Since Sue Kirk started working out with a personal trainer a year ago, she has lost more than 47 pounds and dropped her cholesterol from 212 to 156. Those results didn't come from your average gym membership, however. Kirk, 57, joined a fitness center run by Akron General Health System in Ohio. At the spiffy 218,000-square-foot facility, one of three such centers run by the hospital system, she has access to exercise physiologists, nutritionists and a wealth of wellness programs as well as state-of-the-art treadmills, ellipticals, weight machines and a 25-yard-long swimming pool.
Besides lifting weights and running on an indoor track at the center with her trainer two mornings a week, Kirk has been on a weight-loss plan that included a seminar on good eating habits. "I made a commitment to get on board with exercise and nutrition, and I've had remarkable results," says Kirk, a regional quality manager for Fresenius Medical Care, an international provider of kidney dialysis services. "I'm going to continue. I want to lose 30 more pounds."
A few years ago, the idea of turning to your local hospital to get a good workout may have seemed ludicrous. Not anymore. These days, health systems are actively reaching out to their communities with all sorts of programs designed to lessen the impact of chronic diseases, and, by extension, to keep people out of the hospital. Why now? One reason is that health care reform is forcing hospitals to focus on getting and keeping people well or face serious financial ramifications. Medicare is now charging penalties to hospitals with high readmission rates, for example. The fees will increase from up to 1 percent of the offending hospitals' Medicare revenue this year to as much as 3 percent in 2015. At the same time, more hospitals are joining accountable-care organizations, networks of health care providers that are paid flat "bundled" payments by insurers based largely on the quality of care they provide. That puts a value on keeping covered members healthy, and it also forces hospitals to look for new sources of income – retail services they can offer not just to their patients, but to the community at large.
As bundled payments for quality care replace the old fee-for-service model, through which hospitals were paid based on how many patients had how many procedures, more hospitals will look seriously at wellness, experts predict. "The benefit for the future is, if you keep folks well, you're going to keep more of the bundle," says Anthony Cirillo, president of Fast Forward, a health care consulting firm in Huntersville, N.C. "Wellness programs will play an even bigger role because they're affecting your reimbursement."
Indeed, hospitals that don't start paying attention to prevention and wellness are going to fail to thrive under health reform, predicts Akron General CEO Thomas "Tim" Stover. "Every congestive heart failure patient should be put in an exercise program when they leave the hospital," Stover says. "It should be the diagnosis at discharge. That's how you prevent readmissions."
Each member of an Akron General LifeStyles center gets a fitness assessment and "exercise prescription," along with a nutrition analysis from a registered dietician. A medical director and advisory board oversee the centers, which are equipped to serve everyone from completely healthy members to recently discharged patients. "It's the norm to see a physical therapist working with their patient on one treadmill, a cardiopulmonary rehab nurse working with someone who has an oxygen tank on the next treadmill, and an exercise physiologist working with a [healthy] member on the third treadmill," says Doug Ribley, senior vice president of health and wellness services for Akron General. Members pay monthly out-of-pocket fees that range from $55 to $111.
Whether or not they go so far as to open gyms, many hospitals have launched fitness programs targeted to specific patient populations. Holy Cross Hospital in Silver Spring, Md., for example, runs Senior Fit, 68 classes per week for elderly people focused on increasing strength, flexibility, balance and coordination. Fitness and Wellness Professional Services, which operates gyms for nine hospitals and is working on 25 more, offers exercise classes for people with multiple sclerosis as well as fitness plans tailored to individual members based on information from their medical records.