(unless someone does something about it)
Byline: Andrea Salzman, MS, PT
Insurance Companies Think Water is For the Weak. Insurance companies see the pool through the lens of "buoyancy". In other words, they see it as a place of ease. Their descriptions of the quintessential sample patients for whom aquatic therapy is medically necessary reads like a who's who of decrepitude. Sample of the perfect pool patient: "New amputee who is unable to perform gait training on land because he is too weak post- amputation." Sample: "Multiple sclerosis patient who is too weak to stand". These very sick or very debilitated patients may need the pool, but they are certainly not the only ones. Tell an insurer that aquatics is the place for end-of-rehab training and you will get a hearty guffaw and a quick denial. They do not understand hydrostatic pressure, nor viscosity. They do not understand the pool can be a challenging place to work.
Aquatic Therapy Has Its Own Reimbursement Code. The American Medical Association has given "aquatic therapy" its own billing code (97113). On the face of it, this sounds lovely. The code is even reimbursed at a higher rate. Therein lies the rub. Because payers reimburse at a substantially higher rate for "aquatic therapy" than they do for "therapeutic exercise" or any other land-based therapy, they have the power to deny its use unless (get this) research shows that aquatics is BETTER than land- based therapy. Not equal. Not untested. But research must show that it is statistically better. For more must-have aquatic therapy knowledge, check out our training "50 Novel Aquatic Therapy Ideas for PT, OT, RT & Other Providers."
Insurance Companies Are Making Decisions Based on Old Information. The Independent Medical Reviews that are being done by physicians at the request of payers (especially Worker's Compensation) arewoefully behind the times. These reviews are being used to do two things: 1. Generate local coverage determinations and Generate a concept of "medical necessity" for aquatic therapy. Well, garbage in means garbage out. The decisions that are being made by payers (typically, that aquatic therapy is not necessary) are often based on old or outdated understanding of aquatic therapy. Because of this, aquatic therapy is being suggested only in very limited circumstances (see #1 above).
Researchers Are All Doing Their Own Thing. Much of the aquatic therapy research that is done today is too imaginative. The researchers continue to try and re-create the wheel every time they do a study. There is no priorities list of which populations should be studied (an easy enough list to create based on census) and there is no "template" offered to the researchers. A template is essential. Why? In order for a systematic review to say anything (at all) there has to be enough studies with a similar "frame" to examine. If everyone looks at different populations and uses different outcome tools, it becomes very difficult to have a systematic review conclusion other than "Do better studies, people!"
Too Many Therapists Wear Polo Shirts to Work. So far, all 4 reasons for the potential demise of aquatic therapy are derived from external forces. Unfortunately, the 5th reason is not. We are partially responsible for aquatic therapy being seen as an unskilled treatment. Too many therapists who perform aquatic therapy do not get in the pool. Now, this is a mixed bag. Many therapists do get in the water. But loads of rehab clinics are set-up so that it is impossible from a scheduling standpoint for the treating therapist to get in the pool. This results in therapy that looks and feels like poorly done fitness instruction. There is no skill to it and there is no "power" to it. Patients are not wowed and they do not understand the potential of the pool.