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28 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 3 – November 2021 
 

Treating the Medicare Population in a Clinic Setting 
Alexandria Jauregui-Dusseau, DHSc, LAT, ATC; McCall Christian, DAT, LAT, ATC 
Missouri State University 
 

 
Key Phrases 
Clinic and hospital patient population, organization and 
personal outcomes, comorbidities, geriatric, rehabilitation 
 
Correspondence 
Dr. Alexandria Jauregui-Dusseau, Missouri State University 
901 S. National Avenue, Springfield, MO 65897 
Email: dus10@missouristate.edu  
 
Full Citation 
Jauregui-Dusseau J, Christian M. Treating the Medicare 
Population in a Clinic Setting. Clin Pract Athl Train. 
2021;4(3): 28-33. 
https://doi.org/10.31622/2021/0004.3.5.     
 
Submitted: October 6, 2020 Accepted: September 20, 2021. 
 
COMMENTARY 

Athletic training started as a profession specific 

to sports and caring for the health and well-being 
of athletes within a specific institution. Today, 
athletic trainers serve across the healthcare 
network in areas such as physician offices, 
industrial warehouses, tactical settings and 
performing arts. The profession has continued to 
expand its scope of training from a role in first aid 
and emergency care to incorporate 
comprehensive rehabilitation and prevention, 
ergonomic evaluations, and assistive roles within 
an orthopedic surgical setting. The required 
education needed to obtain certification in the 
profession has transformed from a secondary-
level teaching credential with preparations in 
athletic training to now a professional-master’s 
level education curriculum and many post-
professional doctorate and residency programs 
across the country.1 
 

The practice and education of athletic training has 
progressed leading to the transformation in the 
population the profession treats. As a result, state 
practice acts are changing to accommodate the 
expanding patient populations. With a focus in 

pediatric and active populations, geriatric sectors 
often are not seen by athletic trainers due to 
being primarily treated by other rehabilitation 
specialties. A contributing factor is the lack of 
reimbursement and recognition in the Medicare 
Services sector.  

As a part of a funded research grant, the research 
team began collecting both patient-rated and 
clinician-rated outcome measures on the 
Medicare-eligible population treated by an 
athletic trainer to understand the effect of athletic 
training rehabilitative services. Patients were 
categorized based off their chief concern (lower 
extremity, knee, spine, upper extremity), which 
dictated the outcome measures that were 
collected. Complete characteristics of the research 
participants are reported in Table 1. The outcome 
measures were gathered based on developer 
suggestions for frequency. The intent for this 
project was to provide data that could facilitate 
recognition from Medicare Services. Patients who 
volunteered for this study had no difference in 
their intended treatment plan, but rather, more 
intentional outcomes were collected to understand 
the perspective of their recovery. Taking a 
patient-centered approach at caring for this 
population was a high priority. The structure of this 
research has led to a new perspective of what it 
takes to treat a novel population in the field of 
athletic training. 

PREPARATION FOR THE STUDY 

Understanding the Needs of the Population 

The Medicare-eligible population is a unique 
population to work with as an athletic trainer in 
the orthopedic rehabilitation clinic setting. 
Typically, the patient population ranges from 
seven to sixty years old, and their co-morbidity list 
is fairly short. The needs are unique, and it has 
required more preparation and research to 

mailto:dus10@missouristate.edu
https://doi.org/10.31622/2021/0004.3.5


Treating the Medicare Population in a Clinic Setting 

 

 
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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4 – Issue 3 – November 2021 
 

refresh the understanding of co-morbidities 
specific to the Medicare-eligible population. 
Additionally, these patients have had more 
experiences in the healthcare system. Some of 
those experiences could have negatively 
influenced their perception of healthcare 
providers. For instance, this population is subject 
to ageism and are treated differently by 
providers intentionally or unintentionally because 
of their age. Ageism within healthcare is 
described by Ugurlu et al2 as having 
preconceived notions and prejudices against the 
elderly population. Studies have been conducted 
in a variety of healthcare disciplines to 
understand the intention and influences behind an 
ageist perspective.2,3,4 A study by Ben-Harush et 
al.3 found commonalities among a few healthcare 
professions and the prevalence of ageism.3 
Healthcare providers do not necessarily intend to 
treat older patients differently or inadequately, 
but the presence of implicit bias toward a 
patient’s age and ineffective communication 
strategies impact the care provided to this 
population.2 With this understanding, it was made 
a priority to treat these patients with the respect 
that would be given to any other patient, but also 
to be cognizant of unconscious ageism. It was 
important to keep the expectations of these 
patients high and did not let their age affect the 
goals we set, or they set for themselves. 

Considering Common Preexisting Conditions 

A significant adjustment to working with the 
Medicare-eligible population was understanding 
medical diagnoses not familiar to the clinician and 
how those diagnoses would affect their recovery. 
Co-morbidities prevalent among the aging 
population were foreign to the treating clinician 
and are not extensively discussed in athletic 
training curriculums. Patients with progressing 
Parkinson’s disease, hearing loss, osteoarthritis, 
auto-immune disorders, degenerative joint 
disease, and malignant cancer diagnoses were 
now being evaluated and treated by an athletic 

trainer. Another consideration for the clinician was 
that they were working against decades of 
learned habits and postures. This required 
creative thinking and learning how to tailor the 
treatment approach to meet that patient where 
they were in terms of mobility and functional 
ability.  

Most of the patients had some degree of joint 
degeneration and corresponding range of motion 
restriction. The immobility and range of motion loss 
could be attributed to previous history of injuries 
and surgeries as well as a lack of use of full, end 
range motion. A priority for many of these 
patients has been to restore their functional 
mobility, strength, and overall movement. It was 
imperative to maintain high expectations for 
every patient regardless of their functional 
capacity. There were many situations where 
patients were reluctant to try an activity, 
especially getting down and up from the floor or 
picking items off the ground. Although they were 
active, many were not in the habit of performing 
these seemingly trivial tasks and were not 
confident in performing it independently. This was 
expressed through reporting lower health-related 
quality of life perceptions and disappointment in 
their ability to freely move. Integrating 
transitional movements into treatment sessions, 
such as frequently moving from supine to a 
standing position, became a goal included in the 
patient’s treatment plan.  

Another aspect considered when working with this 
population is how immobility and a lack of 
independence affected their overall health-
related quality of life. For example, if a patient is 
unable to exercise due to pain, functional 
limitation, or a mechanical restriction, existing co-
morbidities could be exacerbated or developed 
from that lack of movement and sedentary 
lifestyle. Several study participants expressed 
their concern of worsening blood pressure, weight 
gain, and general mental well-being due to an 
inability to perform their exercise routine. 



PATIENT-CENTERED CARE COMMENTARY 
 

30 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                     Volume 4 – Issue 3 – November 2021 
 

 

Increasing the patient’s freedom of movement is 
essential to maintaining overall health and well-
being throughout the remainder of their lifespan.  

Prior to the clinician’s involvement in this research 
project, her knowledge of Parkinson’s disease was 
limited. That changed drastically after working 
with three patients who have been battling this 
disease for several years. Parkinson’s disease 
presents differently in each patient, and they all 
managed it in their own way. Although they were 
referred for a musculoskeletal injury, the disease 
profoundly affected the treatment approach. For 
instance, the first patient with Parkinson’s disease 
that participated in the study had a significant 
tremor in the upper extremity and had made the 
personal decision to not take any medication that 
would lessen the intensity of the tremor. She 
became accustomed to working with the tremor 
and adjusting manual therapy techniques and 
therapeutic activities.  However, even when 
working with a different patient that was on 
medication to reduce the severity of their tremors, 
the daily treatment plan would be affected by 
when the medication was taken or if was not taken 
that day.    

Hearing loss is common issue that affects the 
Medicare-eligible population. The therapy area 
is a large, open workspace with ten clinicians 
treating patients.  This environment can make it 
difficult to hear when conversing with patients. It 
is important to pay special attention to 
communicating effectively and respectfully with  

 

patients that suffered from hearing loss. To 
enhance communication between clinician and the 
patient, the implementation of strategies such as 
maintaining eye contact, using concise 
descriptions, and expanding teaching styles by 
providing visual and tactile cues and examples. 
Communicating in a respectful way that does not 
make the patient feel uncomfortable or 
embarrassed is key to building a strong rapport 
with the patient and earning their trust.  

Another consideration in treating the geriatric 
population is exposure to extensive medical 
histories and chart entries that were unfamiliar. 
The healthcare provider list is more extensive, and 
the patient might be undergoing active treatments 
for co-morbidities. In many cases, the treating 
clinician had to refresh their knowledge of lesser 
seen diagnostic and lab outputs. Additionally, 
medication lists for this population are also more 
intensive and it is important to consider how they 
affect treatment. For instance, the tissue of a 
patient that is on blood thinners will react 
differently to instrument-assisted manual therapy 
and the provider must pay attention to these skin 
reactions. Interprofessional collaboration was 
essential when working with these patients, not 
only to stay updated about evolving issues, but 
also to provide those providers with information 
about a patient’s progress and how it ties into 
their overall health profile. Building relationships 
with referring physicians and other members of 
the patient’s health care team is a practical 

Table 1. Patient Demographics  
Variable n % M 

Age  - - 69.6 
Gender    
   Female 49 50 - 
   Male  49 50 - 
Chief Concern    
   Lower Extremitya 37 37.76 - 
   Knee  22 22.45 - 
   Upper Extremity  34 34.69 - 
   Back  5 5.10 - 
Length of Stay (weeks) - - 13.9 
a Lower extremity encompassed hip, lower leg, ankle, and foot injuries. 



Treating the Medicare Population in a Clinic Setting 

 

 
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Copyright © Indiana State University   Clinical Practice in Athletic Training 
ISSN Online 2577-8188    Volume 4 – Issue 3 – November 2021 
 

strategy to familiarize oneself with a specific 
patient and to better understand the extensive 
health histories of geriatric patients. 

COMMON CHALLENGES 

Working with a population that is vastly different 
from which is commonly associated to athletic 
training was a unique and challenging 
experience. These patients present with a variety 
of pre-existing conditions, complex medical 
histories, and may have had negative experiences 
within healthcare. Unfortunately, geriatric patients 
are subject to lower expectations due to societal 
norms and ageism. Stereotypes against 
Medicare-eligible patients can significantly affect 
their care and how they are treated by 
healthcare providers.2,3 For example, a clinician 
exhibits an ageist attitude if they decide to “take 
it easy” on an elderly patient and lower their 
standards of what constitutes full function. On 
more than one occasion in working with these 
patients, they have made comments about how 
they were treated by other providers and how 
they felt about the expectations set for them 
because of their age. These patients are very 
aware of how their treatment plan is dictated by 
their age and many of them aspire beyond the 
conservative plans of a clinician. Another 
sentiment expressed by our patients is how some 
providers expressed that their issue was “just due 
to their age” and could not be remedied. Prior 
experiences like this shaped their perception of 
healthcare providers and healthcare in general. It 
presented the challenge to earn their trust and 
change their mind about health care providers 
and increase their knowledge of athletic trainers. 

BENEFITS TO THE CLINICIAN AND THE 
POPULATION 

Exposure to this population has created the 
opportunity to expand knowledge and to provide 
quality care to a deserving population. In every 
patient encounter, the clinician strived to instill 
confidence in their abilities and facilitate a sense 

of ownership over their healthcare journey. 
Promoting elevated expectations among this 
population can improve their perspective of long-
term care, functionality, and success in 
rehabilitation. Conversations with the patients 
have indicated that there are gaps in 
rehabilitation care and there is limited focus on 
returning to functional and recreational activities. 
Patients expressed that past therapy experiences 
mostly focused on returning to activities of daily 
living and did not address more dynamic 
activities. At the conclusion of participation, each 
individual was asked to complete a patient 
satisfaction survey. Over fifty participants used 
the open comment box to express written strength 
and weaknesses. Table 2 shows a compilation of 
these comments. Agreeing on patient goals and 
the treatment plan must be a collaborative 
process and should not be determined solely on a 
patient’s Medicare status or age. 

CONCLUSION 

Athletic trainers are not known for treating 
geriatric patients but are more than capable of 
providing quality care to this population. 
Considerations must be made to complex medical 
histories and co-morbidities, but the expectations 
of what a geriatric patient can achieve should not 
be underestimated. Gaining access to this 
population would be a multi-faceted process and 
would require cooperation from various entities 
and stakeholders. This research study has 
indicated what this patient population values in 
their therapy experience and has yielded 
outcomes that demonstrate the effectiveness of 
athletic trainer provided services to this 
population through patient satisfaction scores and 
patient-reported outcomes. This patient 
population needs comprehensive therapy that 
strives to improve their entire movement profile, 
address the whole-person, and improve overall 
capacity to engage in physical activity across their 
lifespan. It is a worthwhile endeavor to ensure that  

 



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Copyright © Indiana State University   Clinical Practice in Athletic Training 
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these patients receive quality care and continue to 
perform functional activities without limitation. 

REFERENCES 

1. National Athletic Trainers’ Association. 
History. 2020. Available at: 
https://www.nata.org/history#:~:text=T
he%20National%20Athletic%20Trainers
'%20Association,the%20future%20of%2
0their%20profession. 

 

 

 

2. Ugurlu Z, Kav S, Karahan A, Akgun Citak 
E. Correlates of Ageism Among Health 
Care Professionals Working with Older 
Adults. J Transcult Nurs. 2019;30(3):303-
312. 
http://doi.org/10.1177/10436596188
10128. 

3. Ben-Harush A, Shiovitz-Ezra S, Doron I, et 
al. Ageism among physicians, nurses, and 
social workers: findings from a qualitative 
study. Eur J Ageing. 2017;14(1):39-48. 
http://doi.org/10.1007/s10433-016-
0389-9. 

Table 2. Themes in Patient Satisfaction Responses with Quotes 
Personal Attention: • Took a personal interest in me and remembered things from one 

visit to the next. Very professional but made me feel like I was her 
only client. 

• Personalized attention. 
• Has been a very professional, personable experience.  
• Very professional but also very personable. 
• The care taken to address my unique needs at each session – it 

was definitely “patient driven” as opposed to “program driven.” 
• My issue was addressed on an individual basis. No one else 

helped my hip problem and I finally go answers. 
• Personal touch was good. Showed me lots of new stretches. Felt 

cared for! 
• The athletic trainer is very personable and professional. 

 
Focus on Whole-Person: 
 

• Physical/intellectual/emotional blend of support. Excellent. 
• The attention of my aches, regardless of its location, whether it is 

part of original problem or not. Allowing me to be me during 
entire process (humoring me when I ask sideways questions (“what 
the muscle called?”)) It is easy to feel ‘old’ when surrounded by 
youth—I never felt old.  

• Excellent listening, care, suggestions, knowledge… friendliness.  
• Interested in my total welfare. Very friendly.  

 
Established Relationship/ 
Compassion: 
 

• The athletic trainer was patient and caring! 
• Compassion for the client/patient. 
• Empathy. 
• Loved the care and rapport with the athletic trainer. 
• Rapport, concern with meeting my needs.  
• Kindness and empathy. 

 

http://doi.org/10.1177/1043659618810128.
http://doi.org/10.1177/1043659618810128.
http://doi.org/10.1007/s10433-016-0389-9.
http://doi.org/10.1007/s10433-016-0389-9.


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ISSN Online 2577-8188    Volume 4 – Issue 3 – November 2021 
 

4. Blackwood J, Sweet C. The influence of 
ageism, experience, and relationships 
with older adults on physical therapy 
students' perception of geriatrics. 
Gerontol Geriatr Educ. 2017;38(2):219-
231. 
http://doi.org/10.1080/02701960.20
15.1079709. 

 
 

 

http://doi.org/10.1080/02701960.2015.1079709.
http://doi.org/10.1080/02701960.2015.1079709.

