The M.O.G. (Medically Oriented Gym):
Bridging the gap between Medicine and Fitness
Russell A. Certo PT OCS
In an article published two years ago in this publication, Vol. 16 No.18 August 2005 the Medically Oriented Gym (M.O.G.®) concept was presented. The M.O.G., (pronounced mawg), concept recognizes that there still exists a huge disconnect between the needs of the community and the ability of the medical and insurance groups to successfully deliver needed fitness services. Currently, the greatest detrimental public health trend in the United States is obesity and its related problems, and the fitness industry has failed their communities as a vehicle for addressing those problems.
The M.O.G. concept is based on the premise that the Physical Therapy profession is perfectly and uniquely positioned to bridge the gap between the medical communities, health insurance industry and the fitness industry. As Physical Therapists, we entered the profession because we wanted to serve our communities. As a profession we found a multitude of patients in need of rehabilitative services in multiple settings. As we grew, we gained the respect of the medical community and the insurance community. We are now recognized as an integral part of the overall health care system.
The M.O.G.
The vision of the M.O.G. was to deliver a fitness service that was a valuable and life altering experience. It had to appeal to the healthy motivated population and at the same time define a culture and an image that would attract and retain the unmotivated and unhealthy members of the community. We also needed to somehow capture the attention and confidence of the medical community so that they would faithfully refer the medically compromised patients who were in the greatest need of sophisticated exercise and fitness services. Finally, we needed to convince third party payers that our approach to exercise and fitness was worth reimbursement.
Two years later, we have succeeded on all counts. The M.O.G. has developed an image and culture that delivers a fitness experience that is qualitatively different and far exceeds our competitors. We have developed procedures that identify and address on an individualized basis the physical limitations of our health club members and the patients referred to us. Another hallmark of the M.O.G. has been its flexibility. The M.O.G has identified the need to continually amend programs and services to meet the substantive needs of our members and patients and to address the motivational element. As programs have evolved, we have likewise discovered that specific staff positions had to be designed, implemented, and re-crafted.
The result has been the development of a membership of both healthy and medically compromised members who utilize our services on a regular basis. Our referring physician list has increased as the need for our services became apparent, and we demonstrated our ability to effectively deliver those services. Finally, third party payers are utilizing the M.O.G. in ways they had not considered with the fitness industry.
The M.O.G. is a first class facility that appeals to the healthy motivated member of our community. Our members range from 8 year old students to octogenarians. A typical member at the M.O.G is 45 years old, equally split between male and female, has at least one health issue (i.e. elevated triglycerides), has a body fat and BMI value above the high end of normal, and has previously tried, on more than one occasion, to exercise and diet.
We made a deliberate decision to not offer short term, 3 month, memberships. We believe that exercise is an important part of a healthy lifestyle and want to convince our membership that short term memberships are a recipe for failure. We have one year memberships that are considered both peak and off peak. We offer a college student membership for those college students who otherwise have access to their University exercise facilities. While they are on summer, spring, and winter breaks, they can continue their exercise programs at the M.O.G. Because we are located in a northern climate, we also have an “anti-snowbird” membership that allows seniors who relocate back home from May through November an opportunity to continue their exercise. Although we do not offer the typical three month membership, we do offer a limited opportunity for prospective members to experience the M.O.G. without having to commit for one year.
A percentage of our membership have real medical complications and, until they came to the M.O.G., had no idea how to begin exercise. They became members either by referral from doctors to our Physical Therapists or have been referred through word of mouth in the community. For example, our members include the obese (some morbidly obese), members with diabetes and its related complications, and those with high blood pressure. Some of our members have had or currently have cancer of one form or another. The M.O.G. has members that have had a recent or old cardiac bypass. Most recently, we were referred a patient whose doctor felt he needed to improve his physical condition prior to undergoing a kidney transplant. This is not the typical membership of your local fitness club.
The common binding thread of all of our members is that they recognize that physical fitness, social interaction and a refreshed spirit are all required for a healthier lifestyle.
In order to fulfill our mission, we implemented policies and procedures that we had found successful in our physical therapy clinic. We discovered that the greatest frustration of fitness club members was the lack of supervision and attention paid to the member from the staff of the club. We knew that if we gave our membership the same attention to detail in the club as we do our patients in the clinic, we would be providing a level of service unheard of in the fitness club industry. Therefore, we designed a system of evaluations and program progression that keeps us in touch with every member. Additionally, we have a system that keeps us up to date with those members who for one reason or another have decreased or just stopped attending the M.O.G.
These systems are an outgrowth of our experience in the clinic. As Physical Therapists we evaluate a patient’s current status and, through treatment plans, progress patients to independence. If for one reason or another, patients fail to show up for an appointment, a classic “no-show” visit, we contact them and keep in touch with them. If Physical Therapists ran clinics like a typical fitness club, we would never have contact with the patient after the initial evaluation. Instead, we would assume that the patient can progress themselves. Unlike health care where we get paid only if we perform a service, in the fitness industry payment is made whether the member uses the club or not. So if we followed the fitness industry model, we would rejoice, from an economic perspective, when the patient did not show up at the clinic.
We have designed an exercise facility for people who typically would never set foot in a fitness club. Because we are caring for medically compromised members, we have had to make sure that part of their exercise programs include, but are not limited too, balance activities, mobility activities, assisting depression and tracking medication doses as a measure of success. The M.O.G. has monthly blood pressure screenings and a regular health lecture series. If we promote a healthy lifestyle as a quality of life issue, we need to deliver services beyond just a physical exercise program.
The M.O.G. tailors individual programs to the needs of the member. It requires constant attention and daily modifications. For example, in a survey of club members we found that cleanliness is the primary impression of a prospective member taking a club tour. Therefore, one of the many things that require daily attention is the cleanliness of the entire facility. Many of the members utilize our facility frequently enough that they have developed a feeling of ownership at the M.O.G. Therefore it is imperative that the staff keeps the facility spotless and comfortable. Our mission is to make their exercise experience better than what they expect so that they want to return.
Programming and Staffing
With a membership age range from 8 to 89 we have developed programming that addresses the needs of all our members. Of course, we offer the typical exercise design for new members, individual and group personal training, as well as sport specific training, pilates, yoga and aerobic classes. We partnered with the local School District, the Pediatricians in town, the local Supermarket and the Rotary Club to begin a community based kids program. “MOGKidz” has addressed the needs of childhood obesity by developing an activity program with a nutritional component included.
For the senior citizens of our community, we offer a series of group exercise that not only address the physical aspect of our senior members, but also address the mental and social aspects. A good number of our senior members represented the M.O.G. by marching as a group in our local 4th of July Parade. Periodically, we have simple contests and awards all based on attendance and interaction. One-fourth of our membership is Medicare eligible and, therefore, we have designated a staff member to supervise the programming for the senior members.
The M.O.G holds diabetic training classes, blood drives and the dietician has a “supermarket savvy “class. We have hosted wine tasting events, BBQ luncheons and outside social events as part of our Member Appreciation week.
In order to serve the medically compromised member, we have designed a staff position that is the liaison between the physical therapy office and the fitness club. This Member Care Coordinator makes sure that the physical therapy patients who are transitioning into club members have a specific staff person who is overseeing their care. This patient/member has become independent with a specific individualized exercise program and the Member Care Coordinator makes sure that the exercise is progressed at appropriate times and that any questions or issues the patient/member has are answered by the appropriate personnel.
Referral Sources
One of the easiest things we had to do when the M.O.G. was opened was to convince our referral sources that it was in everyone’s best interest to utilize the services of the M.O.G. Physicians have long been frustrated when their diabetic, hypertensive and overweight patients would ask them where they could exercise. For many of these patients, the traditional fitness club was a very scary and intimidating environment and did not present a viable option. When we began to market the M.O.G., it was easy to convince our referring physicians that we could serve that population. Suddenly, the physicians had a place that could not only make their patients comfortable, but get them to “buy in” to the idea of exercise. The physicians knew us and had confidence in our abilities as therapists. They did not have to be convinced that what we were “selling” was legitimate. The Physician/Therapist relationship that our profession worked for years to cultivate, and that we had developed locally, assisted us in obtaining referrals that we never received before.
Not only did our typical base of referrals send us new patients, we were also able to develop new relationships with other Family Physicians and Internists. Additionally, we began to receive referrals from Oncologists, Gastric Bypass Surgeons, Cardiologists and most recently Surgeons who perform transplants. We are sure there are a number of other specialty physicians who have patients that could benefit from the M.O.G services.
Third Party Payers
Many third party payers are now providing a health club benefit. As they do with prescription drugs, the actual benefit is determined by the specific insurance plan. In our area of the country, three major HMO’s provide the majority of the coverage. Each of these has a health club membership benefit. Unfortunately, the benefit is overseen by the marketing divisions of the insurance carrier and not the medical department. As medical providers, we must meet specific criteria and obtain objective outcomes in order to be reimbursed for Physical Therapy services. The health club membership benefit, however, has no such criteria and requires only that the member ask for the benefit to be paid.
When the M.O.G. began operations, we had meetings and presentations with all three HMO’s. Ultimately, we simply asked the insurance carrier about its rationale for paying for club membership benefits when no outcomes of any kind were required. We suggested in our presentation that the third party payer at least tie the benefit to attendance, since there can be no simpler or more objective criteria.
By telling our story of the M.O.G. and earning some level of credibility, we convinced the local HMO’s to reimburse physical therapy services for medically compromised patients who would be referred for exercise. We designed a behavior modification program that reimbursed the initial physical therapy service, and allowed the transitioning patients an opportunity to experience the M.O.G. The behavior modification program has a 30% retention rate which we believe is remarkable considering that we are dealing with a very unmotivated, inactive population.
Our final inroad with the insurance industry was a proposal we made to a local carrier that would demonstrate that the return on their investment in health club memberships to a facility like the M.O.G. would be a better insurance benefit. Beginning last January, a formal study was designed and applications for funding were made. The study will compare diabetic patients in a supervised exercise program at the M.O.G. against diabetics who chose a health club of their own. Patients involved in the study will begin their year long participation in early 2008 at the M.O.G.
The Future
We believe that there is a tremendous opportunity for the Physical Therapy profession in the fitness industry. We believe that a fitness club associated with a Physical Therapist has great potential in the workers compensation and auto accident arena as well as from other medical specialties We have developed a workable framework in the M.O.G. that has been successful in our community. We have also had the opportunity to consult with Physical Therapists from across the country that are ready to step into this arena. We have allowed them to gain from our experience and learn from our mistakes. We believe that we have barely scratched the surface, and that there are Physical Therapists who could enhance this aspect of Physical Therapy farther than we have alone.
The M.O.G. and Grand Island Physical Therapy PC have done all of this in a small town that has a population of less than 20,000 people. The town has 2 Family Practitioners and no specialists and is further hindered by being on an island with bridge traffic issues. It would be interesting to collaborate with providers who have multiple sites in heavily populated areas, as well as with clinics that are doing similar things. Two years ago when we first published the concept of fitness and physical therapy, we started with a dream. For us the dream has become a reality.