Chiropractic wellness centers located within health clubs prove beneficial to all, especially patients

From left: Peter DiGuilio, Kencare Management LLC cofounder and principal member; Spencer M. Broad, DC, Karmich Chiropractic LLC managing member; and Jason M. Conviser, PhD, FACSM, Bally Total Fitness vice president of clinical services.

During the past 4 years, Spencer M. Broad, DC, and his colleagues estimate they have burned "a couple of billion calories" engaged in strenuous sales, marketing, and administrative exercises while installing chiropractic offices in health clubs throughout the Mid-Atlantic region. So far, though, they have not shed a single pound. And neither has their enterprise—Karmich Chiropractic LLC—which, to the contrary, has gained in size. But that is the whole idea, Broad assures.

"At present, we’ve opened 24 of these facilities in health clubs that include Bally Total Fitness, Gold’s Gym, LA Fitness, and individually owned health clubs in Pennsylvania, New Jersey, and Washington, DC," says Broad, CEO and chief doctor of chiropractic for Philadelphia-based Karmich, known as Karmich Wellness Centers. "We’re scheduled to open six more by this coming June, with expansion into Virginia."

Fitness Buff

Broad says the enterprise has been operating in the black since 2000, its second year of operation. "Not one single health club has cancelled or discussed canceling our arrangement," he offers. "The managers of the clubs have told us that they are very pleased with our program."

Each Karmich Wellness Center is staffed by at least one full-time, sports-health chiropractor and other personnel as required. "The centers specialize in the combination of chiropractic care, supervised physical rehabilitation, nutritional and weight-loss counseling, and all necessary forms of diagnostic testing," explains Peter DiGuilio, cofounder of Kencare Management LLC in Pennsauken, NJ, which manages Karmich Chiropractic. "Many of the health clubs where we have wellness centers also have swimming pools, so we are now developing a special aquatic therapy program."

Brian Baldia, DC, performing a postural analysis to detect spinal misalignment.

The Karmich sites are open mornings through evenings, Monday through Friday, and on Saturday by appointment only. The most common complaints seen at these locations are back problems, followed by headaches, shoulder pain, miscellaneous stress-related problems, carpal tunnel syndrome, and temporomandibular joint syndrome.

Karmich currently has 26 chiropractors deployed at these centers—all of whom are employees of Karmich Chiropractic. "We hire chiropractors to be dedicated full-time to our enterprise, which means they have to give up their outside interests in another practice," says DiGuilio. "In some instances, we’ve purchased the practices of the chiropractors we hire and simply moved them into a Wellness Center."

DiGuilio believes the newly hired chiropractor who is most successful in this type of arrangement is one who enjoys working in a health club environment. "Our doctors possess what we call a ‘fitness center personality,’ rather than one befitting a conventional clinical setting," says DiGuilio. "Having this type of personality enables our doctors to better blend into and become an integral part of the health club staff and programs. This is crucial to the success of our concept."

For a chiropractor interested in volume, the attraction of working in a Karmich Wellness Center is the direct access to what is, in effect, the most tightly targeted and desirable group of prospective patients imaginable. "You can’t beat this kind of exposure," says Broad. "Thousands of people pass everyday by the Karmich Wellness Centers and are able to see into the chiropractic offices, getting a better understanding of what the chiropractor does—every one of the centers has glass windows and an open adjusting area. Many people have never seen the inside of a chiropractor’s office. We’re taking the mystery out of it."

Within and Without

Just happening to pass by the Karmich Wellness Center en route from the lockers to the stair climbing machines is not the only way members find out about the availability of chiropractic and related services in their club. "The centers are announced to members through periodic mailings, as well as by posters displayed in strategic locations around the club," says DiGuilio. "Additionally, we conduct health care classes and seminars for the members and club staff. We also participate in all internal and external health fairs sponsored by the health club. At those, our chiropractors perform spinal screenings and other evaluations, and provide other services and products to help make the health fair successful. Spinal screenings, performed with a spinal analysis machine, are also offered periodically in the lobby of the health club."

As a part of posture treatment, Baldia supervises stabilization exercises.

The Karmich doctors themselves play a role in marketing. Primarily, they participate in the club’s activities, such as spinning classes, and use those occasions to meet members, talk informally about health issues, and invite them to drop by the Wellness Center, DiGuilio indicates.

As for external marketing, Karmich advertises in local media and lists the locations of the health clubs where the Wellness Centers are located. And, says DiGuilio, a network of "cooperating companies and professionals are being developed for referrals, including MRI centers, attorneys, DME providers, orthopedic surgeons, neurologists, medical doctors, and outside chiropractors."

Soon, Karmich officials hope to begin making the centers known to local employers who might be interested in starting or augmenting a work-related injury prevention program. "The way we envision this being marketed is to companies via their human resources department and workers’ compensation panels," DiGuilio explains.

Of all the ways, internal and external, that the Wellness Centers are marketed, the most effective appears to be free evaluations offered as a privilege of membership. According to DiGuilio, each club provides Karmich a list of new and renewing members, who are then contacted by Karmich’s telemarketing staff and offered a complimentary health examination at the Wellness Center. If the member accepts, the telemarketer schedules a date and time convenient for the member. When the member arrives for the appointment, he or she spends 20 minutes with the doctor. DiGuilio will not talk specifics, but he hints that the conversion rate of members who become regular patients afterward is impressively high.

"It gives us exposure to upwards of 200 new members each month, but it’s effective because it gives us a chance to spell out to the members in a personal, one-on-one conversation the benefits of utilizing the Wellness Center," says DiGuilio.

Novel Idea

The genesis of the Karmich Wellness Center concept dates back to 1997. One day, while knocking around ideas with a client of theirs, DiGiulio and Berdj Kalustyan—friends who had been involved in the financing and supplying of equipment for the health care field for nearly 25 years—entertained the notion of placing physical rehabilitation centers in health and fitness clubs. "We researched the market and found that there were only a few companies doing that kind of thing," says DiGuilio. "These companies did not appear to be organized, financed, and managed professionally. However, the concept made sense, since there are thousands of potential patients in every health club."

Convinced the health club model had merit, the pair proceeded to develop it. Originally, they were going to use physical therapists to run these rehab centers. However, further market research suggested that it would be more advantageous to have chiropractors who possessed adjunctive procedure licenses and physical rehabilitation training in charge. "We realized that potential health club patients would find it more convenient to visit a chiropractor, since they would be able to do so without a prescription," DiGuilio explains. "A prescription would be required if the only type of practitioner available at our centers was physical therapists."

At this point, DiGuilio and Kalustyan recruited Broad to serve as the clinical partner in their planned enterprise. Broad had acquired Karmich Chiropractic in 1997 after spending the previous 18 months working for a large rehabilitation services provider that he had joined following 10 years in private practice. Kencare Management LLC was formed to oversee Karmich and, specifically, to develop the club model.

"We opened a total of seven Wellness Centers as beta sites during the course of 2 years," says Broad, a 1985 graduate of Pennsylvania College of Chiropractic in Langhorne, Penn, who holds a master’s degree in education from Temple University in Philadelphia. "During that time, we noted various shortcomings in our design of the model and took the necessary steps to resolve them."

One of the problems was a need to arrange for sufficient space from the host clubs. Too little space made it impossible for the doctor and support staff to properly serve the patients, the team noted. "The minimum amount of space we found that works is 400 square feet," says Broad. "But it wasn’t just a question of adequate space. The space had to be in a location where the Wellness Center would be visible. Without visibility, the center would not receive the exposure to members we felt it would need to attract and sustain sufficient utilization."

Broad performs a manipulation of the thoracic spine.

Another problem was somewhat beyond the control of Karmich, and that was high rates of turnover among employees of some of the clubs. The frequent replacement of staff meant that Karmich would have to spend more time and effort than expected on training new employees of those clubs.

"The club employees are considered an integral part of the success formula for our centers, since they are a key referral source," says DiGuilio. "When club members ask someone on the club’s staff basic questions about the Wellness Center, we want them able to give appropriate and knowledgeable answers, which we could only count on occurring if the staff were educated and trained for that."

Recruiting the Best

Finding and selecting the right chiropractor for the right club was also a daunting task, Broad says. This required Karmich to create a recruitment program that includes use of the company’s website (www.kar michchiro.com). "Our website is linked to several search engines and all chiropractic colleges," says Broad. "In addition, we have a list of all licensed chiropractors in a specific area so that we can directly mail employment opportunity notices to them."

Once chiropractors sign on with Karmich, they undergo extensive training in the company’s policies and procedures, all of which are spelled out in a manual of more than 400 pages.

"Each chiropractor receives 3 weeks of formal training in the business of running a center," says Broad. "The training covers billing, collections, practice management, and marketing. The majority of those functions are handled for chiropractors at the corporate office so that they can be free to concentrate on patient care and on building relationships with the health club staff. But, still, we want them to know about the business aspects. Our entire operation is more efficient and effective that way."

Following training, chiropractors can expect additional instruction at regular intervals. For example, all of the doctors are required to attend monthly meetings where various clinical and practice management topics are presented. "Some of the instruction is provided by consultants from the outside and some from our own in-house experts," says DiGuilio. "Our basic premise in requiring doctor participation in these presentations is that knowledge is power."

Knowledge is also advanced by computers, which link all of the Wellness Centers to the corporate office. The system tracks billing and management information, and is essential in helping chiropractors understand how their individual centers are performing. "Each week, every doctor receives a ‘critical controls’ numbers report, as well as a monthly ‘report card,’ which is a combination financial statement and patient management report," says DiGuilio. "Providing this kind of information is invaluable because, if the doctors do not know where they have been, they will not know where they should be going."

The same is true for the company, which knows exactly where it is going—up. According to DiGuilio, Karmich aims to have a total of 110 Wellness Centers by the end of 2005. What’s more, the services provided will broaden, with greater emphasis on diagnostic testing, durable medical equipment supplies, nutrition, orthotics, and weight-loss products, he discloses.

For Broad, an exciting aspect of the Karmich model is the contribution to the larger interests of the chiropractic profession. "It’s helping create a greater awareness of chiropractic in general," he contends. "Thousands of people are learning that chiropractors do more than ‘crack backs.’ If every one of the more than 5,000 health clubs in the United States had a wellness center with at least one chiropractor, the profession would be able to educate more than 15 million people every day."