W hy is a life in Tennessee, South Dakota and Texas worth more than a life in Hawaii and New York? There is really no reason other than the insurance companies and state politici ans that you have elected into office allow it to be. We are a country of laws and regulations and it is these laws that dictate the marketplace and how doctors are reimbursed for their services. In most states, it is based upon the usual and customary fees of the doctors, the carriers paying a percentage of those fees. However, in other states, like New York, the state sets the doctors’ fees and they are driven by politics at their ugliest.
The collections listed in the following table depict what chiropractors are collecting in their offices as of November 2010, on a per-visit basis for a typical treatment. The numbers exclude examinations, X-rays, supports and any other ancillary services or testing. The sampling taken, although not 100% accurate for a statistician, is an accurate representation of what doctors are collecting today.
Logically, one would think that the higher the cost of living, the higher the level of reimbursement. That is not the case. In fact, New York and Hawaii are two of the most expensive states to live in, yet have the lowest levels of reimbursement nationally. New York, which, in spite of its ranking 46th with regards to cost of living, undoubtedly a result of its vast rural areas, pushes it out of the highest ranking. A 500 square foot office in downtown New York City can cost $7,000 per month to rent, yet the maximum reimbursement a chiropractor can receive is $33.70 per visit and has been so for 16 years, no matter what services the doctor provides. In addition, the carrier sends for an IME after a few visits in order to limit the amount of care, further reducing the doctor's ability to receive fair and equitable reimbursement.
By law, the State of New York sets a doctor’s personal injury (no-fault) fees, as they are tied into the workers compensation fee schedule. After a 16 year absence of any fee increase, chiropractors in New York were just given a pay raise to $46.24 per visit. Over the last 16 years, while chiropractors were reimbursed at $33.70, physical therapists were reimbursed $61.60 and medical doctors were reimbursed $67.60 for the same services by CPT code. The new fee schedule in New York was created without a chiropractor being able to contribute to the political process, yet the American College of Occupational Medicine and large labor unions in New York played major roles in shaping the future of chiropractic in New York.
As a result of the low fee schedules in New York, doctors of chiropractic are emigrating and relocating to other states. Considering that the average chiropractic case, according to Chiropractic Lifecare of America (2009), is $3,799, while the average non-surgical hospital stay is $15,059, spinal surgery averages $77,107 without complications and ranges from $117,901 to $260,584 with complications, not including any doctors’ fees, according to Virginia Healthcare and Hospital Association (2010). For every chiropractor that emigrates in any state, the cost of healthcare is rising.
In addition, a 2004 study by Legorreta, Metz, Nelson, Ray, Chernicoff, and DiNubile compared more than 1.7 million insured patients seeking treatment for back pain. The outcomes showed, when chiropractic care was utilized in comparison to the standard medical approach, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including X-rays and MRI’s, was reduced by 37%. Furthermore, 95% of the patients that received chiropractic care reported in the study that they were satisfied with their treatment. Utilizing chiropractic care as the first treatment option for back pain was estimated to have the potential to reduce US healthcare costs by more than $28 billion annually.
Fair and equitable reimbursements for any provider will determine if a doctor can afford to live in any community nationally, and wise legislators will take into account the above statistics, so as not to be "penny wise and dollar foolish," unlike those elected officials in New York. There are solutions to ensure that this scenario does not happen in your state, but that is a topic for a future article.
1.American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css. cfm?T1ID=13&T2ID=68.
2.Chiropractic Lifecare of America. (2009). The MESTAT Project.
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3.Russo, A., Wier, L. M., & Elixhauser, A. (2009, September). Hospital utilization among near-elderly adults, ages 55 to 64 years, 2007.
Agency for Healthcare Research and Quality. Retrieved from
4.Legorreta, A. P.; Metz, R. D.; Nelson, C. F.; Ray, S.; Chernicoff, H. O.; & DiNubile, N. A. (2004). Comparative analysis of individuals with and without chiropractic coverage: Patient characteristics, utilization, and costs. Archives of Internal Medicine, 164(18),1985-1992.
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