The Condition of Medical Fitness

As the U.S. continues to face a healthcare crisis, the merging of the medical and fitness communities grows increasingly inevitable. As such, medical fitness programs are becoming less of an added commodity and more of a necessity.

“I think people in the fitness industry don’t realize they’re already working in this space,” said Lisa Dougherty, the founder of MedFit Network. “About 65% of America has been diagnosed with one chronic condition, and 40% has two or more chronic disease conditions. That’s who clubs’ clients and members are.”

Armed with this knowledge, several health clubs have already integrated medically-focused programs — rehabilitation, physical therapy and more — and pursued partnerships with medical institutions, in the hopes of gaining referrals for these medical fitness programs.

“We are seeing dramatic increases in physician referrals for facilities that have developed clinical pathways, complete with documented outcomes for referred patients in virtually every conceivable chronic disease condition, as well as other medical needs, such as prehabilitation for elective surgeries,” shared Bob Boone, the president of the Medical Fitness Association.

In fact, Boone believes the amount of, and need for, medical fitness programs in clubs will only increase. “The growth trend is picking up speed,” he said. “For clubs that want to help meet the growing demand, there is great potential for growth in this sector.”

The Medical Fitness Trend

As more clubs implement medically-focused programs and seek partnerships with medical institutions, it’s important to understand the shifting healthcare landscape itself.

Traditionally, healthcare entities are reimbursed by insurance agencies or the government based almost solely on the number of patients they service. However, there is a new movement in healthcare that focuses more on the quality of the services provided or procedures undergone.

“The trend in healthcare moving toward a population health-based model of care and a value-based model — as opposed to a fee-for-service reimbursement model — is moving along slowly,” said Boone.

In other words, don’t expect a major change in the system anytime soon. However, this might not be a bad thing for club operators. “Its full implementation is still a few years away, but this is actually good news for the fitness world,” explained Boone. “It gives a little more time to develop medically integrated programs capable of creating accountabilities and tracking outcomes to meet the needs of patients and providers.”

With the emphasis in healthcare slowly shifting toward quality over quantity, clubs have to be ready to answer the call. This means equipping trainers and instructors with the tools they need to serve individuals with chronic medical conditions — and the most important tool is education.

“If you’re really going to deliver the service and outcomes, you need trainers to have an education on how to work with these people,” said Dougherty. “To gain the respect of physicians, it’s going to come down to the education of your staff.”

This is a subject in which Dougherty is well-versed, as it’s a hot topic at her Medical Fitness Tour conferences. “I’ve heard fitness professionals say, ‘I want doctors to refer to me, and I know I could help their patients — why don’t doctors refer to me?’” she shared. “And one of my presenters said, ‘Doctors go to medical school for four years, do a residency for two years, and you just went through a 12-week online personal training certification. Why would they refer their patients to you?’”

A club armed with education, as well as the right equipment and programming to assist individuals with chronic medical conditions, is prepped to serve an entirely new demographic of members.

However, there’s a common question operators might be asking: “If we’re helping a patient through rehabilitation or physical therapy, will we get reimbursed the same way a medical institution would?”

At this point, the answer is likely no. However, in the coming years, that all might change.

Insurance Reimbursements

“Direct reimbursement for exercise interventions is possible, but I believe unlikely in the present environment,” said Boone. “However, in the future, I believe there will be reimbursement built into bundled pricing for procedures or conditions.”

Or in other words, reimbursement isn’t completely out of the question. “There are some possibilities for billing with today’s CPT codes for medical nutrition therapy through registered dietitians,” explained Boone. “A few innovative facilities are working directly with primary care offices to contract with them to provide chronic disease prevention and management for a cohort of patients, which the practice then bills to get reimbursed. This is a limited opportunity, however, as there are restrictions for which specialties can bill these codes.”

In fact, the value of exercise services provided at health clubs is trending upward in the medical community, according to Boone. “There are some efforts underway to get recognition of the value provided in exercise interventions, but the likelihood of implementation soon is low,” he said. “However, there is a move toward being able to have health coaches reimbursed under certain circumstances beginning next year.”

The key to a compelling argument for reimbursement is showing tangible outcomes. If physicians are referring patients to health clubs, the clubs have to be able to show results to insurance companies.

“It’s mostly related to the results clubs are able to help members achieve,” explained Dougherty. “And it can’t just be anecdotal. They need to be designing workout programs that are periodizations, keeping track of stats, going through an assessment with the client, and showing where they are after 12 weeks.”

According to Dougherty, a game-changer for clubs with medical fitness programs is integrating technology that allows for more advanced testing than would typically be found at a fitness center.

“There’s so much technology now where you can do lab work, and see cortisol levels, A1C or blood sugar levels are dropping, for example,” said Dougherty. “If clubs got into those types of diagnostics to show where members were and where they are now … that’s what the insurance companies will want to pay for.”

If you feel you don’t have the right partnerships in place yet to facilitate reimbursement — whether directly through an insurance company or in partnership with a medical institution — it’s important to remember the healthcare landscape is constantly changing. “The playing field is complex and only time will tell how everything shakes out from a reimbursement perspective,” said Boone.

As the medical and fitness industries continue toward closer collaboration, clubs need to understand their current resources and plan for how they can serve members with chronic conditions. If they’re able to deliver the outcomes physicians are looking for, clubs could be set up for consistent reimbursement and success in medical fitness in the future.