Exercise is Medicine Referral Process Utilizing an EMR Medical Fitness Association Annual Meeting December 2012 By: Deb Riggs, MEd, General Manager
Faculty Disclosure Deb Riggs Deb Riggs has listed no financial interest/arrangement that would be considered a conflict of interest.
Background TriHealth is an integrated health care system : Bethesda North and Good Samaritan in Cincinnati, Ohio. Own 33 Physician Practices Employee over 11,000 people
TriHealth Fitness and Health Pavilion Opened 1997 The nation s First Certified Medical Fitness Facility 110,000 square feet includes: cardiac and pulmonary rehabilitation; physical and outpatient therapies, a spa/ integrative medicine center; primary care physician practice; chiropractor; Mayfield Spine Institute; plastic surgeon; physiatry practice and a large array of fitness and wellness services.
What is Exercise is Medicine? Background Multi-organizational global initiative launched in November 2007 by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA). Developed to encourage primary care physicians to include exercise when designing treatment plans for patients. Calls on doctors to prescribe exercise to their patients. Committed to the belief that exercise and physical activity are integral in the prevention and treatment of diseases, and should be assessed as part of medical care and integrated into every primary care office visit. Vision To make physical activity and exercise a standard part of a disease prevention and treatment medical paradigm in the United States
Why is EIM important at this point in our history? What has been the Effects of Inactivity
Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5 4 person) 1990 1999 2009 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30%
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Exercise is Medicine Effects of regular physical activity at the correct intensity: Reduces the risk of heart disease by 40% and stroke by 27%. Reduces the incidence of high blood pressure and diabetes by almost 50%. Can lower mortality and the risk of recurrent breast cancer by almost 50% and colon cancer by over 60%. Can lower the risk of developing Alzheimer s disease by one-third. Can reduce depression as effectively as Prozac or behavioral therapy.
Cost of Medications
Cost of Medications
What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? Would you prescribe it to your patients? If we had a pill that gave all of those benefits and was readily available, we would find a way to make sure every patient took it. -Robert E. Sallis, M.D., FACSM, Exercise is Medicine Task Force Chairman
The Solution: Physical Activity Why isn t this happening with exercise? Lack of media advocacy No tangible success measures Physicians are lacking the time to effectively counsel patients about exercise No national reimbursement for referrals
Opportunity for Improvement Four out of 10 physicians (41%) talk to their patients about the importance of exercise, but don t always offer suggestions on the best ways to be physically active. ACSM research indicates that 65% of ACSM research indicates that 65% of patients would be involved in exercise if advised by their physician and given additional resources.
TriHealth Pilot Program
Grand Rounds TOPIC: LIFESTYLE MEDICINE: TOOLS FOR PROMOTING HEALTHY CHANGE SPEAKER: EDWARD M. PHILLIPS, M.D. TARGET AUDIENCE: Internists/Family Practitioners OBJECTIVES: Identifying for physicians the essential elements of Lifestyle Medicine including exercise, nutrition, weight management, smoking cessation, and stress management to support coaching of their patients toward taking responsibility and making improved lifestyle choices. Discuss and facilitate improvement in physician health choices to enable physicians to serve as role models for patient lifestyle change
Goals of Pilot Program Create awareness that exercise is indeed medicine Make the level of physical activity a standard vital sign- PAVS score Help healthcare providers become effective in counseling and referring patients as to their physical activity needs Produce an expectation that healthcare providers should and will ask about exercise and patients have responsibility to follow up on filling their prescription Encourage healthcare providers to be physically active
Pilot Practices Piloted the process with three physician practices consisting of 17 providers. Feb June 2010
Electronic Pathway Developed **Medical Assistant enters Physical Activity Vital Sign. Physicians assess physical activity. Prints script and refers to Pavilion if deemed necessary. Assessment performed & exercise specialist enters results for next Physician visit. Exercise specialist receives prescription Schedules assessment
Patient Education
Developed EPIC Documentation Pathway PAVS Questions 1) How many minutes per day do you get moderate or intense physical activity such as a brisk walk? 2) How many days in a typical week do you perform activity such as this?
EPIC Documentation Pathways Patient Assessment Tool FITNESS ASSESSMENT FORM PHYSICIAN NAME: Name: Employee # Phone# Email Blood Pressure Resting Heart Rate: Height: Weight: Age: Sex: Body Composition (Bioelectronic Impedance): BMI SIT & REACH TEST Inches Rating COOPER S 12 MINUTE WALK/RUN Mile: V02 Max Rating 3 MINUTE STEP TEST Heart Rate Rating HAND GRIP (KG) Right Left Total Rating PUSH UPS Repetitions Rating CHAIR STAND TEST (30 Seconds) Reps Rating
EPIC Documentation Pathways PLAN A Cardiovascular: Sample Fitness Program Recommendations Week 1-5 minutes a day, three day a week Week 2-10 minutes a day, three days a week Week 3-15 minutes a day, three days a week Week 4-20 minutes a day, three days a week Week 5-25 minutes a day, three days a week Incorporate a strength training routine twice a week on non-consecutive days Include a stretching exercise program of at least 10 minutes for a minimum of 2-3 days per week.
Innovative Programs Launched Fit in 6 A six week/$60 introductory program Lifesteps Weight Management Program Behavior Modification Based
TriHealth Pavilion Homepage
Prescription for Good Health
Pilot Summary Referrals included 50%males & 50% females, ages 19-82 years A wide range of PAVS s, 64.5% sedentary Major disease categories Heart/Vascular disease 21.7% Metabolic disease 25.3% Respiratory Disease 19.3% Nearly 50% with greater than 1 risk factor Other risk factors Dyslipidemia 51.8% Hypertension 48.2% Medications Usage 77.1% Chronic Painful Conditions Back 21.7% Knees 20.5%
Exercise is Medicine Summary PILOT (Feb June 10) 364 Total Physician Referrals 167 Completed Assessments (46%) (Feb 10 - Mar 11) 2030 Total Physician Referrals 546 Completed Assessments (27%) 17% converted to membership 2500 2000 1500 1000 500 0 Pilot Thru March '11 Physician Referrals Completed Assessments Exercise is Medicine Results
PAV Score Data in EPIC (through 9/12) Number of patient visits with PAV recorded =119,424 Number of unique patients = 46,837 Number of unique patients with PAV score 0 (i.e. completely sedentary) = 25,052 (53 %)
Summary Evidence is now overwhelming on the health burden of physical inactivity. The benefits of exercise in the treatment and prevention of chronic disease cannot be denied. No patient should leave a doctor s office without an assessment of his/her physical activity and proper prescription of an exercise program, or a referral to a certified fitness professional.
Result The MFC is now seen as an integral part of the patient s continuum of care. Health coaches, dieticians, clinical exercise specialists. Therapeutic exercise reimbursement?
Healthcare Reform Bottom Line The Patient and Affordable Care Act will usher in a new era of preventive care and wellness programs. By maximizing physician/hospital systems alignment, investing in information sharing technologies, and exploring novel service venues, medical fitness facilities and wellness programs will become an integral component in setting a new standard for healthy living in America. * * ACSM Health and Fitness Journal, Vol. 14, No. 6 p.34
PCMH National Initiative 19 of 33 TriHealth Physician practices were chosen for Patient Centered Medical Home model national initiative
The doctor of the future will give no medicine. But will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease. - Thomas A. Edison
Here We Grow!! Exercise is Medicine and Medical Fitness- Making a difference in people s lives.
Questions??? s and Thank You!! TriHealth Fitness and Health Pavilion Cincinnati, Ohio www.trihealthpavilion.com Deb_riggs@trihealth.com