the aquatic therapist

Questions about the Pool and Spa Safety Act? Here are your answers

Did you miss the Aquatics International webcast on implementing the Pool and Spa Safety Act?

Experts from CPSC, APSP and other industry pros discussed the Act in a roundtable discussion. Here is the Q&A session from registered participants to some of the questions asked and answered.

Note: We have not received any response from the CPSC to our questions about whether therapy pools must comply with this act. We will keep you posted, but for now, assume that you must even though therapy pools are not always considered "public pools" by the states.

It's a "best practice" issue even if it isn't the law.

Great download: The APTA answers your frequently asked billing questions

Answers to these questions (PDF) and more:

[Editor's note: The APTA answer to the question about whether therapists must have exclusive use of a community pool for Medicare patients is no longer accurate. Since this audioseminar took place Medicare has changed its policy to allow therapists to use a PORTION of a pool for their clients.]

SAMPLE QUESTIONS ANSWERED IN THIS PDF:
Q: Is the 2008 therapy cap of $1810 the allowable rate or actual payment received?

Q: Why do the therapy caps not apply in outpatient hospital departments?

Q: Is it okay to offer Medicare patients an “aftercare” program if they use up the cap at a
reduced rate or flat fee? What if the PT or PTA is also certified as a Personal Trainer or
CSCS?

Q: If a Medicare beneficiary has therapy in an outpatient hospital department (exempt
from the cap) and later goes to a private practice, does the private practice have to include any money spent by Medicare at the hospital based facility?

Q: Does the Medicare program require a referral/prescription/order for outpatient
physical therapy services?

Q: Are physical therapists allowed to bill for the plan of care? Is the code the same as a
progress note?

Q: Does the 90 day recertification period apply to both Medicare A and Medicare B
residents in a SNF? Does the fact that we bill for the services provided to our outpatient
beneficiaries on the UB-04 form make a difference?

Q: Can you tell me if there are any Medicare regulations or policies on whether or not a
private practice can determine how many Medicare referrals they will take?

The Medicare Advisor on Medicare rules for hospital vs. private practice pool use

SCENARIO: Do Medicare rules about community pools relate to hospital therapists?
Query: I am employed by a hospital and perform outpatient PT in an area leased from the hospital's wellness center. Can I bill Medicare for aquatic therapy for my patients, if other pool users are in the pool when I am treating my aquatic therapy patients? My CFO informed me that since the wellness center is owned by the hospital, private practitioner rules and regulations do not apply. Read the "Medicare Advisor" answer (tab down to 2nd question)

The design matrix: Calculating the costs and benefits of putting in a therapeutic pool for aquatic therapy

Hot dog. Your administrator is finally on board and the new facility is going to include a therapy pool. Or you have finally decided to stop using the pool at the local Y or hotel. Unfortunately, you’ve been assigned the task of determining how much to budget for
the construction and yearly operations of the pool. Gulp.

Getting the ball rolling The first smart decision you can make is to attend a conference and/or hire a consultant to help you with the project. This is too big a potential money-pit to have a novice making decisions.

Here are the best resources available to help you design your pool right the first time.

QUICK LINK:  Design Matrix Article: Designing Therapy Pools for Aquatic Therapy

MANUALS & BOOKS:
How to Successfully Launch an Aquatic Therapy Practice (manual)
To order: info@aquaticnet.com
Nearly 300 pages. Comprehensive guide to designing, building and/or buying a therapy pool. Also includes practice information on billing, programming, documentation, etc.

How to Successfully Launch an Aquatic Therapy Practice (DVD of 3 day seminar)
To order: info@aquaticnet.com
3 days of programming from annual conference of the same name. Comprehensive guide to designing, building and/or buying a therapy pool. Also includes practice information on billing, programming, documentation, etc.

Developing an Aquatic Physical Therapy Program (manual)
To order: aquaticpt@assnoffice.com

Aquatic Therapy Policy and Procedure Manual (manual and CD)
To order: h2obabies@cox.net (Lynette Jamison)

CONSULTANTS:
Andrea Salzman, MS, PT
Aquatic Resources Network
Plymouth, Minnesota
Email: asalzman@aquaticnet.com

Alison Osinski. PhD
Aquatic Consulting Services
San Diego, California
Email: alisonh2o@aol.com

Doug Cook, PE
Counsilman/Hunsaker & Associates
St. Louis, Missouri
Email: dougcook@chah2o.com

Mick Nelson, Director Club Facilities Development
USA Swimming
Colorado Springs, Colorado
E-mail: mnelson@usaswimming.org

Ask ARN: Lightning storms and aquatic therapy pools

The Aquatic Resources Network gets questions from clinicians each day. We think everyone should learn from the answers!

Question: Should we close our therapy pool during lightning storms?

Answer: The first place you should look is at your state code for swimming pools. To get a copy for your state, click here for state pool codes.

If there is nothing there, your state probably does not regulate the issue. You can then look to outside authorities.

For instance, here is a site on lightning safety and indoor pools.

Be aware that six states have recommendations or regulations for suspending indoor pool activities when under lightning threat: Delaware, North Dakota, South Dakota, Maryland, Rhode Island, and Michigan. Delaware’s state code reads "during electrical storms the use of a pool (indoor or outdoor) shall be prohibited."

Several large national groups describe building interior pool hazards (*) or have recommended indoor pool activity suspension (**) when nearby thunderstorms threaten. See:

National Athletic Trainers Assn.** (NATA)
www.nata.org (type "lightning" in search box)

National Collegiate Athletic Assn.* (NCAA)
www.ncaa.org/library/sports_sciences/sports_med_handbook/2002-03/1d.pdf

American College of Emergency Physicians ** (ACEP)
www.acep.org (type "lightning" in search box)

US Swimming, Inc. **
www.usa-swimming.org (type "lightning" in search box)

YMCA Services Corporation**
www.yservicescorp.com/Docs/Guidelines/LightningPoolGuide.doc

All pool buildings should be equipped with lightning protection as specified in the most recent version of National Fire Protection Association NFPA-780 Standard for the Installation of Lightning Protection Systems. Special attention should be paid to surge protection and bonding issues. A comprehensive inspection should be conducted by a qualified electrician every five years.

CMS Issues New Directive on Community Pool Leasing

The Centers for Medicare and Medicaid Services (CMS) has issued a long-awaited new directive that allows aquatic therapists in private practice to rent or lease a specific portion of a community pool, rather than being required to rent the entire pool when providing services to Medicare patients.

CMS Transmittal 88 that was released on May 7th states:

When therapy services may be furnished appropriately in a community pool by a clinician in a physical therapist or occupational therapist private practice, physician office, outpatient hospital, or outpatient SNF, the practice/office or provider shall rent or lease the pool, or a specific portion of the pool.

The use of that part of the pool during specified times shall be restricted to the patients of that practice or provider. The written agreement to rent or lease the pool shall be available for review on request.

When part of the pool is rented or leased, the agreement shall describe the part of the pool that is used exclusively by the patients of that practice/office or provider and the times that exclusive use applies.

Other providers, including providers of outpatient physical therapy and speech-language pathology (OPTs or rehabilitation agencies) and CORFs, are subject to the requirements outlined in the respective State Operations Manual regarding rented or leased community pools.

 

Read the complete transmittal. (Pool rental section is on page 14):
220.1.2 - Plans of Care for Outpatient Physical Therapy

Congressional Passage of Pool and Spa Safety Legislation Increases Need for Higher Education

The recent passing of the first federal pool and spa safety law amplifies the need for higher education of Pool and Spa Operators.

There are many things that can go wrong if the water is not properly cared for and the facility is not properly maintained.

"The key to assuring a safe and enjoyable experience when people are swimming is directly connected to the higher education of those who maintain the pools and spas. It is critical now, more than ever," says Connie Sue Centrella, Program Director of the Keiser University online Aquatic Engineering Technology degree program.

The protection and safety of guests at hotels, condominiums, and aquatic facilities, as well as private pools has gained recent public attention with the passing of the Virginia Graeme Baker Pool and Spa Safety Act of 2007.

Keiser University is the first and only accredited university providing a higher education degree program in the pool and spa field.

Read  more about the degree...

 

Considerations for leasing or renting space in community pool setting for aquatic therapy

Question: If I lease a community pool to treat my Medicare patients, is it alright for other people to use the pool at the same time that I am performing therapy?

Answer: Physical or occupational therapists in private practice have more stringent rules for therapy provisions than therapists who operate in a facility (e.g. a hospital, skilled nursing facility, home health agency, etc.)

In order for private practice PT or OT services to be paid for by Medicare, they must be providing in one of two places: 

The therapist’s or group’s office, or the patient’s home.

It is possible to rent an outside space to increase your “office space”. For instance, many clinics do not have a pool of their own. They lease space in a community, hotel or health club pool.

Medicare states that, in order for such a pool to be considered “your office”, your patients must have exclusive use of the space. In other words, there cannot be other users in the pool at the same time as your Medicare patients.

Here’s how the Medicare rule reads:

The office is defined as the location(s) where the practice is operated, in the State(s) where the therapist (and practice, if applicable) is legally authorized to furnish services, during the hours that the therapist engages in the practice at that location.

If services are furnished in a private practice office space, that space would have to be owned, leased, or rented by the practice and used for the exclusive purpose of operating the practice.

Example, a therapist in private practice may furnish aquatic therapy in a community center pool. The practice would have to rent or lease the pool for those hours, and the use of the pool during that time would have to be restricted to the therapist’s patients, in order to recognize the pool as part of the therapist’s own practice office during those hours.

Why NOT rent or lease space in a community pool? Well, a lot of reasons...

Many therapy and rehab clinics want to offer aquatic therapy, but they do not have an on-site therapy pool. They look around at the local community swim-center, Holiday Inn or an unused pool in a local YMCA.

Let's assume for a minute that you have found a potential site for your aquatic therapy needs. You still need to ask yourself the following questions before diving into a relationship with an existing pool:

·          Who "owns" the rights to the patients you see in the pool? Are they yours, to take with your when you decide to leave, or are they the pool's (to keep by hiring another therapist to take over your schedule)?

·          Even if you are allowed to "take" your patients with you, will they want to travel the distance to a new site? Will your new pool be close enough to keep your clientele, or will you be starting from scratch when you move?

·          Who owns the equipment that you use? What if you buy equipment — is it yours to take with you?

·          Who is ultimately responsible for the pool's physical liability — you or the pool? In other words, if someone slips and falls (or drowns or cuts himself, etc.) while at the pool, whose insurance will cover that situation? (Note: we are not talking about malpractice insurance here. Your malpractice insurance would cover situations of negligent care during your treatment times. We are talking about "environmental" risks which have nothing to do with the care provided). Is it necessary to name the rental facility on your liability policy, your workers compensation, and your malpractice insurance to protect the facility from lawsuits?

·          Who is ultimately responsible for the cleaning and care of the pool? What happens if your patient causes an pool shutdown (for a fecal accident or vomiting, etc.). Who is responsible for the pool care which must occur? What happens if the pool's standards are lower than your own?

·          Who is responsible for the lost revenue that occurs with the above situation?

·          How will you be told of patient cancellations? How will you notify patients of pool closures? Will you be allowed use the receptionist or phone systems of the facility or will you use your own mobile phone?

·          What happens if the water temperature is unsatisfactory? What happens if it vacillates from day to day? What happens if the extra costs of heating the pool to a usable temperature are more than your leasing facility envisioned?

Content is KING! Aquatic therapy downloads...

And so it grows and grows...

We are going active with dozens of fabulous How-To aquatic therapy downloads.

Here are some you can access right now.

• Speech therapy in aquatics
• Leasing therapy pool space
• Selecting depths when building a therapy pool

Crave more? Of course you do. You are merely human. Go to Aquaticnet.com and join up. It's all there. Content is king!