title: Visit time as a framework for reimbursement: time spent with chiropractors and acupuncturists.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  Random sample of 130 licensed chiropractors and 133 licensed acupuncturists surveyed in 1998-1999, each from one Western and one Northeastern US state.
  
  
  METHODS
  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.affiliation: 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.
authors.forename: Gloria Y
authors.initials: GY
authors.lastname: Yeh
authors.forename: Russell S
authors.initials: RS
authors.lastname: Phillips
authors.forename: Roger B
authors.initials: RB
authors.lastname: Davis
authors.forename: David M
authors.initials: DM
authors.lastname: Eisenberg
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Cherkin
mesh_terms: D015670:Acupuncture Therapy / Q000191:economics* / Q000706:statistics & numerical data; D000328:Adult; D005260:Female; D017048:Health Care Costs; D006302:Health Services Research; D006801:Humans; D008297:Male; D026882:Manipulation, Chiropractic / Q000191:economics* / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009819:Office Visits / Q000191:economics* / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D012051:Reimbursement Mechanisms; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D014481:United States