Some years ago, I excoriated the American College of Sports Medicine for partnering with a medical screenings company to push useless screens upon, of all things, their membership. You can read the post here. It was truly embarrassing to a supposedly credible organization. The leadership’s reply, in addition to having their communications director call me and implore me to take the post down, was to claim they had no idea this was happening.
Now, the American Council on Exercise, another fitness industry trade group, beggars itself with an open letter to the U. S. Congress, in which it essentially asks to hop aboard the national healthcare gravy train. You can read the entire plaintive wail here. The essence of it, however is this:
Let me translate both the highlighted paragraph, and, indeed, the entire letter: hey, Congress, everyone else is making money from healthcare reform, what about us? Where’s our handout? We’re healthcare providers, too, sort of. That ought to be enough to qualify us for reimbursement, even though we have zero evidence that the fitness industry, or any specific category of fitness professional (you could be one by 5:00 pm today), actually can change outcomes. Exercise? Important almost beyond expression. Fitness industry and its entire coterie? Not so much. Over the past three decades, the fitness industry has boomed. There is a gym on virtually every corner in America, you can stream fitness programs 24 hours a day, and personal trainers are popping up like mushrooms. And, yet, we are fattest, laziest culture on the planet. Viewed in this light, one can only surmise that the fitness industry is an abject failure. Surely, the answer is not that it failed because its services are not reimbursable?
The last thing Americans should want is “extending the clinic into the community.” The clinic is killing us, sucking away time, money, and energy, and creating stress where there does not need to be any. If the Council wants to make a contribution to the health of Americans, it might concentrate on helping to rid its industry of an apparently inexhaustible supply of stupid, embodied by charlatans, gimmicks, and supplements, most of which are unproven and many of which are dangerous, but which play a prominent role is the mysterious, miasmic magic-bullet messaging that permeates fitness.
What I find really ironic about fitness industry apologia like this letter is the staggering ignorance about healthcare and health policy they betray. Asking for further entanglement with government, health plans, and other risk-bearing entities, such as ACOs, is to invite yourself into a bear pit. Your industry, which could actually be adding value to the lives of Americans, instead of adding to their cost burden, will suddenly find itself negotiating coverage and reimbursement with health plans that have made an art of demoralizing their contracted entities. How many visits will a plan pay for? What happens then? You cut the patient/client loose? Or, they’ll pay full rates? Will you tell them that in advance? Will you raise your rates broadly so that you can weather the penurious reimbursement Aetna, Cigna, and United will shove down your throat?
Can you imagine the tatted-up, pierced $15.00 per hour neophyte at your gym desk having responsibility to submit a claim to your health plan with the right diagnostic and procedure codes and then resubmitting denied claims with supporting documentation? Or, will gyms hire for, or contract out, billing? Won’t that be fun (and expensive). Documenting progress for health plans and attending physicians? Establishing and demonstrating the achievement of actual clinical outcomes? The most prominent and prolific physicians and surgeons in the country can’t agree on how to measure outcomes in their specialties, but gym rats will? Will gyms need to join the idiocy that is health IT? Then, there all the implications of suddenly becoming a covered entity under HIPAA.
The letter also makes one wonder about whether fitness leaders take math classes, let alone classes in economics. Adding to the panoply of bottom feeders in line at the healthcare reimbursement ATM (putting themselves in the fine company of durable medical equipment hucksters and chiropractors), isn’t going to lower anyone’s healthcare spending. It’s going to increase it, which means upward pressure on premiums for years, because populations don’t go from unhealthy to healthy overnight. Can’t beat ‘em? Might as well join ‘em. When you can’t actually do what you should, you might as well ask to get rewarded with taxpayer-subsidized dollars for your incompetence. It’s the American medical care industry way.
If the fitness industry had any actual leadership it would strive to separate itself from the corporate-statist healthcare machine that is slowly eating away at the health, wealth, and morale of Americans. What the fitness industry ought to be doing is talking about how personal engagement in living a healthy life and building sustainable fitness is the only pathway to eventually shrinking (rationalizing) the medical care industry and getting it occupy a smaller segment of our lives instead of engaging in a perpetual land and money grab. What the fitness industry ought to be doing is challenging the idiotic, government-fomented notion that all we need is physical activity and that schools are better places with less health and physical education.
The fitness industry should concentrate on teaching Americans why personal fitness is essential not just to their own wealth and health, but to the future of the country. This is not such a radical idea. It was articulated in 1961, by a guy you may have heard of: John F. Kennedy. Unfortunately, when you don’t actually know what you are talking about, it’s hard to concoct a vision for anything other than the most facile and trite claim in all of American culture: show me the money.