As the new fall sports season arrives, you’re no doubt reviewing and walking through your emergency action plan, a practice that is essential for preparedness and management. At many schools, reviews of procedures and practices are conducted on an annual basis prior to the start of the season, but planning and practicing your emergency plan on a regular basis throughout the season can help reduce risk by building a safety-centered culture.

One meaningful way to continually reinforce your emergency action plan is by conducting a medical timeout before every practice, game, or organized athletic activity.

The medical timeout concept is inspired by pre-flight checklists for aircraft. Prior to every take-off, the pilot and aircrew must first review and perform the preflight checklist—a list of essential tasks and checks—to help protect the safety of themselves and their passengers by ensuring that everything is in place. This process of pre-flight planning, pre-flight checklists, and emergency procedures with checklists is a core part of the aviation industry’s excellent safety record.

Following the same principle, a medical timeout is a structured time before any athletic activity commences that allows the emergency response team to go through a checklist to review and reinforce the emergency action plan (EAP). Participating personnel go over the EAP, review emergency procedures, confirm the availability and functionality of required equipment, assign roles to personnel, ensure emergency vehicle access where the activity is held, and any other relevant actions. Consequently, if an emergency occurs during the athletic activity, everyone has been properly briefed, knows their role, and can respond efficiently.

It is commonplace for sports medicine personnel to do a medical timeout at competitions to inform visiting teams about personnel available, procedures, and facility orientation. This is a sound risk management strategy and it makes sense to extend this strategy and have a medical timeout before every practice or activity, not just at competitions. Doing regular medical timeouts gets everyone dialed in on the importance of the EAP, and the muscle memory that you will build from practicing the procedure frequently could help save a life.

For an example of a medical timeout checklist, see NATA’s “Official Statement on Athletic Health Care Provider ‘Time Outs’ Before Athletic Events.”

 

 

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

When reviewing an intercollegiate athletics insurance program, there are many elements to consider. Based on the NCAA’s Effective Practices for Managing Student-Athlete Insurance (2018), here are some questions to think about as you evaluate your program’s policies.

Administration

  • Do you have a formal risk management team?
  • Who are your risk management representatives?
  • Do you have athletics department representation on the campus-wide student health committee, or any other relevant committees?
  • Who is responsible for coordinating the day-to-day administration of the insurance program?

Primary Insurance Requirement and Verification

  • Does your institution require students to have primary insurance?
    • Is there a hard or soft waiver in place?
    • Does your athletics program require primary insurance for student-athlete participation in intercollegiate athletics?
    • If you require primary insurance, how do you communicate this requirement to the student-athlete?
    • Are government-administered policies (e.g. Medicaid or TriCare) accepted as primary insurance? If yes, are there policies in place about handling medical expenses and access to providers? If no, do you have a written policy to that effect?
  • Do you verify primary insurance coverage? If yes, consider the following:
    • Who is responsible for verifying student insurance?
    • What verification method is used?
    • What information is verified (depth of information)?
    • How often is coverage verified?
    • Do you have a policy to procure coverage if a lapse is identified?

Insurance Coverage and Policies

  • Do you have a Catastrophic Incident Policy?
  • Are there policies in place for handling medical expenses and access to providers? Consider the following situations and services:
    • Scholarship/non-scholarship athletes
    • Pre-existing injuries and coverage
    • Non-athletic injuries and illnesses
    • Treatment or rehabilitation during institutional breaks
    • Post-separation care of athletic injuries
    • Access to physical therapy
    • Access to ancillary medical providers (i.e. chiropractic care, acupuncture, massage therapy)
    • Dental expenses
    • Vision expenses
    • Pharmacy and medication expenses
    • Durable Medical Equipment (DME) expenses
  • Do you perform background checks on ancillary providers (e.g. chiropractors, acupuncturists, or massage therapists)?
  • Do you have a clear, consistent pre-authorization procedure?
  • Are there policies in place regarding the following topics?
    • Provision and procurement of disability insurance
    • Provision and procurement of loss-of-value insurance
    • Prospect insurance
    • Travel coverage
    • Medical coverage (campers and staff) for athletic camps at your institution

Cost- and Time-Saving Methods

  • Are any of the following cost-saving opportunities included in your insurance program?
    • On-site care at no charge
    • Sponsorship funds from medical providers
    • In-kind services
    • Discounted services
    • Direct provider arrangements (contracts)
  • Does your program utilize any of the following time-saving methods?
    • Online claims reporting (If this method is included, does your EMR communicate with the online process?)
    • Online access to claim reports
    • Dedicated, accessible service team

Risk Reduction

  • Do you ask for a medical history and conduct orthopedic screening of recruits?
  • Do you require a robust medical history and pre-participation exam?
  • Do you conduct a mental health screening of student athletes?
  • Are you familiar with AHA guidelines, including recommendations for ECG standards?
  • Do you have a concussion management plan?

Have More Questions or Need an In-depth Conversation?

These questions are just the starting point. There’s a lot to consider and every program has unique consideration. If you are interested in a deeper dive, feel free to contact me.

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

 

A year after I became a certified athletic trainer, at age 24, I was named Head Athletic Trainer at Wofford College in Spartanburg, South Carolina. I had spent that first year learning on the fly and trying to emulate what my mentor had taught me, so I thought I knew what to expect. But when I started at Wofford, I realized I was ill-prepared for the onslaught of responsibility–particularly the administrative duties–that comes with being a head athletic trainer. I often felt overwhelmed by my obligations to my athletics department, staff, and student athletes. Four things usually kept me up at night:

  1. Managing Athletic Accident Insurance Claims

A critical aspect of athletic accident insurance is getting claims paid in a timely fashion, and you can’t accomplish that unless your insurance claims administrator provides great customer service and efficient claims processing. When I arrived at Wofford, this was not the case–I was greeted by a 3-foot high stack of folders on my desk containing unpaid bills. And one of the first calls I received on the job involved a former player who could not purchase an engagement ring because he had a bad credit rating due to an unpaid medical bill he received from athletic participation.

As I whittled the stack of bills down, I looked for a better solution that could help me manage my insurance claims efficiently. While the premium price is important when purchasing intercollegiate athletics insurance, the “cost” of unprocessed claims leading to people having unpaid bills that potentially impact their credit must also be factored into the selection.

  1. Budgeting and Cost Containment

Athletic trainers need to know how to manage the dollars they’re allocated and have a strategy for making budget requests. Yet everything impacts the bottom line and prioritization can be stressful.

Containing costs became an important part of my budgeting strategy. I looked for ways to keep expensive line items (like athletics insurance premiums and equipment investments) manageable, while keeping an eye on the little stuff too. Even a $0.10 cost increase/decrease per case of athletic tape makes a difference when it comes to staying on budget. Sometimes I even saved costs in unexpected ways–once, I took the time to help a local car dealer rehab a calf injury and that led to him providing the department with a dealer car!

  1. Managing Risk

Athletic Trainers also need to develop and implement a risk management strategy. My strategies were always multi-pronged–from being organized with the basics (like the Pre-Participation Physical) to evaluating my program for complex problems (like determining how I could best physically cover the highest risk sports, while also being available to provide care for those sports that did not get on-site coverage)–so the rigor, frequency, and evaluation of the strategy-setting was essential. I am now a strong advocate about the importance of regular program assessments as a risk management component.

  1. Networking

Networking (both internally and externally) plays an important role in building one’s reputation as a knowledgeable health care provider. At Wofford, I worked hard to develop relationships with campus stakeholders, medical providers, and community members that would enable me to deliver better care and create a safer environment for my athletes, as well as garner more resources. As my experience with the car dealer shows, I never knew when a connection that I made would help me, our athletes, or the department down the line.

That first year in Spartanburg is largely a blur of long hours. I lost 25 pounds working and worrying, but the lessons learned were worth every moment and they informed how I approached my role as athletic trainer during the entirety of my career.

 

About the Author

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). He’s passionate about sharing his learnings with others so that their first days can be a little less chaotic and stressful than his were.

Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

I attended a UCLA medical school graduation a couple weeks ago and the ceremony made me recall the beginning of my own athletic training career. I can remember the day I received the envelope with the news that I had passed my Board of Certification exam. (That was the old days—it arrived by snail mail and we had to wait six weeks for the results.) Getting that letter meant I was officially a certified Athletic Trainer and ready to take over the sports medicine world!

But receiving that notification was only a starting point. After 33 years in this career, I am keenly aware of things I didn’t know as I embarked on this journey:

  • Building trust in the athletes under my care would be a challenge.
  • Gaining trust from coaches would be even harder.
  • Providing care to athletes forges life-long relationships.
  • Building a program centered on safety is essential.
  • Navigating the business element of being an athletic trainer – including budgeting, risk management, cost control, insurance, and networking within your institutional framework – would require me to learn new administrative skills on the fly.

Boy, did I learn fast. But after a few years, I had gained the confidence that comes with experience. Treating a range of injuries became routine and my care-giving took on a matter-of-course tone.  (“Oh, don’t worry – I have seen this before.”) It was at this point that my mentor pointed out that even though I was no longer a newly certified athletic trainer and now had dealt with the repercussions of an injury/surgery/rehab many times, it was probably the first time that the student athlete and their parents were facing the situation. Dealing with an injury (and the potential implications for a college playing career) can be daunting enough; having to face potential medical bills and untangle complex insurance claims adds a whole other layer of anxiety to an already stressful situation.

That advice made me see that the meeting of knowledge and empathy is the cornerstone of the care we provide. If we don’t have both of those things, it is very difficult—if not impossible—to provide the student athlete what they need when they are injured or sick, or just need someone to talk to.

At the UCLA graduation, I heard the familiar quote that seems foundational to the holistic approach we need to take in our work as athletic trainers: “Nobody cares how much you know, until they know how much you care.”

I know enough now to know this is true and look forward to sharing more about all of these topics in future posts.

 

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

All intercollegiate athletics programs come with inherent risk that may result in a range of injuries or even death, despite the safety precautions in place. To create the safest possible environment, participants in an athletic program—administrators, coaches, healthcare providers, and student-athletes—must have a shared philosophy that the health, safety, and welfare of the student-athletes takes precedence over every other consideration. With this mindset, approaches for prevention of injury and mitigation of risk should be prioritized in the design and implementation of all programming and activities.

Indirect Deaths

The incidence of indirect deaths (i.e., non-traumatic deaths) in intercollegiate football, creates an opportunity to review current best practices for the prevention of sudden death in any intercollegiate athletics program. According to the article “Exertional Heat Stroke and American Football: What the Team Physician Needs to Know,” in football, the most common causes of indirect deaths are systemic failures such as heatstroke, sudden cardiac arrest, or sickle cell trait.[1]

Common elements that can contribute to indirect deaths include the following:

  • Intensity of exercise and over exertion, particularly early in the training cycle;
  • Conditioning that is not sport-specific and physiologically sound;
  • Improper development, training and implementation of Emergency Action Plans (EAPs); and
  • Lack of appropriate healthcare staff coverage for high risk activity.

Early season conditioning sessions can be a particularly vulnerable time for student-athletes because their bodies may still be acclimating to their sport. If pushing student athletes’ physical limits is framed as desirable—a way to push through mental limits or mimic stressors of a competition setting—it can lead to a “too much, too fast, too soon” scenario resulting in tragic consequences.

Best Practices to Help Reduce the Risk of Sudden Death

In 2012, The Inter-Association Task Force for Preventing Sudden Death in Collegiate Conditioning Sessions produced a document with best practices recommendations. Endorsed by the American College of Emergency Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, American Osteopathic Academy of Sports Medicine, Canadian Athletic Therapists’ Association, Collegiate Strength and Conditioning Coaches Association, Gatorade Sports Science Institute, Korey Stringer Institute, National Academy of Sports Medicine, National Athletic Trainers’ Association, and National Strength and Conditioning Association, the 10-point plan provides a template to help reduce the incidence of sudden death:

  1. Acclimatize progressively for utmost safety.
  2. Introduce new conditioning activities gradually.
  3. Do not use exercise and conditioning activities as punishment.
  4. Ensure proper education, experience, and credentialing of strength and conditioning coaches.
  5. Provide appropriate medical coverage.
  6. Develop and practice Emergency Actions Plans (EAPs).
  7. Be cognizant of medical conditions.
  8. Administer strength and conditioning programs.
  9. Partner with recognized professional organizations to define effective practices.
  10. Provide adequate continuing education for the entire coaching and medical teams.

The full report is worth a read, and is understood to still be the most comprehensive set of effective practice guidelines generally available and endorsed by those listed organizations concerned with student-athlete wellbeing. Following each of these recommended steps is extremely important in helping to provide a safe environment, but a critical step—the one that provides the foundation for every other step that follows—is for each institution to embrace the shared responsibility for the health, safety, and welfare of all student-athletes, regardless of the sport.

To help ensure that all planned activities meet these established effective practices and requirements, there must be real and continual coordination between the medical staff, strength and conditioning staff, coaches, and administrators to create a safety-centered culture. Together, they must work concertedly to see that each aspect of program design and planning prioritizes student-athletes’ wellbeing, and to take all appropriate steps to help prevent “too much, too fast, too soon” behaviors that can lead to sudden death. Finally, everyone needs to be on board with fully developing and practicing EAPs and executing them appropriately when the need arises. The risk of every day injuries and sudden death in intercollegiate athletics is evident, so we should plan and prepare to mitigate the risk.

 

Andy Massey is an Athletics Risk Consultant for Relation Insurance. His career in intercollegiate athletics spans three decades, including Director of Athletic Training at Tulane University (LA); head athletic trainer at Appalachian State University (NC), where he also taught in the Department of Health, Leisure, and Exercise Science; and head athletic trainer at Wofford College (SC). Andy now consults with intercollegiate athletic departments across the U.S. and also serves as an ATC Spotter for the NFL. Andy can be reached via email at [email protected] or on LinkedIn.

Click here to learn more about Relation’s insurance solutions and services for Intercollegiate Athletics.

 

 

Hi, I’m Andy, Relation’s athletics risk consultant.

They say that experience is a great teacher. Thirty-four years as an athletic trainer, and seven additional years of athletic training education as a high school student, undergraduate student, and graduate assistant have taught me a lot about athletics and shaped the style of care and the administrative oversight I brought to the programs I was privileged to lead.

One of the most important lessons I learned was from my mentor, Andy Clawson, a NATA Hall of Fame Athletic Trainer who just completed his 46th football season at The Citadel. I believe he models the importance of lifelong learning, particularly as it pertains to one’s vocation.

Since leaving the clinical setting 18 months ago, I’ve had the time to read, reflect, and gain some perspective on the intercollegiate sports medicine landscape, along with the different ways the “business” of college athletics affects athletic healthcare at all levels. In my new role as an athletics risk consultant for Relation Insurance, I aim to draw from everything I’ve learned to provide content that better informs the work of time-pressed athletic trainers as they continue to deliver care to the student-athlete. I’ll speak to the issues that confront intercollegiate athletics, sports medicine, and insurance, such as risk and liability identification and reduction, organizational administration, cost savings, and revenue generation.

Experience may be a great teacher, but a lifelong quest for knowledge broadens the experience. Throughout my athletic training career, I’ve made a point to talk and learn from people across the country who represent many levels of experience and stakeholder groups. I’m excited to pass on what I’ve learned and look forward to having this dialogue with you, so that we may all get better at what we do. As John Dewey stated in Experience and Education, “The most important attitude that can be formed is that of a desire to go on learning.”

 

First up? Reducing Risk in Intercollegiate Athletic Programs through a Safety-Centered Culture.

Continue the conversation with me on LinkedIn!

 

 

 

4 ways to understand and optimize your student health insurance plan

Claims data can provide a wealth of knowledge—if you know where to look. To start, be sure to keep your eye on these four data points that can help identify costly problems or student trends that need addressing.

Determine whether atypical large claims are derailing your plan.

Review the section of your claims reports that shows the large-dollar claims (i.e., the large-dollar claim diagnosis); then delve deeper to see if those claims are being considered as part of a normal trend or if they are unusual. Trends, and any large claims resulting from them, will typically be factored into your insurance rate going forward, but atypical, nonrecurring large insurance charges—such as an acute condition resulting in a lengthy inpatient stay or a complex surgery—should be separated and pooled with your carrier’s portfolio of other large claims.

If you discover a large atypical claim, be sure you understand how this event is affecting your claims experience. Ask your broker or carrier if that charge is being removed from the completion factor or how it is being discounted from the experience. Large claims can and do happen, but they shouldn’t upset an otherwise stable insurance plan.

Are students seeking care where you want them to?

Because network providers are typically more cost-effective for both the insured student and the plan, in-network care, as opposed to out-of-network care, is the preferred option. A close analysis of your claims report can reveal how many student health care services are being provided in network.

Find the section of your claims reports that identifies the total allocation for in-network versus out-of-network services. Because large claims amounts can have an outsized effect, allocation data alone doesn’t tell the whole story. To get a more complete picture, you can examine allocation amounts in conjunction with the specific numbers of in-network and out-of-network claims.

Perhaps you will find that 85 percent of payment allocations are in network, but only 50 percent of all total claims are filed in network—revealing that many students are accessing out-of-network care. Armed with this data, you can compare current student activity to your school’s goals and can evaluate whether or not there is a need for marketing-communications campaigns to help drive student behavior. Messages to students about the value of seeking care with network providers—in both digital and real-world locations where they typically look for information—can be very effective.

Is the student health center being accessed enough?

A health care center can be a vital part of your student health plan and have a significant effect on costs, so you’ll likely want to try to optimize usage and leverage your student health center as a cost-effective care provider.

Claims data can help you as you seek to answer questions, such as the following:

  • How many students are going to the student health center for care?
  • How often are they going?
  • What services are they seeking most frequently?
  • Because students are filing claims for similar services with other providers, are there certain services offered by the student health center that are being underutilized?

Your campus may have other specific questions about student health center usage that an in-depth claims data analysis can help you understand. To increase awareness of health care options on campus, you might consider developing a marketing campaign geared towards students that evaluates how and where students access information about the student health center (especially online), conducting information sessions in collaboration with residence halls, and/or using targeted messaging to address a specific problem revealed by your claims data analysis.

Identify excessive emergency room use.

Your claims report can also reveal if your students are making too many trips to the emergency room—a common problem, especially within international student populations who are unfamiliar with alternative health care options. An average ER visit can often lead to claims exceeding $2,000, proving costly for both students and health plans.

Consult with your broker or carrier to determine how your school’s emergency room claim amounts compare to claims from other providers during the same period. Emergency room claims data from previous years or, if available, other schools, can also provide a valuable frame of reference. Check to ensure you understand what practices your plan’s claims administrator has in place to obtain proper discounts, adjudicate claims that may arise from nonemergency care, and remove unreasonable charges (whether or not they are emergency room claims).

One way to address high emergency room usage is to implement an effective training program to educate students on how, when, and where they should access care. It may be useful to emphasize to students their potential cost savings (e.g., reduced coinsurance payments and/or no balance billing) if they access care at the student health center or, if treatment is needed before they can see their primary care provider, at an urgent care center.

Understanding how your school’s student health plan is being accessed throughout the policy year can provide valuable insight about the health of your student health plan and your campus. These tips will help you get started, but they also only scratch the surface of what can be learned from claims data—there are a myriad of possible factors to consider once a claims report hits your desk.

A regular claims data review can serve as a student health plan barometer, helping identify any trouble areas that must be addressed. Also, while insurance carrier underwriters use many different analysis tools to project your insurance program’s cost, claims data review can be used to help you anticipate and prepare for any potential plan increases that may result the following year. Additionally, consistent review before your annual policy renewal date can help pinpoint activities, utilization behaviors, or trends that will influence important decisions about your plan, such as the changing of a benefit offering or the incorporation of a different network.

You may also be able to use claims data to help diagnose specific campus needs, such as an increased emphasis on wellness, greater mental health assistance, or more education on how students can consider cost when obtaining care. Uncovering behaviors that drive up plan costs is key to making the data-informed decisions that can help you better manage your student health plan and better focus on the well-being of your students. Whether you review your claims activity monthly, quarterly, or by semester, the process can allow you to see how the year is progressing and consider year-over-year performance.

Diving into data analysis may seem daunting, but there is good news—you are not alone. Your broker, consultant, or health plan provider can be a valuable partner in the process by regularly reviewing claims data with you and providing analysis on what that data means for your program. Scheduling a claims data review will help you more fully evaluate the intricacies of your institution’s student health care plan and feel more confident that you are managing your plan strategically and sustainably.

 

About the Authors

 

Michael Babore is Executive Vice President of Consulting Services for Relation Insurance Services’ Education Solutions practice. Connect with Michael at (310) 566-2061 or [email protected]

 

 

Neil Majors is President of Relation Insurance Services’ Education Solutions practice. He can be reached on LinkedIn, via email at [email protected], or via phone (310) 566-2051.

 

 

This article originally appeared on the University Business website here. To learn more about Relation Education Solutions and our custom insurance solutions and services, click here.