Can You Get Paid for Prescribing Exercise?
(February 12, 2014 - MedPageToday.com) Not many doctors argue against more exercise. The problem is whether they're reimbursed for prescribing workouts, particularly when patients can expect little help from flexible spending accounts (FSAs) or tax credits. The IRS will only cover health club dues if exercise is prescribed for a specific condition.
So we reached out to Jordan Metzl, MD, a sports medicine physician at Hospital for Special Surgery in New York City. His newest book, "The Exercise Cure," looks at the scientific basis for exercise instead of pills for the treatment and prevention of disease. And while we thought "cure" was a rather strong word, we wanted Metzl's take on prescribing exercise in practice. Here's a lightly edited version of our email exchange.
1. Physicians and health professionals already know that exercise works for patients, so what's new?
My thought here is that saying "go exercise" is easy, but most health professionals don't really know too much about how to write an exercise prescription.
In the second half of the book, I walk through the how to's of setting up a home-based program based on someone's level of fitness: Bronze, silver, or gold? What I've tried to do is give examples of easy-to-perform exercises that people of all levels and ages can perform on their own. I hope this gives health professionals the tools to feel comfortable prescribing exercise as medicine for their patients.
2. So how do physicians get paid for prescribing exercise to patients?
At this point they don't get any direct reimbursement. The IRS includes specific tax deductions for gym memberships and programs designed to encourage weight loss only in patients diagnosed with diseases, but that's about membership fees, rather than actual activity. Certain companies, like Cerner Corporation in Kansas City, have activity-specific programs for employees where the number of steps calculated on a digital pedometer correlates to reduced healthcare costs for employees, but this is the exception rather than the norm.
My thought is that once we help spread the word on the drug of exercise, which by all metrics is the most far-reaching and effective drug we have across the spectrum of human illness, the medical community will start leading the charge toward demanding that exercise. Preventive wellness becomes something that is taught in medical schools, encouraged for patients, and reimbursed by healthcare organizations. Healthy people cost less money; we need to incentivize our population to move.
3. What are your personal experiences with payment for exercise treatments?
I went to med school to help patients and to encourage health. I see exercise as a safer way to encourage healthy behaviors. The money issue isn't really an issue, especially since I think I've provided a formula that works and takes almost no time for docs.
4. What will get physicians to prescribe exercise?
The first step here is education. Most docs know that exercise is good for their patients but aren't as comfortable with then instructing them on how to set up an exercise program. I think this really is an area where as a profession we can and should do better. I think that once they realize the powerful nature of the drug called exercise, which I think still needs some work, they will be more enthusiastic about prescribing it. I think that many docs, especially in the younger generations, are on board. The key now is changing the paradigms in medicine to make that happen.
5. How do doctors respond to patients who might resist a prescription for exercise?
If a patient has high blood pressure and is on antihypertensive medication and their doc said "just stop taking your medicine for a month," they'd look at their doc and think, "Have you lost your marbles?" If you look at the clinical efficacy of exercise, it works just as well as many of the medications that are currently being prescribed for a whole host of problems. The argument here is that exercise is safe, cheap, readily available, and it works. Once the perception of exercise as a "drug" is made, having patients take their medicine is actually much easier.
6. What was the most surprising thing you learned researching the book?
I had always known about the cardiac benefits of exercise, including lower blood pressure and lower cholesterol. When pulling together the research for "The Exercise Cure," I was amazed how much strong evidence exists for exercise as the first line treatment for hundreds of ailments.
I decided to organize the argument for exercise by body system, making the case that exercise should either be the first line or adjunct treatment for many medical problems that are now primarily treated with medication. Particularly in the brain section, the evidence for exercise as a treatment for mild to moderate depression, sleep problems, anxiety disorders, and even dementia, is simply irrefutable.
In the book every disease state and exercise plan has one or two research studies that corroborate the claim I am making. Viewing exercise as a part of treatment, a medicine, is not only medically sound, it also reduces the dependence on many of the higher cost and less safe treatments.
7. What's the difference between exercise for prevention versus first line treatment? And which one do you advocate?
When I first started writing "The Exercise Cure" I was actually thinking more about exercise from a prevention standpoint but as I got deeper into the research, I realized that not only is exercise amazing medicine for prevention, it actually works as well for disease treatment as many of the medicines we are currently using (for much less cost and health risk). At the least, it reduces the amount of medicine people need to take.
I'd say now that after writing the book I have come to the conclusion that exercise is BOTH a preventive medicine and a therapeutic medicine and should be viewed as such. As my friends at the American College of Sports Medicine have said for years, "Exercise is Medicine." My feeling today is that for both prevention and treatment, exercise works, and my hope is that health professionals will learn as much as they can about how to effectively dose and dispense it.
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