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Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists.
Altern Ther Health Med. 2003 Sep-Oct; 9(5):88-94.AT

Abstract

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.

Authors+Show Affiliations

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.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14526715

Citation

Yeh, Gloria Y., et al. "Visit Time as a Framework for Reimbursement: Time Spent With Chiropractors and Acupuncturists." Alternative Therapies in Health and Medicine, vol. 9, no. 5, 2003, pp. 88-94.
Yeh GY, Phillips RS, Davis RB, et al. Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists. Altern Ther Health Med. 2003;9(5):88-94.
Yeh, G. Y., Phillips, R. S., Davis, R. B., Eisenberg, D. M., & Cherkin, D. C. (2003). Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists. Alternative Therapies in Health and Medicine, 9(5), 88-94.
Yeh GY, et al. Visit Time as a Framework for Reimbursement: Time Spent With Chiropractors and Acupuncturists. Altern Ther Health Med. 2003 Sep-Oct;9(5):88-94. PubMed PMID: 14526715.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists. AU - Yeh,Gloria Y, AU - Phillips,Russell S, AU - Davis,Roger B, AU - Eisenberg,David M, AU - Cherkin,Daniel C, PY - 2003/10/7/pubmed PY - 2003/10/28/medline PY - 2003/10/7/entrez SP - 88 EP - 94 JF - Alternative therapies in health and medicine JO - Altern Ther Health Med VL - 9 IS - 5 N2 - 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. SN - 1078-6791 UR - https://www.unboundmedicine.com/medline/citation/14526715/Visit_time_as_a_framework_for_reimbursement:_time_spent_with_chiropractors_and_acupuncturists_ L2 - https://medlineplus.gov/chiropractic.html DB - PRIME DP - Unbound Medicine ER -