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A Business Primer for Athletic Trainers Staffing Community Events

George Goodridge, MS, AT, ATC Scott Linaker, MS, AT, ATC John M. Valencia, AT, ATC, CSCS, ITAT Partners, Arizona Sports Care, LLC.

Objectives

Understand the benefits of community athletic training

Understand the legal issues involved in community athletic training

Understand best practices in providing athletic training services to the community

Provide tools for an athletic trainer to provide community athletic training services in a legal, ethical and positive manner for the advancement of the profession of athletic training.

Community Athletic Training

The provision of athletic training services to athletic teams, leagues, clubs, associations, events and schools, colleges or universities on a contract basis as an independent contractor.

Arizona Sports Care, LLC Events in 2016

DII College Softball Leadoff Classic

US Open Playoffs

USTA League National Championships

NJCAA Women’s Tennis National Championships

Western Region Rugby Championships (USA Rugby)

Tohono O’odham Community College

Marana Unified School District Cross Country Meet/Middle School

USA BMX Western Regionals

Arizona Sports Care, LLC has provided athletic training services at approximately 160 events from Winslow to Wilcox in 2016

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Our Philosophy

Events in our community, affect our entire community, so we represent the community we live in, as athletic trainers the best we can.

All athletes regardless of age and ability deserve the best sports health care available. Multi-disciplined evidence based practice.

Providing athletic training services in the community expands our contact base as a profession and promotes athletic training into areas previously unserved by ATs.

Employee vs Independent Contractor

Employee vs. Independent Contractor Employees:

W-2 (Taxes withheld) can file regular 1040

FICA (Soc. sec.) taxes paid by employer

Covered by workman’s comp. Insurance, professional liability ins., other benefits

Employers provides supplies and control work schedule.

Independent Contractors:

1099-Misc. responsible for self-employment tax and must do schedule C for Sole Proprietor,, other tax forms depending on type of business entity

No Social Security benefits Must purchase own insurance, prof. liab., W/comp., general liability, etc. Pay for own equipment and supplies. No benefits unless you purchase your own. Need business license(s).

Typically paid twice what employee makes!

Types of Business Entities

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Types of Business Entities

Sole Proprietor

Limited Liability Company

Professional Corporation

“S”-Corporation

“C”-Corporation

You need to decide what works best for you?

What are you worth?

Average mean salary for ATs in AZ May 2015

Maricopa County-$29,960-$42,110

Pima County-$50,550-$68,850

Approximately $20,000 difference. Why the difference?

Do we continue to take low paying jobs just to have a job?

Do you demand what you are worth at your job?

Will new DOL overtime rules bring ATs up ($47,476) ?

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AT pay difference between Pima and Maricopa Counties

Pima County:

Approximate hourly wage at low end of range is $24.30/hour.

Most HS ATs 5/5 AT duties, teaching is overload

Less new grads and licensed students

More longevity at positions, but is that due to more job satisfaction and less work hours?

Maricopa County:

Approximate hourly wage at low end of range is $14.40/hour.

Most HS AT split between teaching and AT duties for 5/5 contract

More turnover of ATs out of state due to low paying jobs and also student return to home state after AT school.

Are you worth more than a convenience store assistant manager?

AT in Maricopa County

Yearly pay $ $29,960-$42,110

Works 2100-2310 hours per year

$13.50-$18.97/hour

QT assistant manager in Arizona

Yearly pay $37,800 (with $3200 average bonus)

Work 2392 hours per year

Approximate hourly pay with bonus $15.80/hour.

Community AT pay, what are you worth?

Employee

Maricopa County $29,960-$42,110 approximately $14.40-$20.25/hour

Pima County $50,550-$66,850 approximately $24.30-$32.14/hour

Plus benefits, Social Security, medical ins., w/comp. ins., life insurance, 401k, ASRS, 403b, etc.

Independent Contractor

Maricopa County approx. $28.80-$40.50/hour

Pima County $48.60-$64.28/ hour

We have charged up to $45.00/hour.

Decreasing Liability

Liability Insurance, Medical Direction, SOP, Contracts, and Documentation

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Notre Dame Hit With Lawsuit October 13, 2016 On October 4, a lawsuit by Edelson PC accused the University of Notre Dame, along with the NCAA of “reckless disregard for the health and safety of generations of Notre Dame student-athletes,” through hiding information about the long-term effects of concussions.

According to The Observer, the complaint states that Gary Gray, who played football for Notre Dame from 2007 to 2011, experienced multiple concussions while on the team, and because he was not properly treated, he now has anxiety, depression, and mood swings. The complaint alleges that Notre Dame ordered players to ignore their symptoms and continue playing, and did not contact former players about the possibility of long-term brain damage.

Decreasing Liability

Negligence, Athletic Trainers at Heart of Football Lawsuit Colter Rios was playing in a junior varsity football game for Grossmont (Calif.) High School in 2008 when he felt a pop in his right ankle as he was tackled. Although he complained of pain when he tried to stand up, his coaches sent him back into the game without having the ankle examined. Colter was eventually removed from the game and sent to the athletic trainer to get his ankle taped. The athletic trainer, Keoki Kamau, was not there, so Adrian Dunn, a college athletic training student who had been assisting Kamau on a volunteer basis, examined Colter's ankle. Dunn found no bruising, deformity or other abnormality and, after taping Colter's ankle, had him jog, zigzag, sprint and backpedal. Colter told the trainer he felt fine and was then cleared to return to the game. Upon returning, however, Colter fractured two of his cervical vertebrae and injured his spinal cord when he was tackled. The injuries prompted Rios' mother to file suit against the Grossmont Union High School District, alleging that the district was negligent to allow Colter to continue to play after injuring his ankle, and that the initial injury caused him to subsequently sustain permanent and debilitating injuries.

Decreasing Liability

Negligence, Wrongful Death, Concussion Protocol > Former High School Athlete wins $4.4 Million Settlement Against Negligent Athletic Trainers > Lawsuit: New Trier athletic trainer failed to seek medical help for injured cheerleader > Trial Date Set For Wrongful Death Lawsuit Of Frostburg Football Player > Lawsuit Claim: Concussion Protocol Missteps Led To

Paralysis > October 2016 - NCAA facing 43 concussion lawsuits - D1 football

Decreasing Liability

Decreasing Liability

●  JB case

●  OL case

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Professional Liability Insurance

Professional Liability Insurance

Have Your Own versus Rely on Employer?

JB case - no personal representation

OL case - “Trust” representation

Professional Liability Insurance

●  Occurrence versus Claims-made

○  occurrence - covers any injury that occurred within the life of the policy, even if claim is filed after policy has been canceled

○  claims-made - covers any injury that occurred within the life of the policy, except when a retroactive date is applied to the policy (purchase of “tail” coverage)

Professional Liability Insurance

● Keeping track of hours for IC work

○  as when engaging in volunteer, moonlighting or self-employed activities

○  must be within a specific % of total athletic training services of full time employment

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Professional Liability Insurance

●  Purchasing Policy

○  Proliability administered by Mercer (NATA preferred provider)

○  Healthcare Providers Service Organization (HPSO) ○  CPH and Associates ○  American Professional Agency, Inc ○  CM&F Group Inc

Other Insurance

Other Insurance

Umbrella general liability policy (ASC)

Provides protection against catastrophic losses

Workman’s compensation insurance (ASC)

Provides wage replacement & medical benefits to injured employees

Disability insurance

Provides income protection for long term disability

Medical Direction and SOP’s Licensing and Regulating the practice of the Arizona Athletic Trainer > A.R.S. - Title 32, Chapter 41 Athletic Trainers > Rules - Title 4. Professions & Occupations Chapter 49. Board of Athletic Training

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Medical Direction

Instrument of Direction

Daily guidelines/SOPs

Communication guidelines and Philosophy/Mission Statement

NATA Code of Ethics

BOC Standards of Professional Practice

Medical Direction

Address Position Statements

Concussion Protocol

Local protocols or guidelines

AED Medical Direction

Referral to Physician

Referral

Medical direction

Physician/Urgent Care referrals/locations

TOI After Hours Clinic

Massage/acupuncture/non traditional

JB Case - Direct Referral?

Federal Anti-Kickback Statute of 1972

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Communications

Communications

Medical direction

Physician/Urgent Care referrals

Host AT

Other ATs at event (or other venue)

Medical timeout

Communications

Event administrators/officials (comms on site)

Coaches

Parents

Athlete’s regular AT

Emergency Action Plans

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Emergency Action Plan

A proactive approach to emergency preparedness will ensure you are implementing the right policies to help reduce injuries and catastrophic outcomes.

Develop an EAP for managing serious and or potentially life-threatening injuries that is venue specific.

Best Practices for Staffing Community Events

Best Practices

Greeting Coaches/Event Administrators/officials/etc

Venue package (treatment table, supply table, tent, ice chest, supply kit, etc.)

Equipment for loan/purchase

Shift change/advising following AT for continuity of care

Focused vigilance

Health education for participant

Best Practices

Signage

Treating adults versus minors (OL case - Coach present)

Documentation

Emergency equipment (AED, splints, etc.)

AT to athlete/field/court/mat ratio

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Documentation

Documentation

A.R.S. § 32-4103 (B) - post injury treatment guidelines

- § 32-4153 (18) - grounds for disciplinary action: failure to maintain adequate records regarding treatment JB Case - Sworn deposition 3 years & 5 months post surgery - Tx record concerning all other injuries questioned OL Case - Lawsuit, sworn deposition and jury trial 3 years & 7 months after

Incident WSC Case - Knee MCL/meniscus claimed occurred during football

Documentation

Injury reports

Concussion documentation Rehabilitation Progress documentation

Daily treatment records

Injury Management Recommendations

(Hard copy, electronic, photo and HIPAA)

Contracts/Agreements

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You need some kind of agreement!

Verbal is not acceptable!

Some clients provide agreements of their own.

Some clients ask for you to provide.

What if a client does not want a contract

Invoice Terms? 30 days net?

Supplies? Ice? Shelter?

OL Case

Now what?

Is community athletic training right for you?

●  Are you willing to take the risks as an independent contractor?

●  Are you willing to put in the extra time and effort to do it right?

●  Are you willing to negotiate an appropriate fee for your professional and expert services?

Thank you!