The reinvention of prevention: the role of the fitness provider in the changing health care system

Much of the medical model used today is based on treatment, not disease prevention. Despite efforts to educate the population in need of routine medical screening and care, most individuals do not seek the care of a physician until they perceive a medical problem. By this time, disease processes have often advanced. What's needed is a new medical model with a proactive rather than reactive focus.

Cutting Costs

Historically, health care providers have charged for their services, and the client or insurance company pays the bill. In the early 1980s, it was decided this system allowed hospitals and health care practitioners to raise prices beyond what was reasonable for insurance agencies and individuals. In response, the government designed the Diagnostic Related Groups (DRG) system for use with Medicare and Medicaid.

Research was conducted to establish average practice and cost patterns, and reimbursement was assigned according to findings. If the standard gall bladder removal cost is 2,000, the hospital would be reimbursed for this sum. If the hospital was efficient in delivering care and minimizing its costs to $1,000, it would still receive the stated amount and earn a profit. On the other hand, if the hospital was not efficient and its procedure cost $3,000, it would experience a $1,000 loss. This encouraged hospitals to evaluate its systems and minimize costs. This program became so attractive to the insurance and health maintenance organizations, soon all reimbursements to health care facilities were provided in this method. However, health industries continued to treat disease with little focus on prevention.

The next wave of reimbursement policy sweeping the country is that of total capitation. This program is different from the DRG system by limiting funding to hospitals and health care providers. Under capitation, hospitals receive no money for procedures and services rendered. Instead, the organizations receive per member per month payments that cover all individual health care costs. For example, a family of four with health care insurance would pay a fixed amount per family member, per month (such as $50) for a total of $200 per month or $2,400 annually. This would have to cover all health care costs incurred by that family. An individual needing an open heart surgery might incur costs of $35,000, but reimbursement would remain at the fixed rate. It is necessary, under this model to focus on wellness and the prevention of disease rather than healing the already ill.

New Responsibilities for Fitness Providers

In the past, the medical profession has not valued the effects of exercise on health and wellness. New research points to exercise as one of the most important components of wellness. Physicians are beginning to include exercise as a prescriptive method, along with medication and diet, to improve health. This will pose new challenges to the fitness professional. People with underlying disease processes possess a higher risk of suffering a physical injury during exercise. They will require an increased level of monitoring and ongoing evaluation. This changing client base will force fitness professionals to take on new responsibilities.

It is not the intent, nor is there a need, to convert fitness Providers into health care workers. It is necessary, however, to prepare to deal with the changing population. The inclusion of a new client base presents the potential to expand programs and enhance revenue opportunities.

Professionals will need to continually keep track of demographic changes in the fitness and health care industries. The new fitness professional will understand the concept of change as the only constant, analyze present programs and adapt new methods of training.

With the expectation to improve fitness levels, it is important for providers not only teach a class, but be a resource. Besides developing effective exercise programs, the fitness professional should read the latest research and keep up with breakthroughs in exercise technology. Any questions from the class that cannot be answered should be referred to the appropriate professional.

Emergency Treatment

It is important for the fitness provider to be familiar with first-aid procedures such as CPR and basic treatment. Fitness providers should be certified in such programs as the AFAA Emergency Response certification, which provides a wide knowledge base including first-aid, emergency response planning and exposure control.

First-aid training provides skills to identify an emergency, and teaches instructors how to provide the appropriate care while waiting for the arrival of a medical team. There has been an increased incidence of cases in which employees of a club are not prepared or chose not to intervene in the first-aid response of an individual, resulting in death or other serious adverse effects to clients. An increase in lawsuits has prompted clubs to realize a duty to act and protect individuals on their own premises.

Each fitness facility and provider needs to develop an emergency action procedure in the unlikely event of an accident or injury. All emergency situations should be handled consistently and completely with appropriate follow up to eliminate the possibility of future hazards. A well-developed step-by-step plan should be implemented. Guidelines are outlined in the AFAA Emergency Response Program workbook.