A Special Report: First Annual Fees and Reimbursement Survey Results

Welcome to Chiropractic Economics’ first annual fees and reimbursement survey! This enlightening survey for the chiropractic profession is the first to provide all-encompassing details of what you charge versus what you’re actually paid. How do your fees and reimbursement levels stack up against the norms set by your colleagues? It’s easy to compare by referring to the accompanying charts, tables and commentary.

SURVEY DEFINITIONS­­

Figures calculated by average or mean were achieved by dividing proportionately the total number of respondents per question. Medians were determined by calculating the middle number or range.

The survey reflects averages, regardless of the number of responses received to each question.

Welcome to Chiropractic Economics’ first annual fees and reimbursement survey! This enlightening survey for the chiropractic profession is the first to provide all-encompassing details of what you charge versus what you’re actually paid. Once again, we thank our loyal readers for taking the time to share their most private financial information. How do your fees and reimbursement levels stack up against the norms set by your colleagues? It’s easy to compare by referring to the accompanying charts, tables and commentary.

Response to this first fees survey was excellent and consistent with our continuing reader surveys. Only surveys received from May through July of 1998 have been tabulated here. We will offer a comparison, where applicable, of our general reader profile with the American Chiropractic Association’s “Summary of the 1995 ACA Annual Statistical Survey on Chiropractic Practice,” by Christine Goertz, DC. Published in the June, 1996, Journal of the American Chiropractic Association, this summary is, to the best of our knowledge, the most recent published data available by a national chiropractic organization. According to the ACA, the 1998 results are due to be released in the near future.

Chiropractic Economics’ survey was sent to recipients of the June 1998 edition of Chiropractic Economics magazine. Immediately following is a summary of demographic data­­plus what forms of payment and terms you offer, acceptance of credit cards and health care cards, in addition to office visit fees for new and established patients, radiology and after-hours calls. Information derived from this survey will be used in future articles and to help determine topics of interest to our readers. The results are in no way, implied or otherwise intended to be a suggestion of what your fees should be. Those who are interested in additional information about this survey may contact Chiropractic Economics’ Business and Editorial Office. Thank you to everyone who participated!

Chiropractic Economics General Survey Findings

Respondent Profile
DC: 87%
Retired DC: 4%
Associate DC: 2%
Other: 7%

Comparison to ’95 ACA Survey

Fees vs. Payment By Group, Gender

SOLO

GROUP

MALE

FEMALE

Fees vs. Payment By Age Group

38 AND UNDER

39-55

56 AND UP

Office Visit Fees Around The Country

PROFESSIONAL CARE

Code Description

Overall Response

Southern Region

Eastern Region

Midwestern Region

Western Region

NEW PATIENT EXAM

Code Description

Overall Response

Southern Region

Eastern Region

Midwestern Region

Western Region

RADIOLOGY

Code Description

Overall Response

Southern Region

Eastern Region

Midwestern Region

Western Region

SUPPLEMENTS, LAB & MISC.

Code Description

Overall Response

Southern Region

Eastern Region

Midwestern Region

Western Region

FEES OF DOCTORS OF CHIROPRACTIC VS.
MEDICAL DOCTORS

Personal Characteristics
Gender, Age, Number of Years in Practice

Virtually all respondents, 97%, are Doctors of Chiropractic; 4% are retired, 2% are Associates, 1% are students, 2% are CA’s or office managers and 4% categorized themselves as “other.” This category includes the following combinations: DC/DO, DMD/DC, DC/DPM, DC/MD and BS/MS/DC. Thirteen percent of survey respondents are female and 87% are male. These percentages are almost the same as those found in many other surveys, including previous ACA surveys. The ages of respondents ranged from 23 to 79, with an average age of 44.5, which is equal to the ACA’s average age of 44. The breakdown by age is 10% under age 30; 18% ages 31-38; 25% 39-45; 29% 46-55, 14% are ages 56 and up and 4% did not respond. Average length of time spent practicing is 16.24 years, compared to the ACA’s 16 years.

Activity Level
Location of Clinic

Respondents are about equally dispersed for the primary location of their clinic. Suburban practices ranked highest with 35.4%, followed by urban locations, 32.3%, then rural at 24.1% and 8.2% did not respond. Every geographical region of the United States is represented in the survey, in addition to 4% who are Canadian practitioners. The vast majority or 96% of respondents practice in one state, although 2.5% reported the number of states in which they practice as two and 1.5% indicated three states.

Principle Form of Employment
Solo, Group, Multi-Discipline

Seventy percent consider themselves solo practitioners compared to 76% of ACA practitioners. Seventeen percent are part of a group or have partners and 5% reported being employed by a DC. Eight percent did not respond to the question. This is compared to the ACA’s 20.6% who are part of a group or have a partner, 2.5% who are employed by another chiropractor and 1% who teach. One third or 32% report being involved in a multi-disciplinary practice. The disciplines reported include 10% who have an MD or DO; 24% offer massage therapy; 12% offer rehabilitation and 10% indicate a dietician/nutrition. Additional disciplines mentioned include acupuncture, biofeedback, counseling, CST, dentistry, exercise, exercise physiology, exercise rehabilitation, hearing aids, herbology, homeopathy, NMD, MFCC, muscle therapy, a pediatrician, a personal trainer, physical therapy, podiatry, urgent care/pain management and yoga.

Payment and Terms
Sources of Revenue, Accepted Credit Cards, Payment Plans and Terms

Ninety-five percent indicated they accept cash as a source of revenue, followed by personal checks, 92%; auto insurance, 86%; workers’ compensation, 86%; private insurance, 83%; Medicare, 71%; major credit cards, 65%; managed care programs, 59%; Medicaid, 30%; and health care credit cards, 18%. Additional forms of revenue include payment plans, personal injury liens and the State of Alaska Fisherman’s Fund.

When asked which credit cards are accepted, 27% indicated they do not accept any credit cards. Of those who do, 64% accept MasterCard and 63% accept Visa, followed by Discover cards, 38%, American Express, 27% and the Care Credit health card with 7%. Another form of accepted payment includes MAC bank cards.

In addition to accepting payment at the time of service, 55% reported that they offer standard payment plans and 19% are willing to negotiate on a per case basis. The average down payment requested is 30%; the average billing cycle is 27.72 days and the mean discount for cash is 16.9%. Prepayment plans are an option in 24% of the respondents’ offices. Other terms mentioned include weekly, bi-weekly, bi-monthly and monthly payments. Special consideration for low income patients is another option for some.

Office Visit Fees
What Chiropractors Charge

Doctors of Chiropractic reported their fees and actual payments in the following four areas: Professional Care, New Patient Exams, Radiology and Miscellaneous as illustrated in the accompanying charts. We have carefully calculated the chiropractic profession’s average fees, mean actual payments, and percentage of actual payment for your review.

The following commentary focuses exclusively on noting some of the differences between fees charged and payment received for CPT codes 99213 (established patient) and 99204 (new patient).

DC’s Fees Compared to MD’s

When Doctors of Chiropractic and Doctors of Medicine compare their overall percentages of actual payment for CPT code 99213 (established patient) and code 99204 (new patient), DC’s received 91% and 93% respectively versus a mean of 80% and 79% for all doctors. For more details, please refer to the chart comparing Chiropractic Economics’ 1998 Continuing Reader Survey results with Medical Economics’ 1997 Continuing Survey, which was conducted in the Spring of 1997 according to the September 22, 1997 edition of Medical Economics.

Fees Around the Country

Doctors of Chiropractic in the East, Midwest, South and West reported their fees and actual payments as outlined in the accompanying charts. The overall national mean fee for established patients, code 99213, is $48.27. The highest fees charged for code 99213 rank in descending order by region: East, $60.66; West, $51.21; South, $46.87 and Midwest, $42.62. The dollar difference in the range of fees charged for code 99213 is $18.04.

The overall national mean fee for new patients, code 99204, is $92.22. The highest fees charged for code 99204 rank in descending order by region: East, $100.89; South, $99.39; West, $98.29 and Midwest, $83.39. The dollar difference in the range of fees charged for code 99204 is $17.50.

Age Does Make a Difference

When it comes to established patients (99213) Doctors of Chiropractic aged 56 and up charge an average of $56.94 compared to their younger counterparts, who reported an average fee of $47.02 (ages 38 and under) and $47.62 (ages 39-55). The opposite is true for new patients (99204), who are charged an average of $76.71 by DC’s aged 56 and up compared to $91.29 for those aged 38 and under and $95.20 for the 39 – 55 age group.

Female DC’s Fees Less Than Males

Female Doctors of Chiropractic charge less on average for CPT codes 99213 and 99204 and receive a lower actual payment on average. The dollar difference of females’ actual reimbursement for 99213 and 99204 is $5.12 and $11.43 respectively compared to males’ $4.13 and $5.90. The percentage of actual payment for females is 88% for 99213 versus males’ 92% and females’ 86% for 99204 versus males’ 94%.

Group Practices Versus Solo

Doctors of Chiropractic who are in a group practice reported their fees and actual payments as less than their solo counterparts for established patient code 99213. The dollar difference between the fee charged and amount paid for 99213 is $4.77 (90%) for solo practitioners compared to $8.04 (81%) for groups. However, the gap narrows for new patient code 99204 with the dollar difference in payment jumping to $7.08 (92%) for solo practitioners versus $4.94 (94%) for groups.