Promote Your Niche


Competition in the aquatic arena.

By Keith Ori, PT

Across the nation, physical therapy clinics are focused on two things: serving their client base and improving their bottom lines. Sometimes, it seems quite challenging to accomplish both goals, especially when it becomes evident that a potential customer base is not coming to a facility because it does not have the best amenities. In those cases, clinic owners can simply continue along the same marketing path and hope they stay in the black, or they can attempt to garner a larger piece of the client pie by adding equipment and services to attract clients.

One tool that many physical therapy practices are using to attract additional clients to their doors, rather than the doors of their competition, is aquatic therapy. Aquatic therapy has long been considered a niche of physical therapy; however, it is becoming a solid performer in its own right. Still, offering onsite aquatic therapies in a technologically advanced warm-water therapy pool can seem daunting, especially from a financial perspective. The key is to ensure that the investment in any type of water therapy equipment, including pools, will provide a sustainable and reliable return on investment.

For practices that are just starting on the journey toward offering aquatics as a modality for clients, especially those clients who cannot fully engage in land-based therapies, the key is to start slowly and do your homework. Pragmatism is a physical therapy clinic owner’s greatest ally; it can help lead the way through the following suggestions aimed at those just dipping their proverbial toes into the aquatic therapy waters.

#1 – Start Working with Clients in a Local Pool

This can be a local YMCA pool or private pool. While it is probably not going to have the warmest waters or equipment, like an underwater treadmill and resistance jets, it will give physical therapists and clients a taste of what is available. Additionally, it provides a good starting point to see how interested people are in having aquatic therapy in addition to land-based physical therapy.

If and when a consistent number of aquatic therapy clients develops, and the annoyance of having to rely on another organization’s pool schedule becomes too great, it is an indication that it may be time to investigate buying a therapy pool for your clinic.

#2 – Investigate Therapy Pool Options

There are numerous therapy pools on the market, and you want to ensure that you will get the best product for your needs. Look less at the overall price tag and more at the features the therapy pools include and decide whether they match your clinic’s needs. For instance, some larger models allow aquatic therapists to work with more than one client simultaneously, or provide aquatics classes. Features that allow for different water depths can be very important. When the pool’s features match your clinic’s specific needs it can lead to a faster return on investment potential. During this period of examination and exploration, visit other clinics around your region—or even the country—with therapy pools and ask about their real-life experiences with the specific models.

#3 – Investigate Relocation Versus Current Site Expansion

A therapy pool takes up a good deal of space. For those who have room to expand through construction, it sometimes makes sense to simply add the pool to their current location. Just as often, though, physical therapy clinics that want to expand to aquatic therapy seek out new real estate. Make sure there is enough space to allow your clients to transition into land-based exercise programs as evidence of progress in their program.

Any properties that are being considered should be easy to find, central to the target population, and offer convenient parking. Commercial landlords should feel comfortable with the inclusion of a warm-water therapy pool on their property. In general, lease terms should be around seven years; this assures the clinic owner that the space will remain available, but he or she is not locked into decades of working in the same spot should conditions change.

#4 – Do the Numbers

If you are at the point of seriously considering adding a therapy pool (and amenities like locker rooms, maintenance of the pool, etc.), you need to be able to come up with data to support the decision. The data most important to consider includes:

  • State reimbursement rates for aquatics codes. (States vary in what they pay for aquatic therapy and similar health care codes.)
  • Cost of new aquatic therapy equipment and construction.
  • Number of patients needed to reach the break even point.
  • Understand your potential patient clientele. What kind of patients are you likely to see—from total joints to chronic pain—and what are their specific needs?
  • Number of additional physical therapists (if any) needed to offer aquatic therapy. How to staff this facility is a critical decision.
  • Amount of marketing dollars allocable toward aquatics.
  • Amount of money set aside for annual employee training.

By carefully assessing current and projected future finances, it is possible to determine the break even point, or how many clients per week are needed to keep the aquatics program viable, and, eventually, profitable.

#5 – Take the Plunge and Start Construction… and Advertising

Do not wait for the pool room to be finished, start advertising your new services when ground is broken. Potential referral sources, such as physicians, surgeons, and perhaps even other physical therapy clinics, should become aware of the opportunity that is opening up for their patients.

As construction continues, it will become easier for others to begin to catch the excitement of what is happening. During this period, consider calling former clients to let them know about the upcoming positive changes. Word of mouth referrals are golden in the physical therapy world!

#6 – Open the (Pool) Doors and Keep Track of the Figures

This is a part of the business plan that too many physical therapy clinic owners fail to complete. They are so thrilled to have an up-and-running therapy pool with underwater treadmill, underwater jets, underwater camera, and variable depth floor that they forget to regularly assess their revenue. It is a costly mistake, because the figures will start to tell a story.

Instead of waiting, start tracking and evaluating immediately. Make sure all projected expenses (e.g., salaries, rent, utilities, upkeep, and annual maintenance agreement) have been included in the numbers. The story will start to unfold thanks to the numbers.

A Case Study: Our Clinic’s Entry into Aquatic Therapy in Rural Montana

Make no mistake—this article has not been written from theory. Our clinic went through the process, too. It went as smoothly as could be imagined, but took a couple of years to complete.

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Being a rural Montana physical therapy clinic that dove into aquatics in the late 2000s, we determined that we needed five visits per day, and two to three units per visit in order to break even. Lo and behold, we hit the mark within the first few weeks of being open.

Since 2009, our visits have been steady and have more than paid for all elements of our aquatic therapy investment. Our average number of annual visits hovers around 2,200, which covers expenses. With that being said, the changes in health care took a slight nip in our profit margins in 2013 and 2014; however, everyone appeared to be hit in those years. Additionally, the charge per visit has varied, but we have been able to compensate.

I am pleased to say that our five-year return on investment summary proves we made a healthy decision. Our return on investment is a healthy 38 percent, and we are actively looking for ways to bring it up even more. Perhaps the most rewarding element of all is that we are able to keep growing and serving more of our population. We have a steady group of clients that return to our clinic for physical therapy due to their success with the aquatic program. By being careful up front, our team was able to make wise choices with the information they had, and they are proud to show individuals around our 2,800-square-foot clinic.

Keith Ori, PT, is the managing partner and chief executive officer of Orthopedic Rehab, Inc. He can be reached at

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