Positioning Aquatic Therapy in a Changing Healthcare Enviroment

Positioning Aquatic Therapy in a Changing Healthcare Enviroment

The following post has been  contributed by one of HydroWorx’s first customers, Ted Yanchuleff, P.T., A.T.C. and Manager of Outpatient Rehab Services for the Pinnacle Health System in Central Pennsylvania

Group of People doing water therapy

On a daily basis, therapists and healthcare administrators try to balance trying to provide evidence-based care in a reduced reimbursement climate. Therapists want the latest technology for their patients, while administrators require increasing returns on investments for the purchase of new equipment or program start ups.  Is there a “Win-Win” scenario for both?  Literature may suggest that establishing an aquatic therapy pathway for patient care may be the answer!

Clinically, the principles of water such as buoyancy, hydrostatic pressure, and viscosity provide a medium for multiple case-mixes to enhance their functional mobility via water therapies.

Buoyancy allows for an environment where land based gravitational effects can be reduced via changing the depth of the water the patient is working in with an adjustable pool floor. Thus, allowing aerobic exercise with little or no impact forces through the joints. Hydrostatic pressure can assist patients with problems with edema by allowing the return of pooled blood collected in the extremities.  The deeper one is submerged in the pool the greater the pressure. Lastly, viscosity is friction in water and as the viscosity increases the resistance to movement increases as well. This is a key to resistance exercises utilizing the water medium.

Once the aquatic provider understands these and other principles of water, then the ability to established customized plans of care over various case-mixes such as pediatric, orthopedic, neurological  and geriatrics is only limited by the provider’s imagination and the patient’s active commitment to the program. For many of these patients, an aquatic therapy program would allow for the following therapeutic benefits:

  • Controlled Weight Bearing
  • The ability to exercise at a lower heart rate
  • Decrease compressed forces on the joints and spine

A review of the literature indicates positive improvements in the areas of flexibility, strength, de-conditioning and range of motion when aquatic therapy is part of the treatment plan for various pathologies.

So then, why aren’t their pools in every therapy department? What is the “Mission” of most organizations in their commitment in providing patient focused care? Unfortunately, in many cases the theme of “No Money – No Mission” echoes in the need to make a profit in the  rehabilitative product line. The Art of Aquatic Therapy now comes into play in understanding the concepts of billing, documentation, and reimbursement. In order for aquatic therapy to be profitable, one must master the use of CPT coding, and insurance verification and authorizations. To better understand some aquatic procedure codes, a therapist would in some cases have to determine if utilizing a 1:1 code that could be billed for every 15 minutes of services is in the best interest of their patient or place the patient in a multiple group setting and utilize the “group code” for which one code is billed for the entire session would satisfy the needs of all patients involved.  The Outcome may not be different, but the reimbursement has significantly changed.

Specifically, in most 1:1 sessions the CPT code 97113 Aquatic Therapy code requires “Therapeutic Exercises or procedures that were performed in water utilizing buoyancy, resistance, and other therapeutic procedures in water to better facilitate movement, strengthening, and functional recovery.” Group Therapy is recognized under CPT code 97150 and for reimbursement requires that therapy was “provided to a group of patient’s with a therapist in constant attendance, but by definition, not providing 1:1 direct care.” An Example includes an instructional class in a water medium such as “joint school” designed for a group of similar patients on similar plans of care.

The Art of Aquatic Therapy continues in trying to understand the reimbursement position that varies with insurance carriers when aquatic therapy is utilized in plans of care. Some carriers feel that coverage should be limited to musculoskeletal conditions thus limiting coverage and benefits to a large segment of their subscribers. Others feel that aquatic therapy is experimental or should not be covered in a group setting thus excluding coverage in the benefit plan.

Person participating in underwater therapy with instructor

However, if one can obtain the support of their land based therapy referral sources, and blend the clinical benefits of aquatic therapy with the business acumen of understanding the requirements of the insurance industry then aquatic therapy maybe a profitable product line for your organization.

If so, weigh the risk vs benefit and jump in, the water maybe warm for aquatic therapy to be utilized as a profit center for your organization.

To view Ted’s webinars on demand click here! 


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