Business Concept

(January 2022)

for

Indonesia German

- Medical Center for Active Rehabilitation -

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 Author :

Joerg Teichmann

Qualification: Sport Scientist, Univ. Degree, Sports Therapist ,

Position: Founder and Director Rehamed Therapy SDN BHD

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persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
Content

1 Concept of Business ............................................................................... 4

2 Facts - Back Pain, an Upcoming Social Problem ............................. 5

3 Approach .................................................................................................. 7

4 Concept of the Center of Excellence .................................................. 8

5 Realisation ................................................................................................ 9

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
1. Concept of Business

In the Island of Bali, Indonesia, a new competence center for active rehabilitation needs to be

built up.

The focus of the “Center of Excellence” is to treat patients after neurology, orthopedic, surgical

operations, and patients with non-operative injuries, locally, based on new concepts from

Germany.

The Center of Excellence enables patients to learn about what they are going through to achieve a

better and healthier lifestyle. A team of multidisciplinary staff has the responsibility to recover

patients with a long-term effect.

Due to the developing medical standards and excellent surgical options in Bali, patients no longer

feel the need or are required to fly overseas for such treatment. There is an increasing number of

patients that do undergo surgeries and non-operative (conservative) treatments within the Island.

Active rehabilitation plays an important role in the chain of an orthopedic and surgical-treated

patient, with the combination of physiotherapy, physical treatment, and active training. The focus is

to bring the most effective treatment standards and patterns into the “Center of Excellence”.

In the current time and age, humans have evolved to adapting to a move active lifestyle.

Unfortunately, due to illnesses and/or injuries, it becomes harder to achieve said lifestyle with pain

and discomfort. Therefore, the Center of Excellence is prioritizing treatment and prevention

programs for these people.

The following de-conditioning of the body occurs after injury or with health problems:

- Decreasing power of the core strength to stabilize the whole body

- Reduction of strength of all active muscles

- Decrease of flexibility and coordination

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persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
- Reduced cardiovascular endurance capacity

- Reduced realization of normal functional movements

According to these physical changes, treatments must be based on a multidisciplinary approach,

proven by current studies (Hildebrandt; Mannion; van Tulder;).

A specification on back treatment offers a spectrum for treatment of a client with decreased

conditions until a severe back pain patient, who needs a high quality-managed and multidisciplinary

treatment program for a long-term success.

2. Facts – Injuries and Back Pain: An Upcoming Social Problem

All non-operative treated and surgical patients need for best treatment results an

excellent after-care.

In general, it can be summarized that ankle, knee, hip, pelvic, back and shoulder injuries

require a passive and active treatment concept.

In addition, the field of metabolic syndrome, obesity and cardiovascular diseases

require rehabilitation and pre-rehabilitation (before injury disease occur) concept, which

is a combination of passive and active treatment.

The “Center of Excellence” combines physical treatment, physiotherapy and active

training with medical tests for motor skills in order to get high progressive treatment

success on top of quality management.

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 Low back pain rank high amongst the reasons for physician office visits and is costly in

terms of medical treatment.

More than 35% of the population within an industrialized country face back problems

and at least 80% have, at least, faced it once in their lives.

40% of employees’ sick days are related to back problems. The number one reason for

retirements is referred to back injuries.

Back injuries and its consequences are high economic costs for a country due to medical

treatment and sick days of employees.

(Source: Pain Foundation 2007)

Thus, prevention is of utmost importance to avoid health drawbacks and costs for later

treatments.

Denpasar is the most populated city Bali with around 900,000 inhabitants. Due to

the strategy of unifying the healthcare policy in Indonesia and the improved health

care in total, it makes business sense to implement the aftercare with local

knowledge combined with German standards.

Active Treatment – Modern Concept

The above-mentioned indications need to be treated with a complex multi-focused concept. The

concept can be separated into different phases:

Phase 1: Pain release and wound care

Phase 2: Mobilisation

Phase 3: Regaining mobility

Phase 4: Stabilisation of motor skills

Phase 5: Prevention for avoiding future injuries.

Based on these phases, physical and physiotherapeutic treatment and training is a necessity for

human beings.

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 Back Pain Treatment – Multidisciplinary approach

Back pain treatment is a non-standardized process, which is sometimes not very ideal because of

the complexity of this injury.

Several scientific research have proven that a multidisciplinary approach for treatment can

break through the vicious cycle of back pain.

Physical conditioning programs, supervised by a multidisciplinary team, that include a cognitive-

behavioral approach plus intensive physical training (training of aerobic capacity, muscle

strength, endurance, and coordination, seem to be effective in reducing the number of sick

daysfor workers with chronic back pain when compared to the more common medical

approach of medication and rest (SCHONSTEIN 2004).

An integrated back pain treatment concept comprehensively fights the circle of pain and

successfully links therapy programs which include strength, endurance, and cognitive training.

3. Approach

A superior approach of a “Center of Excellence” is to get a perfect health and good quality of life

especially focused on the vertebral column.

Orthopedic injuries and related diseases, which are related to metabolic syndromes, obesity, and

cardiovascular limitations, affect people of all ages and sex. The focus is to help the general

population realize that these injuries and diseases affect our daily lives and job-related functions in

a negative way. For that reason, treatments should revolve around the following approaches:

- isolated to integrated approach

- multidisciplinary approach

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
4. Concept of the “Center of Excellence “

The clinic is a professional medical center, which obtains its professional focus with the

interdisciplinary approach. The clinic focuses on the treatment of back pain patients, Orthopedic

injuries Neurology injuries and cardiovascular diseases.

Medical diagnostics is one of the most important disciplines for analyzing an injury and/or sickness.

With the support of the test of the strength capacity, endurance level, coordination and spinal

posture analysis, and the knowledge and experience of the physicians, an exact diagnosis and

progress management can be discussed.

Unfortunately, 80% of back pain patients have a non-specific diagnosis of their back. In addition to

that, all post-surgery patients require passive and active rehabilitative care. For this very reason,

both patient groups, non-operative and operative treated persons, a passive (e.g. manual therapy

and physiotherapy) and active treatment is absolutely necessary. Aside from that, we also consider

the prevention group, whose interest is to avoid these health barriers or lower the risk of

reoccurrence. We may not forget the prevention group, whose interest is to avoid problems. Many

of these problems faced by the prevention group include, but are not limited to, inactivity, casualty,

and repetitive physical demands from work.

The clinic needs to focus on following active treatment groups:

- Active rehabilitation after surgery

- Active rehabilitation after conservative (non-operative) treatment

- Prevention training

- Prevention for non-operative patients

- Prevention for operative patients

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 • Physiotherapy:

o Different treatment tables (2-parts, 3-parts,)

o Interference, middle-frequency and diagnostic product

o Cryotherapy

o Small exercise devices as swiss ball, wall bars, mats

• Active Rehabilitation

o SRT Treatment

o Kardiomed Endurance devices with Kardiowell concept: a test and training system

for analysing the endurance capacity and planning of training based on a metabolic

concept.

o Compass Smart Panel strength line with Powerwell concept: stack machines for

extremity training including a test and calorie-based training software.

The overall concept of these product groups is the transfer from test to training, which gives an

individually personalized treatment for each patient. With the help of the test figures/results, a

successful training can also be monitored and a comparison to reference values of healthy subjects

can show the differences between the physical states of a person.

With a biofeedback training of the SmartPanel devices system patients are very motivated to

exercise on the machines. The comparison to the target curves monitors the quality of the training.

5. Realisation: Minimum Space Area and Equipment Example

To carry out the above-mentioned goals, there must be a flow to the structure and minimum space

area. The following images show the intended equipment and functional layout for the Center of

Excellence in Bali. This example can be transferred to any facility in Indonesia:

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
Details to the required work space:

• Reception for registration incl. waiting area: ~ 8 m²

• Changing room for male and female incl. shower and lockers: each 12 m²

• Physiotherapy: minimum of 25 m²

o Consultation Room’s

§ A minimum of 2 treatment rooms (> 8-12m²)

o Height needs to be at least 2.5 m

• Active exercise treatment: in total ~50 m²

o Diagnostic (Endurance, Coordination, Spinal Posture): ~10 m²

o Diagnostic and treatment: lumbar spine: ~6 m²

o Training Endurance: ~5 m²

o Strength Training: ~30 m²

o Training coordination / flexibility: ~10 m²

Specifications for human resource:

• Medical Doctor specialized in Rehabilitation and/or Sport medicine

• Physiotherapist and/or Strength and Conditioning Trainer with experience in medical

training therapy

• Massage Therapist

• Receptionist

Specifications for machines:

• To realise this concept, the machines from different product groups needed are:

Physiotherapy Products

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 Physiotherapy Tables + Massage Tables

Description: Features: Price:

Vario-Line Technical:

Manipulate 2-section 1500, - US Dollar 3x

Height adjustment: 40
reposing area.
– 100 cm
Special treatment Size: 200 x 65 cm
Head part adjustable:
table for
+ 30° until – 90° by
manipulation and gas spring

therapy. Frame made

of high-quality steel

profiles. All Joints in

Teflon-bushes. Linear

height adjustment

Height adjustment: 40
– 100 cm
400,- US Dollar 3x
Size: 200 x 65 cm
Head part adjustable:

Electrotherapy-products

Description: Features:

IONISON IF Expert. 1200, - US Dollar 1x

- Medium-
The combination unit
frequency current
for two-channel (IF, AMF, MT,
KOTS)
electrotherapy and - Low-frequency

ultrasound. currents (G, GMC,

DF, …
- Ultrasound
(separate or
simultaneous

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 Electrotherapy Transportable 150, - US Dollar 3x

Proxomed Products

Compass SmartPanel devices – for Strength Test and Training

Description: Features: Price

The compass device leg press is a test and • Seat Adjustment 32000, - US
training device for evaluation and training of • Back rest adjustment
the leg and pelvic muscles. The small • Foot plate incline adjustment 1x
increments of the weight stack and variety of • Pneumatic shoulder support
adjustments allows to adapt the device • Fine increments in 2 kg steps
perfectly to the needs of the patient.
• Stepless Variable ROM Limiter
SmartPanel Features:
The software in the SmartPanel, which is
Technical Specifications:
attached to the machine is the link to a test
• Protection Device
and training software on a pc. In addition you
• Meets Requirements of MDD
are guided through an individual training
program.
• Isometric Test
• Dynamic Test
• Feedback training with Target Curves

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 Description: Features:
The compass device Trunk Extension / • Starting angle adjustment in 28000, - US
Flexion combi is a test and training device 10°
for evaluation and training of the pelvic, • Pneumatic Seat height 1x
abdominal and back muscles. The small • Height and depth adjustment
increments of the weight stack and variety of for pelvic stabilisation
adjustments allows to adapt the device • Fine increments in 1 kg steps
perfectly to the needs of the patient.
• Stepless Variable ROM Limiter
SmartPanel Features:
The software in the SmartPanel, which is Technical Specifications:
attached to the machine is the link to a test
• Protection Device
and training software on a pc. In addition you
• Meets Requirements of MDD
are guided through an individual training
program.
• Isometric Test
• Dynamic Test
• Feedback training with Target Curves

Functional Training

Compass Speedy S Pulley System

Description: Features: Price

Functional training for all Technical:

9000,- US 1x
kind of activity of daily
Size (LxWxH): 700 x 600 x
living
2400 cm
Weight stack: 80 kg
Weight increments: 8 x 2 kg,
13 x 4 kg

Balance boards and more

Different Therapeutic Price:

Equipment: 400, - US Total
Mats, Balance boards, any kind of balls
etc. are necessary for a functional
challenging training

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
Cardiomed Endurance Machines

Endurance training is needed for the multidisciplinary treatment of non-specific back pain patients.
Endurance training shows a lot of specific positive aspects. Focus is of course the improvementof
the cardiovascular, pulmonic and metabolic system. But also local blood flow and local and global
pain tolerances are important goals to achieve. A common positive effect is the body shape, which
has effects on psychological level.

The Kardiowell software supports to optimize the training. With a sub maximum test the correct
training heart rate will be calculated. With the support of a calorie calculator a recommended
training amount will be advised.

Following Ergometer’s are recommended for this concept:

Kardiomed UBC

Description: Technical Specifications: Price:

The Kardiomed Comfort for
training of lower • Magnet-Induction-Brake 4500, - US
extremities in sitting (IBS)
position. Best for obese • Watt Load from 25 – 500 W 1X
and back pain involved • Network Independent Power
persons. Supply
• DIN VDE 0750 (PTB Norm)
for cardio-vascular
rehabilitation
Size (LxWxH): 155 x 128 x 62
cm
• Weight: 60 kg

Description: Technical Specifications:

The Kardiomed Basic Cycle 3500, - US
allows training dependent • Magnet-Induction-Brake
of speed and independent (IBS) 2x
of speed. Furthermore an • Watt Load from 25 – 500 W
isokinetic modus is • Network Independent Power
implemented, to work with Supply
a constant speed and • DIN VDE 0750 (PTB Norm)
variable resistance. for cardio-vascular
Especially in the earlier rehabilitation
phase of rehabilitation it Size (LxWxH): 120 x 60 x 145
can be used to train cm
exceptionally gentle and • Weight: 46 kg
carefully.

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
 Coordination Training

SRT Machine

Description: Features:
Stochastic resonance therapy (SRT)
is a form of whole-body vibration
therapy that uses randomized stimuli
that are amplified with the help of Dimension: 120 x 80 cm³
noise The vibration output from SRT is
different from that of a regular WBV in Weight : 80 kg
that it is random and unpredictable.

Price: 75000, - US 2x

Balance system Price: 4500, - US 1x

6. Concepts and Prices

Within the concepts offered in the business concept there are several options.

Complex treatment of orthopedic injuries

For different indications you can standardize a concept, in which passive and active treatment is
included. It is possible to start with a basic package, which you always can extend. This would also
be on the base of German reimbursement system.
E.g.
1. Session 2. Session 3. Session 4. Session 5. Session 6. Session 7. Session 8. Session 9. Session 10. Session
120 min 120 min 120 min 120 min 120 min 120 min 120 min 120 min 120 min 120 min
passive passive passive passive Passive Passive Passive Passive Passive Active
treatment treatment treatment treatment treatment treatment treatment treatment treatment training
Test and manual manual manual Active Active Active Active Active Test and
assessment therapy therapy therapy training training training training training Assessment

60, - US 60, - US 60, -Us 60, -US 60, -US 60, -US 60, -US 60, -US 60, -US 60, -US

è 600, - US

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
Within the passive treatment depending on indication and contraindication electrotherapy, cryo, hot
packs, microwave, ultrasound is used. Also massage can be proposed.
Within the test and assessment, you select all data of health care (weight, fat proportion, height,
blood pressure,.) and problems (anamnesis). In addition a certain test depending on the injury can
be done: endurance, coordination, strength, posture analysis,
Within the manual therapy different exercises are done to decrease pain, increase wound healing, …
Within the active training. Training at the strength machine and or at the cable column can be
realized.

- Spine related programs

1. Session 2. Session 3. Session 4. Session 5. Session 6. Session 7. Session 8. Session 9. Session 10. Session
60 min 60 min 60 min 60 min 60 min 60 min 60 min 60 min 60 min 60 min
passive passive passive passive Passive Passive Passive Passive Passive Active
treatment treatment treatment treatment treatment treatment treatment treatment treatment training
Test and manual manual manual Active Active Active Active Active Test and
assessment therapy therapy therapy training training training training training Assessment
50, -US 50, -US 50, -US 50, -US 50, -US 50, -US 50, -US 50, -US 50, -US 50, -US

è 500, - US

Within the passive treatment depending on indication and contraindication electrotherapy, cry, hot
packs, shockwave, ultrasound is used. Also, massage can be proposed.
Within the test and assessment you select all data’s of health care (weight, fat proportion, height,
blood pressure,) and problems (anamnesis). In addition a tergumed 3D test can be done.
Within the manual therapy different exercises are done to decrease pain, increase wound healing ,…
Within the active training. Training at the strength machine and or at the cable column can be
realized. Depending on pain level tergumed 3D could be focused on as a 1 to 1 training with
biofeedback. If the patient is in a more stable situation a training on SmartPanel compass can be
done.

Team:

Secretary 1x

Business Development 1x

Human Resources 1x

Doctor free lance 1x

Physiotherapist 4x

Masseuse 1x

Sporttherapist 1x

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
Specification:

The center needs an estimate of 25 - 30 patients per day!

Open 10 hours per day

Each physiotherapist can treat 1 patient in 45min

Total investment on a one-time cost for machines etc. (not inclusive of renovation, rent,

salary,electricity, water etc.): approximately US$250,000.

With your advice on the salary scale, other human resource expenditures such as employee

provident funds and other related costs, including taxes in Indonesia must be factored into this

initial investment for the next 2 years projection.

A rough estimate of the above combined investment in year 1 would be approximately US$300,000.

Prepared by
Joerg Teichmann

This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.
This document was prepared by Joerg Teichmann, and contains information which is private and confidential to the
persons to whom it is provided. All materials, unless otherwise stated, are copyright of Joerg Teichmann. The content
within this presentation may not be used or copied without prior, specific, written permission from Joerg Teichmann.