Instituting aquatic therapy programs can phenomenally change the shape and scope of any physical therapy clinic. For patients, walking on an underwater treadmill is an efficient and pain-free way to exercise, as it unloads the burden on the joints and allows individuals to perform at exercise levels they normally would not be able to.
Research has shown that, following surgery, aquatic therapy increases a person's mobility and endurance thanks to the water buoyancy that eliminates 20 to 90 percent (depending on the depth of the submersion) of an individual's body weight. In brief, that translates to patients beginning rehabilitation protocols earlier than they could with land-based physical therapy alone.
Aquatics attract clientele who might otherwise be limited when it comes to land-based therapy options. Additionally, marketing a clinic as a locale for aquatic therapy can have a substantial impact on the bottom line.
However, there are numerous aspects to consider when implementing aquatic therapy in a clinical environment; diving into aquatics isn't a cut-and-dry proposition. Considerations include whether or not aquatics is needed/wanted in the community, upfront and continuing financial investments, billing and reimbursement implications and, of course, revenue generation. Such factors have stopped some clinics from even investigating aquatics. However, with careful planning, deliberation and examination, these issues don't have to be deal-breakers.
Are Aquatics Really Necessary?
It's an excellent question to ask, and the only way to answer it is to go to current clients, referral sources and even the general public. Be aware that sometimes the community will say they want something but won't actually use it; this is where it's important to back your findings with realistic numbers and geographical/competitor stats.
When our clinic conducted a needs assessment to determine if increased aquatic therapy options would be beneficial to us and our customer base, we started by examining our current clients. We discovered that most were between the ages of 50 to 85, gender was split evenly and the majority of diagnoses were orthopedic: knee and hip total joint replacements, spinal conditions (including post-operative care), generalized weakness, fibromyalgia, chronic pain and post-operative surgical knee conditions.
Before we installed our own pool, we were using aquatics in a limited fashion in our orthopedic practice and seeing a profit. We knew that we wanted to diversify and expand our scope of services. When we realized both intuitively and statistically that we were receiving adequate reimbursement for our aquatic therapy offerings, we were confident that expansion was sensible and practical.
Aquatic services would be a natural addition to our business plan, ultimately enhancing the visibility of our therapy services. Plus, we had orthopedic surgeons and other health care professionals on our side, so we knew we would continue to receive referrals from that population of experts. For us, this progression took shape over months. It wasn't an overnight decision; it was one made with careful reflection.
How Much Will Opening a Program Cost?
The financial aspects of incorporating aquatics into a physical therapy operation will likely be the first questions on the mind of its owner and administrator. Certainly, aquatic therapy has its own set of needs, including a pool (or pools), peripheral aquatics equipment, upfront and continuing education for team members, and facility upgrades or changes.
Because the pool is the most critical piece of the puzzle, it's necessary to do a serious amount of homework, spending time initially looking into different pools and companies. Not all are created equal, as our Montana-based facility discovered. There are nuances both big and small that make all the difference. Investing in the right therapeutic pool is essential.
We investigated all current therapeutic pool lines and visited sites to see them in action. We spoke at length with physical therapists, athletic trainers and physicians.
In the end, we chose a pool with a treadmill and underwater camera hooked to a television monitor. It is kept at a temperature of 91 to 93 degrees Fahrenheit, has a massage hose attachment that we use as an adjunct to our pool treatment protocols and incorporates water jets for increased workout intensity.
Our pool setup gave us a plethora of options; not only could our physical therapy staff members provide clients with traditional aquatic therapy, but they could also use the treadmill and massage hose for added benefits. We appreciate the added benefit of watching biomechanics with the underwater video.
Walking on an underwater treadmill is distinctly different than walking in a regular pool. Clinically, we have observed that patients enjoy their sessions, exercise for longer periods of time and have a very low no-show rate for appointments when compared to our other facilities.
Before we signed the contract (one year in advance of the breaking-ground date), we thoroughly examined our financial picture with accountants and bankers.
Once we were comfortable with the figures, we moved forward knowing we had done our due diligence. From a fiscal standpoint, the return on investment (ROI) of purchasing a therapeutic pool has been a significant boon.
How Will Our Billing Model Change?
Each physical therapy business has its own billing model. Though most are similar in many ways, there are subtle distinctions that separate them. Adding aquatics to the list of therapy offerings necessitates a revamp of everything from coding to working with insurance carriers.
Each state has reimbursement rates and regulations involving aquatic therapy. It is very important to understand those aspects of this model. Though each physical therapy clinic needs to develop its own way of working with billing issues, there are some commonly used CPT codes that we suggest using for convenience and consistency:
97001 - Physical Therapy Evaluation;
97110 - Therapeutic Exercise;
97112 - Neuro Muscular Re-education;
97113 - Aquatic Therapy with Ther Ex;
97118 - Gait Training;
97124 - Massage;
97530 - Therapeutic Activities.
It has been our experience that having an all-staff meeting on these codes and any billing modifications is a vital factor in making sure any aquatics program succeeds from the beginning.
Will We Really Make Money with Aquatics?
Yes, the opportunity exists to make money with aquatics. Each physical therapy clinic needs to address marketing and public relations in its own way, but for those businesses willing to invest in proven techniques to attract clients, the upfront costs to implement aquatics can absolutely pay for themselves over time.
From our standpoint, marketing via newspaper advertising, physician-targeted brochures, media contacts and even social media outlets has been advantageous.
And there's nothing like old-fashioned word-of-mouth advertising, which constantly brings people into our aquatic facility. Certainly, your return on investment can be significant, but it takes planning, patience and professionalism. If you have those three elements in place, you'll be off to a solid start.
Is Aquatics for You?
Perhaps it's best to answer that with one patient's experience:
"After my snowmobile accident in which I fractured my femur and tibial plateau, I was unsure whether or not I would ever return to athletics. Walking on land was limited to about 10 minutes because I was in so much pain that I had to sit down. Once I got in the pool, my confidence, both mentally and physically, was completely restored. Being able to run and practice normal body mechanics without the pain and forces associated with gravity was so refreshing. Today, two years after my accident, I still don't think I would have had the confidence to try running if I wasn't able to experience it in the pool first. I was able to strengthen my muscles and transition to normal activities at a greater pace because I was not limited by pain."
Providing this type of service is an essential part of therapeutic intervention. Having an aquatics program in place creates many intangibles, such as unique niches, physician referrals and "outside-the-box" therapy thinking on the part of orthopedic surgeons.
Whether or not aquatics is right for you and your team will depend on many factors; however, there's nothing wrong with forging ahead to "test the waters."
References
1. Cole, A., et al. (2011). Pool Therapy to Relieve Osteoarthritis Pain. Spine-health, www.spine-health.com/wellness/exercise/pool-therapy-relieve-osteoarthritis-pain.
2. Desmond, A., et al. (2010). Health Benefits of Underwater Treadmill Exercise for Active Adults. HydroWorx Benefits in Active Aging Study, Department of Kinesiology, University of Wisconsin.
Keith Ori is a graduate of the University Of Montana School of Physical Therapy and is the founder and co-owner of Orthopedic Rehabilitation Inc., Kalispell, MT. Orthopedic Rehab has four clinics in northwest Montana, including Whitefish, Columbia Falls and Kalispell.