Ribley, Douglas A. M.S.
Douglas A. Ribley, M.S., is the director of Wellness and Administrative Services at Akron General Health and Wellness Center located in Akron, Ohio. He has more than 20 years of experience in the management and administration of commercial, corporate, and hospital-based health, fitness, and wellness centers. In addition, he is the past chair of the Medical Fitness Association and is an appointed member of the Ohio State Governor's Advisory Council on Physical Fitness, Wellness, and Sports.
To understand the definition of clinical integration along with the benefits and challenges of implementing and operating a clinically integrated medical fitness center.
The health/fitness industry has experienced significant change during the past 30 years, but none more profound than the well-publicized resurgence of hospital-based health and fitness. We have witnessed a health care system that has traditionally focused on disease, illness, and injury transition into a profession that now emphasizes prevention, early detection, and outpatient treatment. By integrating a membership-based medical fitness component with clinical rehabilitative services such as cardiac rehabilitation and/or sports medicine/orthopedic physical therapy, there exists a unique opportunity to enhance program quality and credibility, improve member service and retention, and positively impact the bottom line.
True integration used in the context of this article refers to the complete blending of preventive (membership) and clinical rehabilitation services to the extent that there exists little or no duplication of equipment, occupied space, and human resources. Integrated programs and services coexist in a shared environment and participate in a proportional sharing of building expenses, operational expenses, capital equipment costs, and staff. A truly integrated center could potentially have an exercise physiologist working with a fitness center member on one treadmill, a physical therapist rehabilitating a patient on the next treadmill, and a cardiopulmonary rehabilitation nurse working with their patient on the next treadmill. This approach facilitates maximum facility utilization, optimizes member/patient service through the unique continuum of care that is created, and significantly contributes to the financial success of the participating departments and host organization.
Impact on Membership/Patient Service
Impact on costs
When analyzing the expenses associated with the operation of a medical fitness center, it becomes evident that in addition to payroll, the most significant expenses are derived from the securing and occupying of space or building expenses. This includes, but is not limited to, depreciation of construction costs, mortgage or lease, electricity, gas, water, and so forth. In an integrated medical fitness center, these expenses are appropriately allocated among the business units who are sharing the space. The proportional distribution of these expenses allows a medical fitness center to expand and improve the quality of its programs and services while keeping membership fees and dues at a level that makes membership accessible. An integrated medical fitness center has the ability to offer affordable, high quality, programs, and services.
Established continuum of care
The current challenge, as it relates to rehabilitation, shows a progressive decrease in patient reimbursement. Many orthopedic physical therapists have become concerned because in some cases the number of reimbursable therapy visits does not allow for complete recovery of their patients. In addition, many therapy patients who successfully complete rehabilitation are released from treatment with no option to maintain or continue to improve. These patients have experienced success and are feeling good about their achievements; however, once insurance reimbursement ends, they are left to identify preventive membership options on their own. In an integrated facility, the patient is encouraged to transition to medical fitness center membership. This lets the patient continue to work out on the equipment they were trained to use during rehabilitation while having direct access to both the fitness staff and their physical therapist who continues to be visible and active in the patient's transition to membership.
Referrals to rehabilitation
It is common for health/fitness professionals to be asked to provide direction and information on topics for which they are not qualified. Center members will ask fitness professionals how to treat various musculoskeletal injuries. In the traditional health club setting, injury information, advice, and direction are often provided regardless of the staff member's qualifications. In an integrated medical fitness center, each staff member has a clear understanding of the credentials and expertise present on the exercise floor and will immediately direct a member to the appropriate professional. An orthopedic injury question or concern goes directly to a physical therapist, whereas a question regarding the reduction of lifestyle-related risk factors is directed to an exercise physiologist. In all cases, the member is advised to communicate with their physician, and the staff member is prepared to assist the member in finding a physician if it is determined that they do not have one.
Because of the medical presence that exists within an integrated medical fitness facility, it is not unusual to attract an older and higher risk population. It is not uncommon for a medical fitness center to have an average membership age of 40 to 50 years old. It also is not uncommon to find that the majority of members may have never been a member of any type of health and fitness center previously. This is typical of integrated centers and is extremely encouraging because this is a population that the industry at large has struggled to attract. This population will continue to grow, and industry success will directly correlate to the ability of medical fitness centers to attract and serve this mature market segment.
Challenges of Integration
Integration is a concept that has been discussed in theory among health care professionals for many years; however, hospitals have traditionally been so departmentalized and territorial that it has been extremely difficult to take this strategy from theory to practical application. The key to offering rehabilitative services in a medical fitness center setting is to develop a keen understanding and respect between those staff members who will be sharing space and exhibit wide ranging degrees, credentials, licenses, and expertise. Each member of the team must understand that if integration is determined to be important to organizational (member, patient) success, each staff member must acknowledge their own strengths and weaknesses along with those of the rest of the staff, capitalize on the strengths of each staff member, and support an organizational culture that encourages mutual respect.
The medical fitness profession is entering an era in which the integration of clinically based rehabilitative services can have a profound impact on (1) the quality and cost of the services offered, (2) expanded market penetration, and (3) long-term financial success. There are a variety of options that exist in attempting to integrate services and blend diverse and talented groups of center professionals. Through a successful integration initiative, the patient/member experience will exceed expectations and contribute to outcomes that will overwhelmingly support the integration of clinical rehabilitation and medical fitness programs and services.
Condensed Version and Bottom Line
Clinical integration in the context of this article refers to the complete blending of prevention (membership) and clinical rehabilitation services to the extent that there exists little of no duplication of equipment, occupied space, and human resources. Programs and services coexist in a shared environment and participate in a proportional sharing of building expenses, operational expenses, capital equipment costs, and staff. By integrating a membership-based medical fitness component with clinical rehabilitative services such as cardiac rehabilitation and physical therapy, there exists a unique opportunity to enhance program quality and credibility, improve member service and retention, and positively impact the bottom line.
1. Medical Fitness Association. Industry Guide. 5th ed. Richmond, 2004.
2. Medical Fitness Clinical Integration. Medical Fitness Center Resource and Planning Guide. 2nd ed. 2006.
3. Medical Fitness Association. Position Stand: The Medical Fitness Difference.
Available at www.medicalfitness.org