Bringing exercise programs to patients

Bringing exercise programs to patients

September 2016
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Published in the September 2016 issue of Today’s Hospitalist

EVERYONE KNOWS that exercise can help patients prevent and manage chronic illness and, often, recover from acute disease. But getting patients on board can be tough. They complain that they can’t afford it, they can’t find the time or motivation, or they feel uncomfortable at the gym.

To address such concerns, Mercy Medical Center in Des Moines, Iowa, has moved beyond lecturing patients to partner with its local YMCA. Located at the Mercy Wellness Campus, the resulting collaborative program offers services and facilities through a medically integrated fitness model.

According to Richard L. Deming, MD, a radiation oncologist and medical director of the Mercy Cancer Center, the idea first came up while plans were being made to expand the medical center.

“I exercise alongside my patients.” 

what-works-hernandez~Maria Guevara Hernandez, MD, Mercy Medical Center

“We wanted a campus that went beyond medical buildings and could include an affordable, medically-directed fitness facility,” says Dr. Deming. Having the medical and fitness buildings close by would make it easier for patients to integrate wellness activities into their medical appointments, creating a seamless treatment and prevention model.

At the same time, the Wellness Center welcomes not only patients, but members of the broader community. “We wanted to make it possible for people in the community to joining a world-class athletic health club with an overall wellness and prevention focus,” he notes.

Because the vision was to link the hospital with a community-based fitness facility, Mercy drew upon the expertise and experience of the YMCA in offering fitness programs.

“That’s how the relationship was born,” Dr. Deming says, adding that the partnership makes a lot of sense. “The YMCA and Mercy have a common mission of mind-body-spirit.”

Who attends?
The YMCA’s Wellness Center is utilized by patients, hospital employees, community members and star athletes—an unusual combination, Dr. Deming points out. Beyond its medical focus, the facility is also a USA Triathlon-Certified Training and Performance Center.

“Top-end athletes work out next to patients with serious illnesses, such as cancer or COPD,” he says. “An 85-year-old cancer survivor slowly walking around the track is inspired by an athlete training hard for Ironman, while the athlete is inspired by the cancer survivor’s hard work and determination.”

That unique member mix and the center’s medical focus help mitigate the shame that some patients with conditions such as obesity or COPD say they may experience in ordinary fitness facilities. That’s according to Maria Guevara Hernandez, MD, chair of hospital medicine and associate program director for quality and patient safety.

“Working with specially trained staff and alongside other patients with disabilities creates additional motivation,” Dr. Guevara Hernandez says. She adds that YMCA personnel teach most of the classes and activities, and offer “gentle” versions of yoga, tai-chi and Pilates for seniors or members with disabilities.

More than just exercise
When patients enter the program, their initial evaluation includes quality of life as well as physical parameters. Patients are assigned a coach who helps them work on personal goals, Dr. Deming explains. Patients may continue on an individual basis, or they can participate in group classes and activities specific to their needs.

Dr. Deming, for instance, leads a weekly class for cancer survivors. Topics vary and focus on “optimum living, not just survivorship,” he says. He also teaches a weekly spin class for cancer survivors. Afterwards, “we get together for fellowship and fruit smoothies in a demonstration kitchen. Patients become part of a community that involves education, physical activity, healthy food and emotional support.”

The center offers similar programs for patients with COPD, diabetes, stroke, arthritis, Parkinson’s disease and other chronic conditions, says Dr. Guevara Hernandez, who oversees those programs.

Physicians as participants
Most physicians are taught to keep their professional and out-of-hospital lives separate. But that isn’t the case at the Wellness Center.

Both Drs. Deming and Guevara Hernandez regularly use the facility. “I make time to go because I recognize that it is important,” Dr. Guevara Hernandez reports. “I exercise alongside my patients, who are more motivated and inspired because they see their doctor living what she is advising.”

Information about the program is included in all patients’ discharge instructions, she adds. Before discharge, “we contact the patient’s PCP via a secure text message and ask him or her to follow up with the patient and reinforce the program approximately a week later,” linking that conversation with the discharge instructions.

She admits that getting hospitalists to make the referrals is a work in progress because of doctors’ time constraints. “We are continually raising the awareness of our physicians about this program,” she notes.

To make sure patients receive the information, she personally meets with them prior to discharge. Dr. Guevara Hernandez also guess-timates that about one-third of the patients referred to the program follow through.

Making exercise affordable
As Dr. Deming points out, the cost of joining an athletic facility is a big hurdle for many patients. As a result, “we make the program affordable by offering free membership for the first 12 weeks,” he says. After that, patients are encouraged to become dues-paying members.

Third-party insurance covers some program components. For example, the Wellness Center participates with SilverSneakers, a fitness program designed for seniors, which is included in many Medicare plans. But most activities are not.

Still, rates are discounted with a physician referral, and the YMCA offers reduced rates for lower-income patients. Mercy employees also receive significantly discounted rates.

Beyond membership dues, the program receives funding from not-for-profit organizations, such as the Livestrong Foundation, which supports the cancer education series, spin classes and Recovery Smoothie Time.

“What we need,” says Dr. Deming, “is a business model that includes more reimbursement for a program that can demonstrate medical necessity and be linked to a code.”

Batya Swift Yasgur, MA, LMSW, is a freelance health care writer based in Teaneck, N.J.

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