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2014 ACSM: Exercise is Medicine - Implementation & Outcomes in a Medical Fitness Center

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David Flench

on 21 October 2014

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Transcript of 2014 ACSM: Exercise is Medicine - Implementation & Outcomes in a Medical Fitness Center

Laying the Foundation
1. Qualified Staff
2. Clinical Integration
3. Medical Oversight
Exercise is Medicine
Physician Referral Program
Transformational change to operations

Positive business (financial) impact from implementation through first 3 years of operation
Medical Oversight
A process designed to help ensure that the
programs and services
provided by the medical fitness center are both
safe and effective

The end result of medical oversight is that all programs and services offered effectively meet the needs of participants without exposing them to unnecessary risks.

Medical Director: Dr. Lori Hurst
Qualified Staff
Among our key differentiators, which is REQUIRED of our fitness staff members, is having a
and an


These staff members perform our comprehensive fitness assessments, run our clinically-integrated programs, and are equipped with the KSA's necessary to handle special populations.

Clinical Integration
Shared resources
: staff, equipment, space
Programs & services that
create a seamless continuum
in the overall care of patients/members with
chronic diseases
multiple risk factors
, and that
complement other clinical services
Integrated/shared approach
creates greater economies of scale
by spreading fixed costs of building space & equipment over multiple departments/areas
increased community awareness
from a “hub” atmosphere where a variety of services are offered in an combined environment

Exercise is Medicine:
Implementation & Outcomes in a
Medical Fitness Center

partner and integrate
with the local medical community in the
management of chronic disease
safe and effective exercise/wellness services
Provide a
no/low cost, no obligation
service to patients
Provide a
more structured way
for the doctors who are already motivated to prescribe exercise
Encourage the doctors
who are not currently prescribing exercise to do so more regularly
1. Physician completes the Referral for Exercise form and sends to Hancock Wellness Center (HWC)
2. Patient receives a

fitness assessment and exercise prescription
, plus two weeks free at HWC and
weekly 30-minute reviews
with the Exercise Specialist
3. HWC staff sends the
summary report
back to doctor
4. HWC staff offers membership opportunities

Program Objectives
Referral Program Process
New member sales
increased 9%
Member retention
increased 25%
Total revenue
increased 22%
Net income
increased 194%

Financial Impact
Journey to become a Certified Medical Fitness Center

Successful transition to become an integrated component of the Hancock Regional Hospital system

Operational Impact
So you want
to buy a Fitness Center?

January 1997:
Purchased Local Fitness Center from Individual and Hired Manager
November 2000:
Built New Facility
May 2001:
Decided to hire a management company
December 2004:
First year to have a positive contribution margin

January 2011:
Consulting Engagement
February 2011:
Best Practices Site Visits
April 2011:
Recruited for New Director
June 2011:
Transitioned to an Owner-Management Model
July 2011:
Town Hall Meetings with Membership
August 2011:
Advisory Committee Planning Session
September 2011:
Executive Leadership Presentation of Recommendations
January 2012:
Wellness Center Becomes a Department of the Hospital and Staff Becomes Employees of the Hospital

Previous Focus at Wellness Center
Hospital had contracted with management company to operate it
Functioned more as a commercial gym
Membership strong: approx. 3,800 members

Short term focus / decreasing profitability
Disconnected from other hospital services, at times even adversarial
Not highly focused on integration, service, quality, clinical programs

Strategic Decision Considerations & the Reasons for the Transition

The Future of Healthcare
Keeping our Community Healthy prepares us for the reimbursement models of the future
Integration with Hospital activities
Asset to the community

CFO Perspectives
“I heard the Wellness Center will be mostly for people in wheelchairs and rehab now.”

“Are you getting rid of my Zumba classes?”

This model
upon the existing services


Diabetes Supervised Exercise

Cancer Exercise

Pre- & Post-natal (“mommy and me”)

Posture / Osteoporosis

Health Coaching

Potential Menu of Clinical Integration Programs
Physician Referral Exercise Program
Weight Management Program (Am I Hungry?)
Arthritis Foundation
Risk Reduction Program
Cardiac Rehab Phase 3
Diabetes Education & Supervised Exercise
Cancer exercise
Perinatal (“mommy and me”)
Health coaching
*Physical Therapy
*Cardiac Rehab Phase 2
*Physician clinic (Occupational Health)
Details on our
Changes & Improvements
First Year
Member retention
increased 41%
Total revenue
increased 13%
Net income
increased 59%
Non-dues revenue
increased 8%

Financial Impact
Second Year
Today we are
"…improving health & wellness
...one person at a time.”

New management team hired
Culture change: focus on staff development, two-way communication, feedback, continuous process improvement
Change in Business Model and Membership Structure (rates, discounts/incentives, commissions)
Medical Director hired
Hired degreed & certified Exercise Specialists
More comprehensive new member intake process

Healthy “U”: created Employee Wellness Program
Wellness Biometric Screenings: cholesterol panel, glucose, body composition, BMI, blood pressure, flexibility
Collaboration with other hospital departments: Community Education, Nutrition, Physical Therapy, Building Services, Human Resources, Marketing, Information Systems
Health Education Seminars for members
Details on our
Changes & Improvements
Details on our
Changes & Improvements
Health Assessment Functional Assessment Exercise Prescription Equipment Set Up Outcome Review
Technogym Equipment & Software
The Wellness System Provides a
for the Medical Fitness Model

outcome reporting
through recording of participation data and biometric data, both for the entire membership base and for specific clinically-integrated programs
enhanced interaction
between the member and Exercise Specialist, to provide a higher quality of service (positively impacts retention rates)
For implementing a more
comprehensive Fitness Assessment
, which is performed using the Wellness System and where data is collected and then is used to create a customized exercise prescription
immediate progress feedback
to member

1st Year at Hancock Wellness: programmed over
1,500 members
with a key on the Wellness System…Average use =
2.3 x/week
Facility updates: new equipment, locker rooms, showers, pool/spa, parking lot, group ex studio, education center

Building the Brand
Measuring Outcomes
Center wide
Telling Our Story
Hospital meetings
Executive Leadership
Medical Staff
Wellness Center all-staff

Local organizations (Rotary, etc)
Educating our own members…word of mouth promotion

Explain the MEDICAL FITNESS DIFFERENCE and how it makes an impact

Presenters have no financial interest
and/or arrangement that would be considered a conflict of interest.
Measuring Outcomes
Medical Oversight
Medical Director

Physician Advisory Committee

Physician Advisor

Medical Oversight
Aid in
development of clinical programs
Aid in the
development of a mission statement
Facilitate the
relationship with
the medical fitness center’s
community healthcare system
Ensure services provided are both
safe and effective
Ensure services are
medically and scientifically sound
Provide oversight for
emergency response

all clinical programming

review all emergency response incidents

Medical Oversight
Meet with the leadership team as needed as certification benchmarks are met

Provide documentation of the duties under “The job description”

Oversee documentation of compliance with national, regional, and local regulations (CMS, HRH)

Participate in site review day (optional, but highly recommended!)
Medical Oversight
Educational seminars
"Doctor is In" series

Walk With a Doc

Participation in
Diabetes Advisory Committee
Facilitating the “
Am I Hungry? Mindful Eating Workshops

Oversight of
Risk Reduction Program
Articles for
monthly newsletters
individualized weight management program
1. Physician completes the Referral for Exercise form and sends to Hancock Wellness Center (HWC)
Depending on what is desired/indicated, patient receives a

fitness assessment,
and/or referral to our
60-Day Supervised Exercise Program
3. HWC staff sends the
summary report
back to doctor
4. HWC staff offers membership opportunities toward the end of the 60 day program

Referral Program Process
Full transcript