The impact of high school athletic trainer services on medical payments and utilizations: a microsimulation analysis on medical claims

Abstract

Background Increasing athletic trainer (AT) services in high schools has attracted widespread interest across the nation as an effective instrument to manage injuries and improve children’s health, but there is a lack of evidence on potential medical savings. Our study aimed to address this knowledge gap and provide evidence of AT impacts on medical payments and utilizations to inform public policy decision. Methods We obtained medical claims of patients aged 14 to 18 years from the 2011–2014 Oregon All Payer All Claims limited dataset. We calculated payer payments and utilizations for medical claims under AT’s scope of practice. We used zip codes to link patients with the enrollment boundaries of Oregon public high schools, which were classified as either “AT group” or “non-AT group”. We implemented an innovative microsimulation analysis to address the uncertainty of linkage between children and schools. Results Our analysis included 64,115 and 84,968 eligible children with Medicaid and commercial insurance, respectively. Associated with high school AT services, Medicaid saved an average of $64 per patient during the study period, while commercial insurance payment rarely changed. AT services may reduce emergency visits for both insurance types but increase total visits for commercially insured patients. Conclusions Our study provides evidence for the differential impacts of AT services on medical payments and utilizations. The legislators should consider to allocate funds for high schools to directly employ ATs. This will encourage ATs to work to their highest ability to improve children’s wellbeing while containing avoidable medical cost.

Secondary School Socioeconomic Status and Athletic Training Practice Characteristics

“…The observed differences in access among school SES may lead to a variety of consequences that disproportionately affect lower SES communities. These observed differences may include: increased health care costs to the community atlarge and/or the athlete's family; secondary to unnecessary emergency department visits [25][26][27] and subsequent services, 28,29 ; inappropriate referrals 25,30 and lost productivity from missed days of work and school. 31 Further, athletes from lower SES communities may be more at risk of injury mismanagement 32 (in particular concussion injury) 13 as well as decreased availability of the AT to provide evaluative, 25 rehabilitative, 18 and preventative services 26 to athletes.…”

“…In addition to rehabilitative care, athletic training presence has also been credited as playing a central role in decreasing sport injury presentation for acute injury management in higher-cost clinical settings such as emergency departments. 25,26,30 Lateral ankle sprains alone, which are commonly managed by ATs, 34 were shown to incur emergency room charges ranging from $702-$1408 in 2010. 27 These charges are not only an undue burden for society at-large, but also for individual athlete families, and potentially more so for athletes from lower SES communities.…”

Differences in Access to Athletic Trainers in Public Secondary Schools Based on Socioeconomic Status

“…30 After looking at the medical need, a cost-benefit analysis would demonstrate the economic benefit of athletic training services. 31 One study found that athletic trainers reduce emergency visits 10 which cost an average of $2,032 per visit. 32 Two-thirds of hospital emergency visits annually are avoidable which has the potential to save $32 billion dollars per year.…”

“…8 Previous studies have shown that access to an athletic trainer in the secondary school setting positively influences the reported incidence of sports-related concussions and post-concussion management activities, O n l i n e F i r s t reduces emergency room visits and cardiac-related deaths, provides preventative medicine services, and increases patient access to care. [9][10][11][12][13] One reason for this being high school athletic trainers are often not reimbursed through a third party, which gives access to a wider variety of SES groups. 13 Further, at the local practice level, there are several steps that athletic trainers can implement to provide better patient-centered care to these underserved populations, which can increase access to care.…”

Athletic trainers’ unique clinical and teamwork skills contribute on the frontlines during the COVID-19 pandemic: A discussion paper

“…Primary care skills in athletic settings have previously been recognized for the reduction of emergency room visits through statistical modeling and claims data analysis. (Li et al, 2019) This expansion of traditional AT practices to new settings has proven valuable in providing a screening mechanism to protect the patient and the facility while at the same time triaging care needs for musculoskeletal conditions have allowed the facilities to safely continue providing essential services. The shift from the traditional value of revenue generation to upstream triage and clinical care coordination has allowed ATs in outpatient rehabilitation facilities to be directly involved in administrative and clinical operations at a level significantly impacting patient care and practice viability.…”