creating a concussion clinic palm...• greater marketing, billing, education, outreach, and support...

Creating a Concussion ClinicMichael Palm, MS, ATCPractice ManagerNorthshore University Health System

• The statements and opinions contained in this program are solely those of the presenter.

• Treatment options and tools presented are some of many that are available.

• All individuals in control of content disclosed no relevant financial relationships.

• Other CE disclosures can be found in your course information document.

Disclosure Statements

Course Description

Learn the practical aspects of creating a concussion clinic in this course. You’ll learn the must-know tips for creating a successful clinic, including billing, policy, staffing, scheduling, outreach, and education. Examples for both small and large clinics will be discussed.

At the end of the course, attendees will be able to:• Identify the components necessary for setting up a concussion clinic.• Describe the general flow of a concussion clinic from intake to

discharge. • Review the multidisciplinary team members and concussion policy

components integral to a comprehensive concussion clinic.

Speaker Biography

• Bachelors of Science in Athletic Training at Western Illinois University; Masters of Science in Sports Medicine; Masters of Business Administration in Health Service Management: Keller School of Management

• Certified Athletic Trainer since 2002 with experience at high school, professional, and national levels

• Currently manages operations at an orthopedic practice of approximately 45 physicians

• Co-authored NATA Position Statement on Concussion in Sport

• In free time, enjoys playing golf, grilling, and watching sports

Michael Palm, MS, ATCPractice ManagerNorthshore University Health System Glenview, Il

Intended Use

• One view on concussion clinic model• Best model is always best fit for individual facility• Not a one size fits all approach to concussion clinics

Research relevant to creating a concussion clinic

• Concussion incidence and epidemiology• Nearly 4 million concussions annually (Langolis et al., 2006)

• Empirical support for concussion management• Symptom monitoring, balance, cognition, return to activity including learning and

exercise remain important management components (Harmon et al., 2017)• Empirical evidence for concussion recovery

• Pre-injury risk factors, injury severity, and acute clinical characteristics may all affect concussion recovery (Iverson et al., 2017)

Research relevant to creating a concussion clinic

• Previous research relevant to concussion clinics• Multifactorial process (McCrory et al., 2012)• Baseline assessment, symptom checklists, and balance (NCAA Handbook 2013-

2014)• Education, baseline, sideline assessment, individualized return to play and

learning guidelines, and a multidisciplinary team approach (Putukian & Kutcher, 2014)

Goal of a Concussion Clinic

• Pediatric, adult, WC, auto, legal, patient population

• Primary concussion provider role

• Goal/mission will dictate clinic model

Goal of a Concussion Clinic

• Management from injury to clearance• Acute management and then refer

complicated cases• Second opinion, management of

complex cases

Reimbursement

• Payor-mix for your region

• Reimbursement rates for your region

• Insurance panel approved providers in your area also managing concussion

• Out of network rate policy

• Cash pay model

Billing

Neuropsychology codes:• 96116

• 96118

• 96119

Billing

MD codes:• 99204 (New patient)

• 99212-99215 (Evaluation/Management and Time Based)

• 99244 (Consultation)

Billing

AT codes:• 96119 (Testing)

• 97110 (Therapeutic Exercise)

• 97530 (Therapeutic Activities)

Billing

Medicaid/Medicare• 35-40%

Private Payors• 60-65%

Workers Comp• Varies by state

Concussion Management Policy: Internal

• Established ages for treatment• Various providers

• Protocol for after-hours management, concerns, questions

• Medical supervision model

Concussion Management Policy: External

State guidelines regarding return to play• Who can return an athlete to play in your state?

• May even differ by school district, public/private

Concussion Management Policy: External

• Involvement with schools and return to learn

• Management of adult concussion if applicable

Scheduling

• Appropriate time allotted based on complexity• Initial versus follow-up• Complex cases

• Access or availability of the provider• Time of day is likely going to matter based on patient• How quickly do you want to get patients in?

Outreach

• Baseline testing

• Concussion services provision

Outreach

• Establishing a referral network (schools, clubs, etc.)

• Establishing a medical referral network (ED, Urgent Care, providers, PCP/pediatricians)

Education

• Multidisciplinary approach

• Baseline testing

• Trainings

• Print material

• Web-based material

Large System, Small System, and In Between

• Large health system• Many providers with vast array of

training

• Small health system• Typically many fewer providers

available or willing/trained to treat

• Filling in the gaps between the two

• Be who you are

ConcussionManagement.com

Large Health System

Staffing

• Who is the point guard?

• Access to a multidisciplinary team

• Access to specialists

Staffing

• Clinic assistance model (MA/ATC)

• Ancillary support staff (Scheduling, Billing, Outreach, etc.)

Specialization

• Concussion specialist type (pediatric, sport, adult, legal)

• Internal specialists (vestibular, ocular, exertion)

Internal Referrals

• What exists and what needs to be added?

• Therapy (Vestibular, MSK, Vision, Counseling)

• Medical Providers (Neuro, Optometry, Medication Management, etc.)

• Sports Medicine (ATs, MDs, PTs)

• Doing what is best for the patient

External Referrals

• What needs to be referred out?

• Bring external referrals in to capture revenue

• Still… do what is best for the patient

• Know the lay of the land

Access

• Benefit of immediate access

• Scheduling availability based on patient type

• Contracted slots

Marketing

• Unique aspects of the concussion clinic

• Affiliations – teams, schools, organizations, etc.

• Print – logo recognition

• Web-based – health system website

• Social media – based on health system parameters

Intake evaluation

• Patients presenting with pre-existing knowledge

• Interview – risk factors, mechanism, current symptoms

• Exam – balance, neuro, VOMS

• Testing – neurocognitive assessment

Intake evaluation

• Education – trajectories, physiology

• Plan – rest, accommodations, referrals

First follow-up

• Interview – current symptoms, injury progression

• Plan – accommodations, referrals

Continued follow-up

• Caring for the complicated patient

• Differentiating concussion from non-concussion

• Recognizing liability and responsibility

• Handling re-injury

General management

• Taking a triage approach

• Recognition and management of various concussion trajectories

• Rolling with the punches of concussion trajectories

Working within a treatment team

• Communication

• Speaking the same language

• Fostering development of new ideas

• Collective growth and expansion

Advantages

• Access to patients (ED, Urgent Care, ATs, etc.)

• Access to a wealth of resources and providers

• Access to a vast range of multidisciplinary team members

• Greater marketing, billing, education, outreach, and support staff resources

Challenges

• Competition for support

• Turf wars

• Established public perception

• External competition with other concussion clinics

Small Health System

Staffing

• Concussion point-of-contact

• Start with the bare bones and be mindful of growth

• Utilizing the resources currently available

• Taking care of the ancillary needs (Scheduling, Billing, Outreach, IT, etc.)

Specialization (or maybe not)

• Depending on the provider, may need to be a jack of all trades

• Benefits of being a generalist with concussion

• Maybe it’s a role of concussion plus something else

• Possible to still be a specialist

Internal Referrals

• What business can be captured internally?

• Utilizing the resources available

• Contracting or using PRN services

• Recognizing and accepting limitations

External Referrals

• Playing point-guard for the patient

• Utilizing quality providers

• Create a concussion care network or consortium

• The best initial addition… vestibular therapy

Access

• Providing patients access to care

• Types of patients to target

• Working with external referral sources

• Eat what you kill

Marketing

• Word of mouth

• Building a reputation

• Focus on earned media

• Narrow concussion print collateral

• Avoiding the marketing mistakes

Intake Evaluation

• Thorough and comprehensive

• Interview – risk factors, mechanism, symptoms

First follow-up

• Recognizing when an external referral is necessary

• Interview – current symptoms, injury progression

Continued follow-up

• Providing care due to a lack of other options

• Patient’s needs first approach

• The work that doesn’t get billed for

General management

• Familiarity with trajectories and accepting strengths and weaknesses

• Trajectories serve to guide providers

• Starts with being a good diagnostician

Who is the treatment team?

• Recognizing the strengths and limitations

• Utilizing external resources as part of the treatment team

• Always have an eye towards expansion

Advantages

• Flexibility

• Get to potentially wear multiple hats

• Support is likely to be more transparent

• Likely a lack of competition, or at least minimal

• Potential for local branding

Challenges

• Patient volume

• Reimbursement

• Public recognition

• Financial support

Conclusion

Concussion Clinics are Everywhere

• Patients lack-of education dictates concussion clinic boom

• Standing out in a crowd, or against competition

• Promote and celebrate what makes you unique

• The CIC Advantage

Be All In or Be All Out

• Difficult to only do concussion clinics half-way

• Recognize what works best for your system

• Important to be who you are

Concussion Clinics Can Be…

• Financially beneficial

• An entry point for other medical services

• A source of good PR

• An area of growth potential

Question

What are your tips for working with providers who aren’t willing to change their scheduling system? (e.g. for the neuropsychologist who schedules 6 months out)

Question

As far as explaining the ‘why’ of an evaluation – do you show the ImPACT / ImPACT Pediatric clinical reports? Can you detail what you explain?

Question

At what point would a small system refer out versus trying to do it themselves? Any specific markers?

Question

What’s your advice for a provider outside the US looking to get started, knowing the regulations are a little different?

creating a concussion clinic palm...• greater marketing, billing, education, outreach, and support...

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