~~ National Benchmark Survey ~~ How Fitness Facilities Engage Physicians
This report is a result of an internet survey conducted in September 2011. The goal of the survey was
to 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 recent
release of the American College of Sports Medicine (ACSM) Worldwide Survey of Fitness Trends for 2012 that
once 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 of
outcomes and return on investment (ROI); how national resource materials are used; and, the use of social
media 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 is
Medicine® (EIM) tools and resources?
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)
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 Specific Of 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.
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.
Celiac Support Group Stress Management Hyperlipidemia Pulmonary Rehab Healthy Sleep Physical Therapy Parkinson’s Disease Joint Replacement Fibromyalgia Childhood / Youth Obesity Program
Types of Physician Referral Programs in Fitness Facilities 2) Time Specific Forty-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. www.fitmarc.com [email_address]
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 www.fitmarc.com [email_address]
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.
We are just getting started Few referrals anymore. Need more marketing push Not sure Don't have a record of the specific numbers Lots Don't know - too many facilities and not a way to track Respondent Comments
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.
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.
The range for “Greater than 301” is 400 to 730
Several programs began start-up in 2010 and do not have complete data.
Electronic Medical Records (EMRs) 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.
Measuring Outcomes 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.
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
Community education classes
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
Staff Involvement with Physician Referral Programs Facilities generally engage personal trainers and exercise physiologists more than other professionals as leaders and facilitators of physician referral programs.
Other Staff Involved with Physician Referral Programs
Lay staff trained specifically for these programs
Cardiac Rehab Nurses
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
Financial Overview 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 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. 2010 2011 (as of September 1st) 20 No response 150 100 25 Unsure 56 38 25 55 28 20 13 No response 3 3 6+ 30 632 468 XXX 105 7% 15% 20% 20% 42% 40% All All
Return on Investment 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. Depends Total for one year $35,000 Not measured beyond participation and cost per participant Assessing as the program develops 100% Respondent Comments
Resources 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.
Community Outreach 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.
Marketing 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.
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
Newspaper, brochures, flyers
Mass mail, Cable TV ads, TV, Radio
Hospital marketing resources such as brochures
Yelp, Gowalla, Groupon
Flyers, banners, web blasts
Direct mail, billboards, Rack cards
Health Fairs, business fairs, business invite
Word of mouth
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).
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