Document Detail

Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists.
MedLine Citation:
PMID:  14526715     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Visit length is an important component of physician payment systems. As use and insurance coverage of complementary and alternative medicine (CAM) increases, equitable reimbursement strategies for CAM providers will be needed. Little information is available about the time CAM providers spend with patients. OBJECTIVE: To describe the length of visit and determinants of visit time to chiropractors and acupuncturists. DESIGN: Survey of CAM practitioners that collected information on providers (e.g., socio-demographics, practice patterns, training) and professional visit encounters (e.g., patient demographics, payment source, problem acuity, visit length, procedures performed). SUBJECTS: Random sample of 130 licensed chiropractors and 133 licensed acupuncturists surveyed in 1998-1999, each from one Western and one Northeastern US state. MEASURES: Patient, provider, and visit factors associated with visit duration were analyzed using weighted linear regression. RESULTS: Data were available on 2550 chiropractic and 2561 acupuncture visits. Mean chiropractic visit length was 21.5 minutes (SE = 0.8). Mean acupuncture visit length was 56.6 minutes (SE = 0.7) In both professions, new patient visits took longer, while visits for wellness or chronic problems were shorter. Preventive counseling by the chiropractor increased visit time, as did use of manual (vs. instrument) spinal manipulation, soft tissue techniques and physiotherapeutics. Acupuncture visits were shorter when specialized needling techniques (e.g. auricular or scalp acupuncture) were used, and longer with other adjunctive Asian therapies (e.g., cupping or magnets). Self-paid acupuncture visits were longer, as were visits with acupuncturists who had less practice experience or fewer years of training. CONCLUSIONS: For both chiropractic and acupuncture, certain visit factors, provider characteristics, and procedures increase visit length, many of which parallel those observed in conventional medical settings. Thus, a similar time-based payment scheme may be a reasonable starting point for developing methods for reimbursing CAM providers.
Gloria Y Yeh; Russell S Phillips; Roger B Davis; David M Eisenberg; Daniel C Cherkin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Alternative therapies in health and medicine     Volume:  9     ISSN:  1078-6791     ISO Abbreviation:  Altern Ther Health Med     Publication Date:    2003 Sep-Oct
Date Detail:
Created Date:  2003-10-06     Completed Date:  2003-10-27     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9502013     Medline TA:  Altern Ther Health Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  88-94     Citation Subset:  IM    
Division for Research and Education in Complementary and Integrative Therapies, Harvard Medical School, Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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MeSH Terms
Acupuncture Therapy / economics*,  utilization
Health Care Costs
Health Services Research
Manipulation, Chiropractic / economics*,  utilization
Middle Aged
Multivariate Analysis
Office Visits / economics*,  utilization
Patient Acceptance of Health Care
Reimbursement Mechanisms*
Research Design
Time Factors
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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