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Chiropractic News

September 2004

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Are your fees competitive? Check our 7th Annual Fees and Reimbursements Survey report

Setting the right fee is two parts science and one part art: You have to conduct research to know what insurance companies and Medicare will reimburse. You have to examine what your competition is charging. And you have to know what your market is willing and able to pay.

About this survey
In May and June of 2004, Chiropractic Economics invited readers by e-mail and in the magazine to complete a Web-based survey.

• Limited to practicing doctors of chiropractic. We invited only practicing doctors of chiropractic or their designated offices managers/CAs to complete the survey.

• Record number of responses. The survey attracted 609 respondents from throughout the nation.

• Balanced response rate. Response rates were relatively balanced, with 27.3 percent from the West; 26.6 percent from the South; 23.4 percent from the East; and 22.7 percent from the Midwest.

• New codes added. This year we added five new codes (95035 — ultrasound, 97110 — therapeutic exercises, 95851 — range-of-motion measurement, 95831 — muscle testing and 97750 — physical performance evaluation). Whenever comparisons of average fees and reimbursements between 2003 and 2004 are made in the report, these new codes are not factored in to the averages.

If you set fees too low, you undermine the value of your services. If you set them too high, you may risk “scaring” patients away.

You can conduct research in a variety of ways — from informal discussions to online research. In this issue we help you by providing the results of our 7th Annual Fees and Reimbursements Survey.

To keep you as current as possible, we asked coding experts to review and update the list of codes to assure that they reflect the codes actually used in daily practice. Based on their recommendations, we added several codes to the survey:

• 95035 — ultrasound,

• 97110 — therapeutic exercises,

• 95851 — range-of-motion measurement,

• 95831 — muscle testing and

• 97750 — physical performance evaluation.

Note: When making comparisons to 2003 findings, we have omitted these new codes from the averages.

HIGHLIGHTS OF THE SURVEY

• Record number of respondents. The number of respondents in 2004 — 609 —surpassed the number in all other surveys. The area of the country that had the most respondents was the West (27.3 percent), followed by the South (26.6 percent), East (23.4 percent) and Midwest (22.7 percent).

• More solo practitioner respondents. This year, the survey attracted slightly more solo practitioners to respond than last year. In 2003, 73.2 percent of respondents were solo practitioners; this year that number increased to 76.6 percent.

We invited only practicing doctors of chiropractic or their office managers to complete the survey. Of the respondents, 96.5 percent were doctors; 3.5 were office managers/CAs.

Of the doctors who responded, 81.7 percent were male; 18.3 percent were female. (Our 7th Annual Salary and Expense Survey, reported in Issue 6, May 3, 2004, showed that 16.6 percent of respondents were female.)

• Modest increase in both fees and reimbursements. Overall average fees charged in 2003 were $59.50 (for the same codes); in 2004 they were $62.77 — an increase of 5.5 percent. Overall average reimbursements (for identical codes) in 2003 were $47.26; in 2004, they were $50.19 — and increase in reimbursements of 6.2 percent. The reimbursement rate in 2003 was 79.4 percent. This year it increased very slightly to 80.0 percent.

• Most notable changes. The most significant increase in fees charged for a code was for pelvic x-rays (72170 pelvis, AP), for an average fee of $57.71. In 2003, the average for this code was $52.08, resulting in an increase of 10.8 percent.

In 2003, 72170 was reimbursed for an average of $43.36. This year, the average was $46.56, an increase of 7.4 percent over last year.

The most significant decrease in average fees charged was for 99214 (Established patient w/expanded history and exam, with low complexity of treatment decision). The amount charged for this procedure decreased 25.1 percent, from $118.60 in 2003, to an average fee of $88.86 in 2004. Although the average fee dropped, the reimburse-ment rate increased 9.1 percent: In 2003, average reimbursement was $77.57, for a reimbursement rate of 65.4 percent. In 2004, average reimbursement was $70.50. But, configured on the lower rate charged, the average reimbursement rate for this code increased to 79.3 percent.

What does the ‘average’ respondent look like?

Who takes the time to complete a fees and reimbursements survey? Here is a composite view of what the respondent looks like:
• Male. Most (96.5 percent) of respondents are DCs. Of the respondents who are chiropractors, 81.7 percent are male; 18.3 percent, female.
• Middle-aged. Respondents ranged in age from 22-75. The average respondent is 43.1 years old and has been practicing for 13.7 years.
• Independent spirit. Respondents in this survey are in practice for themselves as solo practitioners and 23.4 percent reported being in a group or partnership. (Last year, 26.8 percent reported being in a group or partnership.)
• Best description of practice: chiropractic clinic. The average respondent (82.6 percent) operates a chiropractic clinic, while 12.6 percent call their clinics “wellness centers.”
• Licensed in one state only. Most respondents (58.1 percent) are licensed in only one state, with 41.9 percent licensed in two or more states.
• Integrated healthcare offered. Respondents offer various services: 67.1 percent offer nutritional counseling; 62.5 percent, physical therapy; and 53.1 percent offer massage services.
• Cash accepted. Virtually all (98 percent) of respondents accept cash, while 6.4 percent have cash-only practices.
• Payment plans OK. More than half (55.6 percent) of respondents offer standard payment plans, while 40 percent say they negotiate payment on a per-case basis. u

So … what does all of this tell you? It suggests

that you should study the competition, understand the reimbursement procedures and guidelines of insurance companies and Medicare and know your patients. And most of all — value the services you provide.

Linda Segall is editor-in-chief of Chiropractic Economics. She can be reached at 904-285-6020 ext. 207 or by e-mail at lsegall@chiroeco.com.

How do regions of the country compare in fees and payments?

The East coast is notorious for its high cost of living. But do chiropractors in the East charge more for their services than doctors in other regions of the country?

According to the results of our 2004 survey, the answer is “no.” Overall average fees charged by chiropractors in the East are $61.69. But the highest fees are charged in the South — an overall average of $62.03. Fees in the West are on average $60.85. The Midwest lags behind, with average overall fees of $58.23.

The amount charged is one thing. The amount reimbursed is another. Which area of the country boasts the highest reimbursement rates? It’s the West, with an average reimbursement rate of 84.7 percent, followed by the South, at 82.1 percent; the Midwest, 78.4 percent; and the East, 74.1 percent.

 

Gender not a factor in fees
This year, 18.3 percent of the doctors who answered the survey were female. The survey shows that female chiropractors made gains in both fees and reimbursements this year.

In 2003, female chiro-practors had a reimbursement rate of 74.3 percent and males, 81 percent. In 2004, female chiropractors increased their reimbursements 5.8 percent to a rate of 78.6 percent, while male respondents had a rate of
79 percent.

Does age matter?
Do young, less experienced chiropractors charge the same for their services as their more seasoned colleagues? Our survey shows that age matters — in the amount you can charge, as well as in reimbursement rates.

Our survey respondents ranged in age from 22-75. The mean and median ages of respondents were the same: 43.

The youngest group of respondents (age 30 and under) charge an overall average of $60.08. Their colleagues who are 39-45 charge the highest fees — $64.81.

The amount charged is one issue, but how about reimbursement rates? Chiropractors 56+ enjoy the highest reimbursement rates — 85.2 percent, followed by those who are 46-55, with a rate of 83.2 percent. The group that charges the highest rates (39-45) has the lowest reimbursement rate — 74.9 percent. Respondents 31-38 years of age had reimbursement rate of 77.8 percent.

And the youngest chiropractors? Their reimbursement rate is 77.5 percent, slightly above the overall average rate of 79.8 percent.

Group vs. solo:
Who is reimbursed more? The respondents in our survey were predominantly solo practitioners (76.6 percent). But, we had a significant number of respondents in groups or partnerships (23.4 percent). Which type of practice — solo or group — do you think charges higher fees? Gets better reimbursements? You might be surprised.

According to our data, groups/partnerships charge on average $63.57 for services, compared to solo practitioners, who charge $59.96.

But — groups/partnerships have average reimburse-ments of $46.19, for an average of 72.7 percent, whereas solo practitioners have average reimbursements of $49.46, for a rate of of 82.5 percent.

Cash remains king
In 2003, 96.4 percent of chiropractors accepted cash. This year, that number rose to 98.3 percent. Close to cash is checks: 96.1 accept this form of payment.

Of course, other forms of payment are welcomed, too: Auto insurance (89.2 percent) and personal insurance (88.0 percent) are high on the ways that doctors get paid.

More than three-fourths accept Medicare (78.3 percent) and workers’ compensation (78.9 percent), while 62.2 percent say they are paid through managed-care organizations.

Although almost 100 percent of respondents accept cash, 6.4 percent of them have cash-only practices.

Since not every patient has an insurance card, nor does every patient have cash to pay for chiropractic care, 67.3 percent of respondents offer a flexible payment plan. And 50.5 percent of these practitioners give a discount for cash, while 50 percent also offer some type of prepayment plan.

Which services earn fees?
What kinds of services bring in the fees? A variety. Although most respondents (53.7 percent) reported that they do not practice with another healthcare professional (such as an MD or a physical therapist) in an integrated practice, 76.3 percent offer at least some other type of service (in this case, exercise programs), in addition to chiropractic adjustment.

Exercise is the top service provided, but others include nutritional counseling (67.1 percent); physical therapy (62.5 percent); massage (53.1 percent); weight-loss programs (21.0 percent); acupuncture (19.6 percent); and homeopathy (16.7 percent).

MDs and DCs: How do reimbursements compare?
Chiropractors use some of the same codes used by allopathic physicians. The question is: How do fees and reimbursements compare?

We selected three fees and compared them to results of a fees and reimbursements survey of medical doctors, published in the Oct. 10, 2003, online issue of Medical Economics (www.memag.com). The results showed:

• 99201(E&M, new patient, focused history) — DCs charge on average $55.30 and have a reimburse-ment rate of 84.4 percent. Allopathic physicians (all categories of MDs and DOs) charge on average $59 and have a reimbursement rate of 67.7 percent.

• 99202 (E&M, established patient) — DCs average fee is $73.68, with a reimbursement rate of 82.3 percent. The average MD/OD fee is $85, with a reimbursement rate of 70.7 percent.

• 99203 (Office visit with detailed history and exam) — The DC average fee is $100.60, with a reimbursement rate of 82.9 percent. The MD/DO average fee is $110, with a reimbursement rate of 72.3 percent.

 

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