickerinstitute.org/?page_id=1319. Accessed February 14, 2018.
    3. FastStats. Cdcgov. 2017. Available at: https://www.cdc.gov/nchs/fastats/emergency-department.htm. Accessed February 14, 2018.
    4. National Hospital Ambulatory Medical Care Survey: 2014 Emergency Department Summary Tables.; 2018:15. Available at: https://www.cdc.gov/nchs/data/nhamcs/web_tables/2014_ed_web_tables.pdf. Accessed February 14, 2018.