Tuesday, December 29, 2009

Quotable - Truth Series

"The fact that an opinion has been widely held is no evidence whatever that it is not utterly absurd." - Bertrand Russell
Saturday, December 26, 2009

Game Changers - Crystal Ball Part 1

Game Changers – “Crystal Ball” Part 1

So far in this series we have identified four Game Changing Trends that are and will continue to impact the health, physical rehabilitation, fitness, and wellness sectors. Now let’s step back and ask the question what impact is it likely to have in those sectors. There are seven important impact points to consider. We'll discuss the first three in this post and the remaining four in the next post.

1. Personal function will be a major factor in the health, welfare, and independence of Americans over the next two decades and beyond. Function will also be an important differentiator within the health community and between professional service providers. A quiet transformation is beginning to take place that will ultimately cut across the health professions. It is a transformation that will not go unnoticed by the payors of health care services. The lines are being drawn today. Those lines will divide levels of participation and opportunity within the provider community in the years ahead.

2. Reimbursement will continue to erode. Providers will be expected to deliver more services to more people for less money per unit of service. This will largely be driven by the growing demographics of seniors and increased survival rates related to medical advances. Physical therapy will be particularly impacted because seniors age 65 and over use twice the services of those who are younger. This is likely to be a difficult challenge for many physical therapy providers whose productivity has remained stagnant for decades.

The insurance industry will continue to compete with healthcare providers financially – insurers currently retain about one third of health care premiums for their own operations. Big-pharma will also compete effectively against healthcare providers for its share of healthcare spending.

Clinical providers will need to become significantly more productive. Not all providers will be able to make the transition to higher productivity, value, and performance.

3. Labor expense will continue to grow in the physical therapy sector. Labor expense will progressively eat into profits unless new business models are implemented. This will be driven by three factors: cost of living, productivity, and labor shortages.

Cost of Living: Over the period of 2000 – 2010 the Consumer Price Index increased at an average annual rate of 2.1% (21% overall). Historical data back to 1921 show similar average annual increases. It is unlikely the next 10 years will be any less, and could be significantly more given a weak dollar and increasing global competition for natural resources.

Productivity: During the past 2 decades overall US labor productivity has increased an average of 2.7% annually or about 50% overall. No such gains were realized in the physical therapy sector. In fact, Physical Therapy has the least favorable payroll to sales ratio (51.5%) amongst for-profit healthcare professional clinics in: optometry (21.9%), chiropractic (28.7%), podiatry (32.2%), all outpatient care centers (36.9%), dentistry (37.6%), mental health clinics (37.8%), speech therapy (38%), ambulatory healthcare (44.5%), physicians (49.6%), home health (50.9%), and physical therapy (51.5%). (US Economic Census) Personal training productivity is also constrained by the dominant use of a one to one service delivery business model similar to physical therapy, although group training options provide opportunity for greatly enhanced payroll to sales ratio.

Labor shortages: The physical therapy industry has been challenged with labor shortages for most of the last 50 years. That situation is almost certain to continue due to a perfect storm brought about by: aging population demographics, reimbursement erosion, low productivity, regulatory restrictions on productivity, educational system capacity, doctoral entry level time and financial investment, return on investment constraints post graduation, and professional specialization.

The personal training industry is also challenged, primary by issues of high turnover related to matters of compensation and career path advancement.

The Bureau of Labor Statistics reports that 10 of the 20 fastest growing occupations are healthcare related. Healthcare will create more jobs over the next 10 years than any other employment sector. Estimates project 30% growth in physical therapist positions and 29% growth in personal trainer positions during the period of 2008-2018.

More next post...


(c) Copyright 2009
Performance Builders
Wednesday, December 23, 2009

Quotable - Truth Series

"Protect your mind today. Be vigilant for truth." -Alan Cohen
Sunday, December 20, 2009

Game Changers - Function

In the first three Game Changer postings we focused on national trends that are driving the US health agenda today and that will continue to do so well into the future – an aging population that requires more health care, a growing inability of the nation to pay for that healthcare, and an obesity epidemic that harms health and further increases cost.

Game Changer number 4 is about “Function” or more specifically Applied Functional Science* (AFS). AFS represents a common element that influences the first three game changers.

Function is defined as, “the action for which a person is particularly fitted or employed”. Function is, “the actions for which a person exists”. Function is about normal and specific contributions to the ability to survive and thrive in one’s own life and in the lives of others.

Function is about the “ings” of life – the foundations of walking, sitting, bending, lifting, pushing, etc., and the integration with working in the garden, playing a round of golf, feeding the family, picking-up the grandchildren, and going on vacation. It is the ings that put joy in living. The ings are about functioning. AFS is about the science of functioning – the language of life.

Life is in the doing. Doing is Function. Function is performing successfully in all of life’s demands – work, rest, play, and pleasure. Function is about personal independence, competitive opportunity, and life’s rewards.

Medicine is oriented toward organic disease. The term “Functional symptom” is used by medicine to describe symptoms that have no visible organic basis, suggesting a nonorganic cause, the most common of which is mechanical malfunction – the unique domain of AFS. Interestingly most physicians, therapists, and chiropractors are not trained in AFS.

There are three important aspects to understanding Function:

1. Function represents a sequence of relationships in which one thing depends upon another – think complex biomechanical chain reactions within the body and between the body and its environment.

2. Function pertains to actions and activities that when applied, perform as expected to accomplish the intended purpose – think individualized testing and training under authentic conditions.

3. Function refers forward from the object or process, along some chain of causation to the goal and success – think scientific method and efficacy.

Today’s US health crisis is driven largely by lifestyles and aging. Experts agree that the lack of exercise poses a greater health risk than obesity or smoking. Physical impairment is the primary antecedent to institutional care. The loss of Functional independence is a major driver of healthcare costs and continues to escalate with demographics. The healthcare community, payers, and public has yet to fully understand AFS and differentiate it from traditional intervention, rehabilitation, and fitness training services.

It is a costly oversight – one whose cost is measured both in dollars and in quality of life.

Function utilizes structured, individualized testing and exercise as its primary modality. Generic exercise has no more efficacy than generic surgery. The success of surgery is dependent upon the accuracy of the diagnosis, the appropriateness of the surgical procedure, and the skill of the surgeon. And so it is with Functional Exercise.

To gain some context, consider the three most common complaints that people have when seeking primary health services:

1. I can’t do... what I need/want to do. It’s an ing thing.
2. It hurts when... I do this or that. Another ing thing.
3. I’m afraid that... I won’t be able to do. Again, an ing thing.

People seek professional help when there is something that limits their ings, their doings. It’s all about functioning. In fact, neuro-muscular-skeletal conditions are second only to upper respiratory conditions for those seeking treatment at primary care health centers. Oh and there’s a serious shortage of primary care physicians in the US... hmmm, sounds like an opportunity.

AFS deals with the science, principles, and strategies of biomechanical movement and performance. AFS lies at the intersection of biomechanics, physical medicine and rehabilitation, chiropractic, personal and athletic training, and human performance. Its application encompasses injury prevention, treatment, rehabilitation, fitness, training, and wellness.

As the three primary colors are to all of art, as seven notes are to all of music, and as five amino acids are the building blocks of all life, as 10 numbers are to all of mathematics, as 27 letters are to all of English literature and science, so AFS is to all of human movement. AFS is the Rosetta Stone of function. AFS is the language of movement and the foundation of functional fluency.

AFS holds important implications for aging baby-boomers wishing to remain independent, for workers needing to be productive, for athletes striving to excel in competition, for national health struggling financially, for those overweight striving for better health.

Over the past two decades the term functional has entered the mainstream of sports, rehabilitation, athletic and personal training, and human performance. It seems everything is functional this or functional that. It’s become a hollow fade. It’s one thing to talk the talk but another to walk the walk.
Unfortunately the term functional has become a marketing buzz-word with little substance outside of AFS. Like other marketing terms such as sale, special, limited time offer, and life time guarantee; the promise, potential, and potency of functional has been diminished through misunderstanding, misuse, abuse, and yes, ignorance and exploitation.

In contrast to the “fads” of function are the “facts” of function. The fact is that the systematic and faithful implementation of functional principles produces the high value results that are needed to provide the stable, scalable, and sustainable solutions that are demanded by the challenges associated with seniors, national healthcare expense, and obesity.

There is a tremendous public service and professional business opportunity in function. It has the power to transform lives, practices, and professions. It is this fourth trend that counters the previously discussed three trends.

AFS principles are truths that cut through the trends. AFS is a true Game Changer. Those who are AFS leaders rather than followers possess a unique competitive advantage that is not easily diminished.

*Note: Applied Functional Science (AFS) is taught to health professionals by the Gray Institute through its GIFT distance learning mentoring program and its Chain Reaction Seminar Series.

In the next post I’ll share my “crystal ball” predictions of what impact the four Game Changer trends will have on the practices of therapists and trainers....


(c) Copyright 2009
Performance Builders
Wednesday, December 16, 2009

Quatable - Truth Series

“We can not approach truth from who we are. We think to small. We are confined and confining in our beliefs.” - Margret Wheatley
Tuesday, December 15, 2009

Game Changers - GIFT 2010

My next post in the Game Changer Series will be on Function - expect it to be posted within the week. In the meantime, here is a glimpse behind the topic of Function...

The Gray Institute for Functional Transformation (GIFT) is unequivocally the leading authority in Applied Functional Science (AFS) globally - i.e. FUNCTION. The terms "Function" and "Functional" are found in marketing materials everywhere throughout the rehabilitation and fitness industries - it defines today's standard of practice. Most professionals don't realize the origins of its popularity in those industries - The Gray Institute; and most have barely scratched the surface of what AFS means for their profession, practice, and patients/clients. In fact, most of what is called "functional" in the industry is not functional and most professionals don't know the difference between what is and what is not.

Understanding AFS is the ultimate Game Changer for professionals, clinical practices, studios, and clubs. AFS is the DNA of movement and performance! The only way to Change your Game with AFS is through the unique GIFT Mentorship Program. The only 2010 mentorship opportunity begins mid-January 2010 - now is the time to Change Your Game - Do it!

AFS goes beyond techniques, exercises and protocols by empowering professionals to master the structure of AFS's comprehensuve movement vocabulary, enduring functional principles, and critical thinking skills that open the door to new possibilities and potent impact.
GIFT is a 10 month Distance Learning Fellowship that includes several on-campus learning opportunities. GIFT alumni are an international community of industry leaders, highly skilled clinicians, industry innovators, and successful entrepreneurs. There is nothing else like it in the industry. Go to the Source!

Make an investment in your professional career, one that is certain to be a Game Changer by looking into the GIFT Fellowship now. Becoming a GIFT Fellow in Applied Functional Science offers a terrific return on investment, competitive advantage for you and your patient/clients. GIFT is one of those rare opportunities that is Game Changing, Career Changing, and Life Changing. Don't miss it.

There are risks one can not afford to take. There are risks that one can't afford to take. There are also risks that one can not afford not to take. GIFT is one of the latter. GIFT Fellows are not followers!

Why GIFT? ...View the VIDEO (Flash) or VIDEO (Windows Media).

Want more information? ...Go to GIFT, checkout the GIFT Brochure and Apply before this Game Changer passes you by.

I have been privileged to consult in the formation of the GIFT Fellowship program and to be a member of its faculty for the past three years. I can think of no better learning experience for professionals who treat and train the neuro-muscular-skeletal system than GIFT! It has my unqualified endorsement and strong recommendation.

All The Best!


(c) Copyright 2009
Performance Builders
Monday, December 14, 2009

Game Changers – Obesity

Here's Game Changers number 3 – Obesity.

In previous posts we discussed the exploding senior population and cost of health care. In this post we consider the issue of obesity – a third Game Changer that merges with the previous two.

Obesity is defined as a body mass index (BMI) of greater than 30. Overweight is defined as a BMI of 25 – 29). BMI = mass (kg) / height squared (m squared). Obesity is a major risk factor for cardiovascular disease, certain types of cancer, and type 2 diabetes among other conditions related to endocrinology, reproductive medicine, orthopedics, neurology, and psychiatry.

There has been a virtual explosion of obesity over the past 20 years and its prevalence is predicted to continue to increase. In 2008 the Center for Disease Control reported that the prevalence of obesity in the US ranged from a low of 18.5% in Colorado to a high of 32.8% in Mississippi. It also reported obesity variance by race/ethnicity – Blacks had a 51%, and Hispanics a 21% higher prevalence of obesity compared with whites. Concentrations of obesity have also been identified in the Southeast, Appalachia, and some Tribal Lands.

Trends are particularly startling amongst children. Over the past 30 years, obesity in children age 2-5 more than doubled. For 6-11 year olds the rate nearly tripled; while those 12 – 19 it more than tripled.

It has been said that, today’s kids may be the first generation of Americans that will live sicker and die younger than the preceding generation.

Today, some one-third of adults are obese – experts predict that within 5 years the percentage will increase to over 40%. Two-thirds of adults are either obese or over-weight – that percentage will increase to 75% during the next 5 years.

It is well recognized that obesity is caused by a chronic imbalance between caloric intake (high) and physical activity (low) – a simple relationship between intake and output. Without ignoring other potential contributing factors such as genetics, medical disorders, psychiatric conditions, social determinants, etc., obesity is largely life style/choice related.

On average obesity reduces life expectancy by 7 years and increases medical expenses by 42%.
The weight loss market is about $69B annually.

It is interesting to note the disparity in the monetizing of caloric intake programs (diets) over exercise program in the mainstream. While exercise adds both years to life and health to years, a majority of Americans do not get adequate exercise. The reasons are numerous – knowledge, time, boredom, pain, priorities, fear, etc.

How mainstream obesity has become is apparent in the popularity of diet and exercise in the national media –professional journals, newspapers, tabloids, radio, television, DVDs, and more. The popularity of the reality TV show The Biggest Loser speaks for itself not only in the US but abroad. But real-reality reminds us that for most people there are no $250,000 grand prizes or full time nutritionists and personal trainers waiting at the ready. Without such inducements, few people would put up with the physical and mental abuse to which TBL contestants are subjected. Nor should they need to! Such abuse may be good for theatrical value and TV ratings but it destroys more than it builds.

The reality is that for most people weight management is a lonesome road to travel – a road congested with bad information, lies, unreasonable expectation, inadequate support, constant temptation, and convenient off-ramps to every imaginable failure destination.

There has to be a better way...

With incredible challenge comes exceptional opportunity. The obesity epidemic goes begging for better, more honest and more realistic solutions.

It will be necessary to move beyond the old notions of exercise and all of the negative baggage it carries with it. Physical activity that is accessible, entertaining, captivating, challenging, satisfying, and rewarding will certainly a critical part of any viable and scalable solution.

The matter of obesity holds great promise. Passion and innovation is needed. Professionals who specialize in human movement, fitness, and rehabilitation have the opportunity (and perhaps moral obligation) to take a leadership role. Choloric output is half of the equation!

There are trends and there are truths. Mass marketing gravitates toward trends because that is where the fast-buck is to be found. Its good for business but bad for the public. Professional ethics and credibility demand that innovation be anchored in the truth and that long term vision and benefit be traded for short term exploitation. Any scalable solution will most certainly be based on truth, public benefit, and will have a viral marketing element the core of its strategy.

Is there risk for professionals in traveling the path of innovation? Absolutely YES! But, risk is where the reward is... Obesity is a game changer for the nation, its people, and those professionals that chose to engage the challenge.

Thanks for following along on this series of posts. Your comments and insights are always appreciated – just click on the Comments Link below.

Next post we will consider Function – The Buffing of America.

All The Best!


(c) Copyright 2009
Wednesday, December 9, 2009

Quotable - Truth Series

“All things are subject to interpretation; whichever interpretation prevails at a given time is a function of power and not truth.” - Friedrich Neitzsche
Monday, December 7, 2009

Game Changers - National Health Plan

Now, on to Game Changers number two – National Health Plan

While the American population has changed and continues to change rapidly, so too has the health care that it receives. For most of the past four decades, the growth in health care spending has exceeded the nation’s overall economic growth. The result is that the portion of income spent on health care has tripled over that time. And, it continues to grow - rapidly!

Despite being the global leader in health care spending, America ranks 50th in life expectancy, ranks behind most other industrial nations in infant mortality, and ranked last in a 19 nation comparison of health care quality in 2008. The US is the only wealthy industrialized nation that does not ensure that all of its citizens have medical coverage. That lack of coverage translates into an estimated 18,000-45,000 deaths annually. And, medical debt is the primary cause of personal bankruptcy (62%) in the US.

Over the past century the best way to increase health was through public health initiatives – e.g. municipal water and sewage systems. Today the best way is through personal life-style choices involving smoking, alcohol, diet, and exercise. Some 75% of US health care spending goes for the treatment of chronic disorders and about half of all chronic diseases are linked to life-style choices.

Advances in health technology have contributed to growth in spending and will continue to do so. Consider advancements in organ transplants, computerized imaging, stem cells, and pharmaceuticals. Then consider the impact that the mapping of the human genome will have on “individualized health care”. While innovation has been mind bending, experts tell us the rate of innovation in the next 25 years will increase over that of the previous 25 years by a factor of four to seven. Such innovation promises to further fuel health spending in our current delivery system.

When health care spending, technology advancement, exponential growth in senior demographics, and the increased use of health care by seniors are considered together, the issues driving America’s health care reform debate come into focus.

Over the next 8 years (2010-2018) health care spending is expected to increase 75%, from $2.5T to about $4.5T. Stated in a different way, health care spending is predicted to increase 50% faster than gross domestic product.

By 2012 half of all US medical costs will be paid by Medicare and Medicaid programs. By 2017 the Medicare fund will be depleted. There are similar issues with Social Security funding. Then there are the more recent matters related to war funding, recession, bailouts, and unemployment.

While much is said in the national debate about the uninsured (50 million) and under insured (25 million) – about 25% of US population in aggregate, the issue is less about coverage than it is about the economic burden of providing care in the existing heath care delivery system. The cost of putting a healthy blush in the cheeks of all Americans is unsustainable in the existing health system.

Health care is the top social and economic problem in America today! Is change imminent? Bet on it!

So what does all of this mean to professionals involved in the rehabilitation and fitness sectors?

An important question to ask is, “Whose voices will shape emerging federal policy?” One can safely assume that the insurance industry, big Pharma, physicians, and AARP will have influence. One can also safely assume that voices within the rehabilitation and fitness communities are likely to have little influence.

Debate and lobbying continues. It remains uncertain precisely what final outcome will be enacted. However, one thing appears certain in the context of demographics, politics, economic policy – the rehabilitation sector will likely be expected to do more for less. Such a prediction is solidly supported by the reimbursement trends of the last 2 decades.

The game is changing. Practice viability is threatened. The greatest changes are just now taking shape. They will not be implemented overnight but they will be implemented one way or another.
When games change there are a number of predictable responses by those who will be impacted by the change – surprise, denial, rationalization, depression, and giving-up are common.
But there are also the few who look change in the eye and soberly and systematically set about preparing for it with the knowledge that in doing so they will achieve competitive advantage and opportunity. In taking action sooner rather than later, they also realize that there are short term and midterm benefits that will further enhance their financial and competitive future. Some practices will not survive.

Will current services, practice patterns, treatment philosophies, utilization, professional development, productivity, profitability, and business models carry forward into the new game that others are creating, but in which you will be expected to practice? Is your practice stable today? Is it sustainable through the changes that are on the horizon? Are you prepared to practice differently? Are you prepared to do more for less? Is your practice evolving at a pace that will ensure a benficial future for yourself and those you serve?

The Blushing of America is truly a game changer that demands your awareness and action. It will impact your profession, your career, your compensation, your job security, and your family’s prosperity.

The paradox is that there is an exploding population that needs rehabilitation and fitness services to remain healthy, productive, and independant, while at the same time the finanical resouces for providing such services are rapidly being eroded by other interests.

More next post - Obesity!

All The Best!


(c) Copyright 2009
Thursday, December 3, 2009

Quotable - Truth Series

"Truth has already solved any problem you can think of." - Alan Cohen
Tuesday, December 1, 2009

Game Changers - Age Demographics

This post is the first in a series of articles that I call Game Changers. The series is derived from a presentation by the same name that I gave across the US in the fall of 2009. There are four significant trends that have collided. In the collision everything is changing.

For health, rehabilitation and fitness providers the change is like going from bowling to hockey. Hardwood is being replaced by ice. Shoes are being replaced by skates. Frames are being replaced by periods and pins have been replaced by goals. Jerseys replace shirts and a puck replaces the ball. Hey, where did those sticks, helmets, and pads come from? Is the crowd always this roudy?
The game has changed, and unless your business model changes with it your practice is rapidly becoming irrelevant, your competitive advantage is becoming compromised, and your income and investments are at risk.

The business paradigm in health, rehabilitation and fitness is not being shifted - It is being replaced!

Let's consider the first of the four game changing trends - the Graying of America...

For the last 50 years US demographers have been tracking and predicting the impact of the post WWII population explosion commonly referred to as the baby-boomers. It is a demographic group that has been calling the shots and setting the trends ever since the 1960's and will continue to do so for the next 20+ years.

The inflection point for baby-bomer retirement was 2008 - It was the year when the leading edge of the baby-boomers first moved into retirement and the numbers are increasing exponentially! If we take 2005 as a base line, there were about 35 million people over age 65. By 2015, just four years from now, there will have been a 25% increase in people over age 65. By 2025, the number of seniors will have increased by 70%!

Today's seniors are fundamentally different from previous generations. They are a generation that marched for civil rights, protested war, opposed nuclear weapons, introduced a sexual revolution, demanded women's rights, opposed big business, introduced environmentalism, embraced the digital revolution, transformed medicine and communications, leveraged globalization and world banking, created new economic models, caused the colapse of communism, inspired an economic boom unequaled in the history of man, and much more...

They are a generation that expects change, - no, DEMANDS change. And so it will be in their retirement as well. Health, personal independence, quality of life, and staying active will be priorities. They will not go quietly into long term care facilities and they will not tolerate outdated services or poor accommodations. They will not passively follow tradition. They are a generation that expects a "Disney experience" in everything they engage.

In such change lie both challenge and opportunity for those who would provide baby-boomers with health services.

Here are some facts...
> The number of seniors is growing exponentially.
> Seniors will drive opportunity and expectations in most business sectors - especially health.
> Their use of medical services will increase dramatically- the use of rehab doubles over age 65.
> Over 75% of US wealth is controlled by people over age 65 and that percentage is increasing .

Seniors have the numbers and resources to get what they want. Every health provider needs to understand what it is that they want and what is will take to provide them with it. This tremendous increase of seniors who will require rehabilitation and conditioning holds great opportunity for qualified and competitive providers.
The Graying of America is causing old agendas and priorities to be replaced. It is changing spending and services It is changing economic realities for their children and grandchildren It's big, really BIG! If this reality isn't changing your business strategy, services and operations, your finanical and job security are both at risk.

The Graying of America is a Game Changer that demands your attention. But its not the only Game Changer at work - there is more, much more and it is coming at us like a freight train!

"We've put more effort into helping folks reach old age than into helping them enjoy it."
- Frank A. Clark

More next post... National Health!

All the Best!


(c) Copyright 2009