UNIVERSITY OF CENTRAL FLORIDA ORLANDO COLLEGE OF HEALTH

UNIVERSITY OF CENTRAL FLORIDA • ORLANDO COLLEGE OF HEALTH AND PUBLIC AFFAIRS Organization & Administration, Professional Development and Responsibility Kristen C. Schellhase Ed. D, LAT, ATC, CSCS University of Central Florida

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS O&A in 45 Minutes? ? ? Really? ? ? UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

How many O&A issues can you spot?

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS It all boils down to a few principles…. • Practice ethically • Practice legally • Be proactive, not reactive – Have a policy before you have a problem! – Do your homework (don’t reinvent the wheel) • CARE! And show you CARE! “People don't care how much you know until they know how much you care” (John C. Maxwell) UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Today’s goal…. • Not to cover everything, but to cover things that are commonly confused, missed or forgotten 1. Organizations affecting ATs 2. Legal and ethical considerations • Vocabulary • Paperwork 3. Insurance vocabulary 4. Checklist for your future UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Organizations Affecting ATs • • • Board of Certification - BOC – Role Delineation Study/Practice Analysis (now on RD/PA 6) – Certification exam – Continuing education/competence Commission on Accreditation of Athletic Training Education - CAATE – Education standards State Boards of Health – Regulation – we hope licensure (all but a few states) NATA (Overall) – Position statements (various topics) – NATA Code of Ethics – Lobby for our professional needs/goals – NATA feeds regional (ex. SEATA) and state organizations (ex. ATAF) NATA Education Council – AT Education Competencies (5 th Edition) – Advising of education related concerns UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Legal and Ethical Considerations • Breach of Confidentiality – Violation of a commitment of privacy & protection of information or communications – There are exceptions to the rule of confidentiality • When there is clear & imminent danger to the athlete or other persons – Example: Homicidal or suicidal ideation • When legal requirements demand that confidential information be released – HIPAA and FERPA are examples of laws that protect confidentiality – your employer or conscience may have more! UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS HIPAA and FERPA? ? HIPAA or FERPA? ? Both? ? Neither? ? • Health Insurance Portability and Accountability Act of 1999 – Protects the privacy rights of medical information in written, electronic or oral form – Covered entities are usually those who bill electronically • Federal Educational Rights and Privacy Act - FERPA – Protects the privacy rights of student educational records In every job, you should understand which (or both) you must comply with. Just because you do not fall under either, doesn’t mean you do not have an employer or ethical obligation to protect privacy! UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Ethics Vocabulary Conflict of Interest When the interests of one individual or group are in competition w/ those of another individual or group Exploitation Using another person for selfish purposes, particularly when it comes at the expense of that person &/or without their knowledge or full informed consent UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Confusion About Consent Most AT-patient interactions fall under consent to treat or implied consent • Consent to Treat – A form kept in the medical record, usually done pre-season – Also introducing yourself and asking if you can help them. • Implied Consent – Can cover cases when parents of a minor cannot be contacted, consents are not on file, and/or the athlete is unconscious. Informed Consent – Information given to the athlete/ parents about what the AT believes to be wrong & what they are planning to do about it. Invasive treatments should include explicit written documentation of informed consent. Actions taken without consent are considered battery! UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Legal Vocabulary Liability The responsibility for actions that cause harm to others Malpractice Liability-generating conduct associated with the adverse outcome of patient treatment Tort A legal wrong other than a breach of contract for which a remedy will be provided, usually in the form of monetary damages UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Legal Vocabulary Negligence A type of tort in which an athletic trainer fails to act as a reasonably prudent athletic trainer would act under the circumstances • Omission – the failure to do something that should have been done under the circumstances • Commission – occurs when an athletic trainer performs an act that should not have been committed. UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Paperwork You Should Have! • Physical examination and patient history – with documented clearance from a physician • Assumption of Risk • Consent to Treat Exculpatory Waivers – NO! UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Avoiding Legal Problems • Ensure all athletes are properly cleared and know their medical history • Have documented consent to treat or ask – Recognize when you need informed consent • Adhere to strict professional standards – Practice according to the NATA Code of Ethics and the BOC Standards of Professional Practice – Create and implement strong policies and procedures • Recognize when medical or ethical situations require consultation and/or referral • Document! UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Insurance Vocabulary Third Party Reimbursement • Process by which medical vendors are reimbursed by insurance companies for services provided to policyholders • The third party is the insurance company UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Insurance Vocabulary HMO = Health Maintenance Organization • A corporation financed by premiums whose member physicians (and other providers) provide medical care within certain financial, geographic, and professional limits to enrolled members. HMOs are associated with capitation and with PCPs who are gatekeepers. PPO = Preferred Provider Organization • An insurance company, similar to an HMO, but has a greater choice of providers (in-network or out-of-network). Patients receive higher benefits when they see an in-network physician. PPOs are associated with fee-forservice. A primary care physician may be listed, but is usually not a gatekeeper. Indemnity • Allows the patient to direct their own health care and see whatever provider they like. Insurance agrees to pay a portion of the charges dependent on the policy. UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Insurance Vocabulary • Copay – A set fixed amount per visit (usually a small amount like $20) which is paid by the insured. It usually applies to primary insurance only. It is separate from the bill itself and is usually collected before the appointment. It serves to make it "worth it" for the patient to go (a deterrent). • Coinsurance – The percentage of a medical bill which is not paid by the primary insurance. This must be paid by the insured, the business, or the secondary insurance. For example, the primary insurance pays 80% of a $100 bill. The co-insurance is 20% or $20. • Allowable Amount / Usual & Customary – The amount an insurance company will pay for a specific service, in a specific location. It is based on cost of the service, cost-of-living in that region, and contracts with providers. – When the provider is contracted they must accept the allowable/UCR as the new price (they must give a discount) – When the provider is not contracted the insurance company will still only pay the % of the allowable/UCR but the provider will expect the full price (no discount is UNIVERSITY OF CENTRAL FLORIDA • ORLANDO given)

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Insurance Vocabulary ICD 10 Codes • International Classification of Diseases (ICD) codes are used to classify conditions. CPT Code • The code designated to a particular medical service. This is used by insurance companies to determine what amount should be paid for a particular service. It stands for Current Procedural Terminology. HICF/UB 92 • An official and itemized bill from the provider of service which lists all pertinent information on the patient, the diagnosis, service codes and all other necessary provider codes and fees for the services. This serves as the electronic claim form (the electronic bill) for the provider's service/patient's injury to the primary insurance. (HCFA = Health Insurance Claim Form and UB = Uniform Billing) Explanation of Benefits (EOB) • An official statement from the insurance company which lists the total fee for the service, the amount paid (or not paid), reasons for non-payment, contracted amounts, and remaining balance due. UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Checklist For Your Future Resume oozes your greatness! BOC conquered! Degree earned! Get job that you love! Maintain your certification! Actively participate in your profession! √ √ √ UNIVERSITY OF CENTRAL FLORIDA • ORLANDO

UCF COLLEGE OF HEALTH AND PUBLIC AFFAIRS Reference Ray R, Management Strategies in Athletic Training, Champaign, IL: Human Kinetics; 2011. Thank You! UNIVERSITY OF CENTRAL FLORIDA • ORLANDO