National Benchmark Survey Physician Referral Programs November 2011

~~ National Benchmark Survey ~~

How Fitness Facilities Engage Physicians November, 2011

This report is a result of an internet survey conducted in September 2011. The goal of the survey wasto determine national benchmarks relative to the growth and development of physician referral program(PRPs) within health and fitness facilities. The results and information are particularly timely due to the recentrelease of the American College of Sports Medicine (ACSM) Worldwide Survey of Fitness Trends for 2012 thatonce again identifies physician referrals on the Top 20 list.

We took a look at how facilities interact with physicians; the types of programs offered; the tracking ofoutcomes and return on investment (ROI); how national resource materials are used; and, the use of socialmedia marketing. Do fitness facilities offer specific PRPs? Are the number of referrals tracked each week/month? What is the ROI? Are outcomes measured? Do fitness facilities use available Exercise isMedicine® (EIM) tools and resources?

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Summary of Key Findings

~~ How Fitness Facilities Engage Physicians ~~

• Seventy-one percent (71%) of facilities offering PRPs provide specific programs such as weight management, diabetes education, and cardiac rehab.

• Over 73% offer general memberships to individuals with a written referral from a physician.

• Family Practice is the primary physician specialty referring to fitness facilities.

• A small percentage of facilities report a range of 400 to 730 physician referrals annually.

• Only 4% of facilities are connected to physicians through an Electronic Medical Record (EMR) system.

• The majority of respondents, 80%, track outcomes. Weight, blood pressure, and Body Mass Index are the most common measurements.

• Facilities generally do not monitor any financial data relating to PRPs.

• National resources and tools are underutilized.

• A majority of facilities would like to have their PRP included in a local, regional, and national registry.

• Facebook is the predominant social media marketing tool.

Respondent Overview

One might assume that due to the EIM initiative and the prevalence of physician-related programs through organizations such as the Institute of Lifestyle Medicine (ILM) and the American College of Lifestyle Medicine (ACLM) that all fitness facilities would realize the potential of PRPs. However, of the 191 survey respondents, only 24% reported having a PRP.

Types of Fitness Facilities Reporting Physician Referral Programs (45 Reporting)

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Types of Physician Referral Programs in Fitness Facilities

The following are the responses of those facilities reporting an active physician referral program. Multiple responses were allowed.

1) Program SpecificOf those facilities offering physician referral programs, 71% provide specific programs such as diabetes, weight management, and arthritis. The most common offerings are shown in the table below. Weight management, diabetes and cardiac rehab are the most frequent programs reported.

Specific Programs

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Types of Physician Referral Programs in Fitness Facilities

A number of other types of programs were

mentioned by respondents indicating the

scope of potential offerings when developing

a physician referral program.

Program

Childhood / Youth Obesity

Fibromyalgia

Joint Replacement

Parkinson’s Disease

Physical Therapy

Healthy Sleep

Pulmonary Rehab

Hyperlipidemia

Stress Management

Celiac Support Group

Types of Physician Referral Programs in Fitness Facilities

2) Time SpecificForty-nine percent (49%) of reporting facilities offer time-specific programs such as 30, 60, or 90 days. An example of this type of program is the ACAC Fitness and Wellness Centers, P.R.E.P / Physician Referred Exercise Program® (p.r.e.p). Since its inception in 2007, more than 1,200 people have enrolled in the program, and 67% of participants continue to exercise at ACAC, on their own, or at another facility. The program includes a 60-day membership for $60.

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Types of Physician Referral Programs in Fitness Facilities

3) General Referral Program “Just to Exercise” The majority of reporting facilities, 73%, offer facility memberships to “just exercise” when an individual provides a written referral from a physician. These referrals generally indicate a specific risk factor or chronic disease that needs to be addressed by the patient through physical activity and other lifestyle changes. Physicians generally require progress reports from the facility.

Overview of Physician Involvement

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Number of Physicians Sending Referrals

Respondents indicate a wide range of the number of individual physicians in the community

referring to the program. The range was one (1) physician to 125 physicians with many

facilities not tracking this data.

02468

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Less than 5 6 – 10 10 – 15 Greater than 15

Number of Physicians Sending Referrals

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Respondent Comments

Don't know - too many facilities andnot a way to track

Lots

Don't have a record of the specific numbers

Not sure

Few referrals anymore. Need more marketing push

We are just getting started

Physician Specialties

Family Practice is the primary physician specialty referring to fitness facilities. Of note, however, is that a wide range of physician specialties find power in the prescription pad. Fitness facilities should consider seeking a physician champion within every specialty in the community.

Multiple responses were allowed.

Physician Specialities

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Physician Specialties: Other

Respondents listed a variety of other healthcare specialties referring patients to the fitnessfacility.

• Orthopedist (11 Reporting)

• Primary care

• Physiatrist

• Physical Therapy professionals

• Cardiac Rehab programs

• Neurology

• Gerontology

• Pulmonary

• Endocrinology

• Bariatrician

• Infection specialist

• Obstetrics

Average Number of ReferralsPer Week, Per Physician

Facilities were asked to provide the average number of referrals received per week, per physician, and to comment if needed.

Respondent Comments• Do not track (Note: 4 reported specifically that this metric is not tracked)• There is no regular pattern• Varies per physician• It varies - some weeks we get 4 or 5, then we will go for weeks with none at all• We have a pretty young population at our facility so we typically don't have a lot of people needing referrals. I would estimate 1-2 every two weeks.• 1-2/month from 1-2 physicians. Again, need more marketing push.• We require MD release for folks over 50 but do not currently have a program that receives a designated number of physicians who send patients.• 2 per month

Average Number of Referrals Per Week Per Physician

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45 Facilities Reporting

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Number of Referrals Per Year 2010

The majority of facilities that track data had less than 50 total referrals from all participating physicians for the year 2010. However, five (5) facilities show the potential of a physician referral program reporting a range of 400 to 730 referrals annually.

• 45 Reporting• The range for “Greater than 301” is 400 to 730• Several programs began start-up in 2010 and do not have complete data.

Total Referrals 2010

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Number of Referrals Per Year 2011

Total Referrals 2011 as of Sept.1st

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• 45 Reporting• The range for “Greater than 301” was 301 to 580

The use of Electronic Medical Records (EMRs) is gaining acceptance within the healthcare community. However, connecting electronically to providers in a patient’s support system is not widely used by fitness centers due to limited knowledge of the technology; lack of staff time to launch a system; privacy concerns; and, perceived costs. The chart below shows that a very small percentage of facilities are tied into physicians through an EMR system.

To address this need Interactive Health Group of PCE Fitness, and Exercise is Medicine® are collaborating to develop an online system that will link healthcare providers, patients, and exercise professionals and make physical activity a standard part of disease prevention and treatment.

Electronic Medical Records (EMRs)

4%

96%

Yes

No

Does a facility know the impact its programs and services have on clients, patients, and members? Measuring and tracking outcomes has been a challenge for the fitness industry. However, the majority of respondents, 80%, indicate that they do track program outcomes.

The most common outcome measurements tracked are shown in the table below.

Multiple responses were allowed.

Measuring Outcomes

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Other measurements were identified by respondents. The goal in all cases is to measure those items that are directly related to program results; can be consistently and accurately obtained over time; and utilize user-friendly tools.

• Range of Motion • A1C• Circumference• Community education classes• Participation...effort numbers• Body measurements• Grip strength and height• Body fat to lean ratio, VO2, strength, flexibility• Heart rate before, during and after exercise• Piper Fatigue Scale • Total Visits and Average Number of Visits per Month• Flexibility, cardiovascular fitness, strength• Body Fat Percentage

Other Outcomes Identified

Facilities generally engage personal trainers and exercise physiologists more than otherprofessionals as leaders and facilitators of physician referral programs.

Staff Involvement with Physician Referral Programs

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• Lay staff trained specifically for these programs

• Cardiac Rehab Nurses

• Registered Nurses

• Diabetes Educators

• In-house contract therapists

• Physical Education Teachers and Special Needs Teachers

• Respiratory Therapist & Nurse

• Athletic Trainers, Exercise Specialist PhD

• Rehab & RN, CNAs, LPNs, Medical Director

• Lifestyle Coach

• Wellness Coach

Other Staff Involved with Physician Referral Programs

FITNESS IS A BUSINESS. Determining revenue and expenses for all facility programs is important in order to be financially successful for the short- and long-term. However, only a small number of respondents track return on investment at any level for physician referral programs.

Twenty-three (23) respondents indicated that they were “Unsure / Don’t Know” how many physician referrals converted to a full facility membership once the program had been completed.

Financial Overview

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Track Conversion Rate

Unsure/Don't Know

Other

The table below shows the number of conversions to facility memberships reported by those who do track the information (15 reporting). Responses were reported as a number in some cases and as a percentage of total referrals in other cases.

Financial Overview

2010 2011 (as of September 1st)20 No response150 10025 Unsure56 3825 5528 2013 No response3 36+ 30632 468XXX 1057% 15%20% 20%42% 40%All All

Respondents were asked what was the return on Investment (ROI) for the physician referral program. In other words, were revenues and expenses calculated? Of the 37 reporting, 32 responded “Unsure/Don’t Know” on ROI.

Return on Investment

Respondent Comments

100%

Assessing as the program develops

Not measured beyond participation and cost per participant

Total for one year $35,000

Depends

Exercise is Medicine® (191 Reporting)

The Exercise is Medicine (EIM) initiative launched in 2007 by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) calls on healthcare providers to assess and review every patient’s physical activity program at every visit. The majority of facilities, 91%, do not use the complimentary toolkits and resources provided by EIM that will assist them in connecting to physicians in their community.

Resources

Institute of Lifestyle Medicine (191 Reporting)

The Institute of Lifestyle Medicine (ILM) was founded in 2007 by Spaulding Rehabilitation Hospital and Harvard Medical School to reduce lifestyle-related death and disease in society through clinician-directed interventions with patients. The ILM is a non-profit professional education, research, and advocacy organization. The majority of facilities, 97%, do not use the ILM resources.

Resources

If developed, 60% of respondents (191 reporting) would like to have their facility included in a local, regional and national registry so that physicians and the community can connect to the facility’s physician referral program.

Community Outreach

60%

40%Yes

No

Respondents were asked if they used social media to market programs. Fitness facilities use a variety of social platforms with Facebook the predominant marketing tool.

Multiple responses were allowed.

Marketing

50%

18%

8%

7%2%

15% Facebook

Twitter

Blogs

Mobile Site

Foursquare

Other

A number of other marketing mechanisms were mentioned by respondents. As indicated by the predominant use of Facebook, fitness facilities are rethinking traditional advertising methods in an effort to reach more people at a reduced cost. However, many facilities still impact their operating budgets with paid advertising without tracking the return on investment. The following includes both traditional and untraditional marketing currently used by facilities as reported in the survey.

• Use of facility website (20 Reporting)• Personal physician contact• Grassroots / flyers / marquee• Text and email blasts, Newsletters• Branded Rx script pads• eNewsletter• Newspaper, brochures, flyers• Program Guides• Mass mail, Cable TV ads, TV, Radio• Hospital marketing resources such as brochures• Yelp, Gowalla, Groupon • LinkedIn, YouTube• Flyers, banners, web blasts• Direct mail, billboards, Rack cards• Health Fairs, business fairs, business invite• Word of mouth

Marketing

Facility Certification

Since 2008 there has been a mechanism in place for fitness facilities to benchmark programs and services against standards and guidelines developed specifically for medically integrated facilities. The Medical Fitness Association’s (MFA) Medical Fitness Facility Certification defines standards of quality and safety. One of the primary goals of the certification is to elicit trust and confidence within the healthcare system, and the community, for the fitness industry.

In addition to the MFA Medical Fitness Facility Certification, a nationally represented group consisting of various segments of the fitness industry has been hard at work to develop a broad set of voluntary standards for all health and fitness centers. NSF International, an independent, nonprofit organization, oversees the NSF Joint Committee on Health Fitness Facilities Standards. The committee, that includes organizations such as the American College of Sports Medicine (ACSM), the American Council on Exercise (ACE), IHRSA, the Y, and MFA, is assisting with the development of standards that will lead to a national certification if approved.

The majority of facilities, 90%, reporting in this survey are not certified as a medical fitness facility by MFA (191 reporting).

Conclusions

The results of this survey indicate that health and fitness centers do not fully realize the

potential of PRPs and do not track the data associated with a program. Program effectiveness

will improve if data is collected, analyzed, and acted upon. The positive news is that those

centers that are tracking Key Performance Indicators (KPIs) and Return on Investment (ROI)

show an increase in memberships and a connection to physicians in their communities. “This

is a trend toward an emergent emphasis being placed on partnerships with the medical

community, resulting in seamless referrals to a health and fitness facility and health fitness

professionals,” according to the article on the American College of Sports Medicine (ACSM)

Worldwide Survey of Fitness Trends for 2012.

Conclusions

However, fitness facilities in this survey point out their frustration in connecting with

physicians and are challenged by the lack of response from physicians when a request is made

to meet and discuss the program. This is in contrast to the results of the ILM Global Survey of

Sports Medicine Doctors' Attitudes and Practices in Recommending Physical Activity and

Exercise to Patients conducted this past winter through support from the International Health,

Racquet & Sportsclub Association (IHRSA). The survey's primary objective "was assessing

physician attitudes and referral patterns for exercise and physical activity in their patients."

Forty-one percent (41%) of physicians in the ILM survey say they recommend health clubs to

patients.

ILM Survey Results

Key findings of the ILM survey include:

• Seventy-four percent (74%) of doctors indicate that they recommend exercise while 66% talk to their patients about exercise, yet only 25% actually provide a written prescription.

• Doctors who provide a written exercise prescription rather than a verbal recommendation report seeing more improvement in their patients' physical activity levels.

• Of factors purported to impact a physician's likelihood of counseling patients about exercise, lack of time is the strongest inhibitor, followed by lack of incentives and patient compliance. Personal liability is not cited as a factor.

• Exercise is Medicine resources are the most commonly used educational tools.

• However, respondents noted that the expense of health clubs is among the biggest obstacle to recommending their use.

• When referring to health clubs, physicians are strongly supportive of strength training, aerobic activity and group exercise in that environment.

• In summary, the report concludes that physicians in the sample generally recognize the importance of recommending exercise to their patients.

The entire survey is available on the ILM website: http://www.instituteoflifestylemedicine.org/index.php

Summary

The results of this survey and the ILM survey can provide a platform and system for the successful development of PRPs.

Physician referrals can connect patients—potential members—with facilities and fitness professionals in the community. Physicians want to refer their de-conditioned or at-risk patients to local facilities as a pathway for the patient to implement an exercise prescription. Physicians will write referrals once they have first-hand knowledge of the standard of care and support a patient receives. Facilities can fill this need through proper design, development and marketing of a physician referral program. A facility should see significant growth in both membership and revenue after implementation of a physician referral program.

There are over 8,000 studies that show physical activity and exercise play a vital role in the Control and prevention of chronic disease. Exercise is medicine. Physicians will prescribe exercise. Your facility just needs to provide the pathway and the appropriate tools to do so.

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Responding Facilities By Center Size

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References and Resources

• ACAC http://www.acac.com/

• American College of Sports Medicine (ACSM) Trends Survey 2012 www.acsm.org

• American College of Lifestyle Medicine http://lifestylemedicine.org/

• American Council on Exercise http://www.acefitness.org/

• Exercise is Medicine http://exerciseismedicine.org/

• IHRSA http://www.ihrsa.org/

• Interactive Health Partner (IHP) https://www.interactivehealthpartner.com/

• Institute of Lifestyle Medicine http://www.instituteoflifestylemedicine.org/index.php

• Medical Fitness Association www.medicalfitness.org

• Medical Fitness Circle of Health Physician Referral White Paper http://www.box.com/shared/xk14mxjgupgcyrjihb5a

• Piper Fatigue Scale http://www.fatiguerelief.com/measureyourfatigue.htm

~~ National Benchmark Survey ~~

How Fitness Facilities Engage Physicians

November, 2011

For more information contact:

Cary Wing, EdD

Director of Business Development for Medical Fitness for Fitmarc

[email protected]

804-921-8237

www.carywing.com

Twitter: @caryhwing

www.fitmarc.com 

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