AHA, Inc. Alert: Are you putting yourself at risk?

The AHA, Inc. office, Reimbursement Committee, and Ethics/Advocacy Committee continually address issues related to misconceptions about the role hippotherapy plays in physical therapy, occupational therapy, and speech-language pathology services.

When reimbursement challenges and allegations of fraud occur, therapists’ websites and marketing materials are often reviewed. It is these marketing materials, websites, clinical documentation, and related written materials that are being used against the therapists/therapy practices in question by third-party payers. You are not immune simply because you may not “bill insurance” for your services.

The following information should be carefully reviewed and considered by all therapists who incorporate equines in treatment:

The inclusion of hippotherapy is recognized as a treatment tool which can be utilized when appropriate, while working within your scope of practice according to the American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), and the American Speech-Language-Hearing Association (ASHA).

When marketing your clinical services or speaking about the inclusion of hippotherapy as a treatment tool in physical therapy, occupational therapy, or speech-language pathology, it is imperative that all therapy professionals are clear and accurate in the way that they regard and speak about hippotherapy.

The AHA, Inc. recommends that therapists “lead with the therapy.”  What does this mean? For starters, it means that you should always lead with the professional license that you are working under (i.e., physical therapy/occupational therapy/speech-language pathology) in all of your marketing materials and written documentation. Hippotherapy is just one tool that professionals may choose to incorporate into treatment as part of a larger total plan of care.

Terminology errors and misrepresentation of hippotherapy as a stand-alone service leads to misunderstanding about what is actually being provided. Use of terms that do not “lead with the therapy” place therapists at significant risk. Speaking about hippotherapy as a stand-alone entity using terms such as hippotherapy program, hippotherapy session, and hippotherapy services or use of terms such as horse therapy, equine therapy, equine-assisted therapy, and EAAT puts you at risk. These terms are found on the AHA, Inc. Terminology Guidelines Caution List.

There is no such thing as hippotherapy service, nor are there hippotherapy programs or hippotherapists. Therapists do not “perform hippotherapy” or “provide hippotherapy.” 

Referencing the list of recommended and cautionary terms can help guide you in how you talk about and market your clinical services. Leading with your therapy service goes beyond the appropriate use of terminology. It also refers to both overt and subtle messages in your practice structure, client communications, and marketing materials.

To help protect yourself, ask yourself the following questions:

  • Do(es) I/my practice market as a hippotherapy program, or as a physical therapy, occupational therapy, or speech-language pathology practice?
  • Do I follow evidence-based practices, use clinical reasoning when including horses in treatment, work within my scope of practice, and follow the code of ethics for my clinical profession?
  • Do I include hippotherapy as a tool in a plan of care that includes a variety of therapy approaches, tools, strategies, and methods?
  • Do I put all clients on the horse for the full session, or do I balance equine movement with tasks to address the client’s functional skills off the horse?
  • Do(es) I/my practice follow the AHA, Inc. Best Practice Statements?
  • Do I have an appropriate clinical space to do evaluations and provide treatment?
  • Do I use the appropriate terminology to clearly describe my clinical services?
  • What messages do my practice’s marketing materials give? When a person visits my website or reads my brochure, is the take away that they are visiting a physical therapy, occupational therapy, or speech-language therapy practice, or is the take away that the practice is all about the horse?
  • Am I under the misconception that I am not vulnerable to fraud or malpractice allegations because I am out of network or private pay only and this does not apply to me?
  • Am I under the misconception that I am not at risk because I don’t handle the billing?
  • Do I “lead with the therapy” and follow all state and national requirements and the recommendations from AOTA, APTA and ASHA?
  • Is my documentation consistent with my clinical licensure and services that I might provide that do not include horses?

AHA, Inc. urges use of clean and clearly written information about hippotherapy as a physical therapy/occupational therapy/speech-language therapy treatment tool.

Clarity, accuracy, and transparency are critical in all written materials, marketing, and outreach about hippotherapy as a treatment tool. Therapists place themselves at risk for legal and ethical issues when they do not “lead with the therapy,” from reimbursement and professional malpractice insurance issues to potential payment chargebacks and fraud claims.

Inaccurate marketing of hippotherapy perpetuates major misconceptions by the public at large that there is such a thing as equine therapy for people. Hippotherapy must not be treated as separate service from physical therapy, occupational therapy, and speech-language pathology services.

Whether in casual or professional conversation, it is important to describe hippotherapy accurately, as one of the therapy tools in your toolbox as a licensed therapy professional.

Each practicing professional who elects to include hippotherapy as a treatment tool in their therapy practice bears responsibility for accuracy in marketing, clinical practice, coding/billing, and clinical documentation. Failure to do so puts you and all other therapy professionals using hippotherapy as a tool at risk.

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