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The Sports Center

Elyas Bakhtiari, for HealthLeaders Magazine, January 8, 2010
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Famous athletes and big sports programs may be the public face of sports medicine, but at its core are local communities and, increasingly, the unconventional athlete.

When Michael Phelps made history at the 2008 Olympics and won his eighth swimming gold medal of the games, Scott A. Rodeo, MD, was watching poolside. As one of about 30 medical professionals selected by the U.S. Olympic Committee to join its medical team, Rodeo was tasked with guiding swimmers through doping control, and he spent about 45 minutes with Phelps after each of his gold-medal races.

A few weeks later, Rodeo was back at the Hospital for Special Surgery, a 162-licensed-bed orthopedic hospital in New York, where he serves as codirector for sports medicine and shoulder surgery, taking care of high school kids.

Sports medicine can seem like a glamorous service line at times—surgeons enjoy a pretty favorable payer mix, are easily marketable, and even occasionally work with professional athletes and teams. But most sports medicine service lines are built on a much more relatable patient base: high school and college athletes or weekend warriors who have overextended themselves during a workout.

In fact, patients on both ends of the age spectrum who aren't associated with an official sports team make up the fastest growing segments of the sports medicine case mix, says Rodeo. "We're seeing overuse and sports-type injuries now in older athletes—people in their 60s, 70s, and 80s who are quite active. We're also seeing that in kids under age 10, who are also very active," he explains.

The uptick, particularly for the very young patients, may be due to better diagnostic techniques, Rodeo says. Physicians have gotten much better at recognizing and diagnosing sports-related injuries. But there is also an ironic side effect to the growing cultural emphasis on fitness and health: More Americans are active and exercising at older ages than in the past, and as a result they're getting more of the shoulder, knee, and ankle injuries that are sports medicine's foundation. Their healthier lifestyles are in some ways actually hurting them.

At the same time, surgeons are now willing and able to perform surgeries on middle-aged patients that were in the past only reserved for younger patient populations, says Matthew Matava, MD, associate professor of orthopedic surgery at Washington University School of Medicine in St. Louis. "When I was in training, it was unheard of to do an ACL reconstruction for a person in their 40s or 50s. But if you now tell a person in their 40s or 50s that they're too old for ACL surgery when they play basketball three times a week and go skiing in the wintertime, they'll walk out your door insulted."

The expanding patient base creates plenty of demand and a healthy revenue stream, which can make sports medicine seem like a sound investment for many hospitals. But making it work requires more than just scheduling surgeries. To thrive, a sports medicine program must connect with the local community and offer the full gamut of treatment options.

Success Key No. 1: Hire athletic trainers
When C. David Geier, Jr., MD, started at the Medical University of South Carolina in 2005, he was tasked with essentially building a sports medicine program from scratch. Although the 689-licensed bed medical center in Charleston, SC, had sports medicine surgeons in the past, it didn't have a comprehensive service line, and Geier had to start by adding the nonsurgical components of the program.

One of the most important steps was hiring athletic trainers to work on the front lines and increase referrals into the program. It was also one of the most difficult, he says.

Most sports medicine service lines operate as their own little hub-and-spoke networks. Athletic trainers often set up shop in a local high school or college and mend minor sports injuries and offer training and rehab services on-site. The presence builds brand awareness and, ideally, the athletes will choose the hospital that employs the trainer when there is a more serious injury.

But personnel salaries are one of the biggest expenses in a sports medicine service line, and the return on investment of athletic trainers isn't always self-evident. Geier couldn't convince the orthopedics department at MUSC to bear the cost of hiring trainers, so he instead had to lobby the hospital for the funds and realized that sports medicine would have to be somewhat independent from the orthopedics department.

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