one of the major hospitals in my area already runs a program similar to this:
"Also available on a fee for service basis (no physician referral needed) are personalized programs in multiple areas. As a part of this service, a physical or occupational therapist will help to develop a fitness plan that is personally tailored to fit your individualized needs. This includes personal training, developing an aerobic program to maintain or enhance cardiovascular fitness, aerobic programs for weight loss, individualized aquatic exercise programs, specific strategies to enhance personal sport performance in the sport of your choice, and/or developing a walking program.
Our department also recommends well visits where you can see a physical or occupational therapist for an hour or more as determined necessary to check-in and discuss any issues you may be having or make a personalized program in any of the above areas"
They also educate other hospital employees. Source:
http://my.clevelandclinic.org/rehab/services/fitness_and_wellness.aspx
I think it is a great area for therapists to promote ourselves....i hope that it becomes more prevalent and that some real research is done to investigate its effectiveness
That's great! I wonder how much it costs the patient out of pocket. Or is it covered by insurance?
I actually wonder if there isn't a huge opportunity for PTs and other health professionals such as Dietitians to make some real progress here utilizing a P4P arrangement with private insurers.
There is overwhelming evidence that weight loss and sustaining a "normal" BMI can have a profound impact on a number of chronic conditions which can result in costly medical treatment down the road. So why doesn't insurance pay for a P4P setup that demonstrate objective weight loss results? Is it due to not being able to make a profit? Could they end up making more profit?
It is highly regarded that the BMI measurement, above all else, is the best gross measurement of healthy weight status. There are also a number of other measurements including weight, waist circumference, free-fat mass, skin fold which indicate lower incidence of chronic disease. If you want to get precise( and expensive) you could do electrochemical impedance or the bod pod which have the highest accuracy of specifically body fat percentage. So there are plenty ways of measuring objective data. There's also plenty of evidence suggesting a normal BMI/body fat percentage is ideal to minimize the incidence of the many comorbidities associated with the condition such as diabetes, heart disease, stroke, hypertension, cancer, arthritis, etc. So why isn't diet and exercise for weight loss a prescribed treatment? What we have available now with pharmaceutical and surgical treatment has largely been costly, dangerous, and ineffective. I wonder though if there's not a much easier, inexpensive, safer, and effective way of doing it.
First off pharmacy for weight loss isn't working- despite the efforts to create a pill that decreases appetite, decreases nutrient absorption, increase metabolism. The FDA has approved some foods such as artificial sweeteners and fat malabsorption products (which has their side effects), but that's about as good as it has gotten. Pertaining to surgery, there is gastric bypass, which costs around 36 thousand dollars from the procedure. It also has a relatively high rate of complications and death rate. Many patients also result in stretching the stomach back out over time anyways, making it ineffective. Also consider this surgery is only available to a small sector of the population. So maybe something like this would work.
A gym membership is generally $50 per month for basic benefits. For simplicity sake, why not set up a flat monthly fee from a private insurance payer and utilize this idea of pay-for-performance. Instead of payments of $50/month say it's $500/month. Contract for a three-month weight loss program ($1500 cost to insurer). At the general recommendation of 1-2 lbs per week weight loss, the provider would demonstrate 12-24 lbs weight lost. The program could be continued in three month increments if progressive, sustained weight loss occurred.
It doesn't seem like it'd be that difficult to initiate such a program. It could include an initial diet consultation from a RD and Exercise prescription from a PT with biweekly follow ups. A gym could be provided with staff on provide supervised training if needed. Tools for home exercise programs such as wii fitness/P90X could be lent out. Home care visits could be utilized to increase compliance.
As for patient compliance, I if insurance companies increased co-pays for other invasive surgeries and offered this type of program as a low cost alternative it could work. They could also add incentives such as lowered premiums. From the provider's point of view, they could provide incentives including savings or even a cash rebate for being successful. The same incentives could be rewarded to the employees by way of bonuses.
Looking at it from the third-party payers business perspective, one gastric bypass surgery would pay for over five years ($35K) of a patient demonstrating measurable, sustainable weight loss (278-556lbs). That's the immediate benefit, but what about the cost-reduction over time. It could also be used with a large portion of the population.
From a providers perspective, due to biweekly evaluations and adjustments to the plan of care, most of the work is done by the patient. If something were to happen, a health professional would be there to know what to do. Since it doesn't require a lot of one-on-one time throughout the program, a number of patients could be there at once - just like a gym with trained support personnel.
Maybe if something like this was initiated, the physicians would get on board and start prescribing diet and exercise as medical treatment for overweight/obese patients. Make it a requirement prior to any pharmaceutical or surgical intervention - and make those options much more costly to the patient. It'd be a great solution to the child obesity epidemic as well. Consultation for the child and parent in nutrition by an RD followed by some type exercise prescription such as after-school sports or activities such as wii fitness competition.
Anyways just an idea. Could this work?
