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October 2021

J Manipulative Physiol Ther. 1997 Jan; 20(1): 13-23.

Establishment of total and intraservice work by chiropractic physicians in providing spinal manipulative therapy and evaluation and management services.

Hess JA, Mootz RD, Madden CW, Perrin EB.

State of Washington, Department of Labor and Industries, Olympia, USA.

OBJECTIVE: To develop and test a self-report survey instrument that measures the work performed by chiropractors in the delivery of evaluation and management (E/M) services and spinal manipulative therapy (SMT). Work is one leg of a triad used to develop Resource-Based Relative Values Scales (RBRVS) for physician reimbursement. DESIGN: Reliability study modeled after a tool designed and tested by economists at Harvard University School of Public Health in the development of relative values scales for physician reimbursement. The survey instrument uses magnitude estimation as a means of obtaining reliable and valid measures of the subjective assessments of the dimensions of a physicians work. SAMPLE: A random national sample was drawn from all members of the American Chiropractic Association. RESULTS: Estimates of the work performed by chiropractors in providing E/M and SMT services were established. The reliability of work ratings indicated that chiropractors agree closely on their ratings for work. The validity of the results indicated a high degree of consistency in rating work, which implies that the results are realistic. A review of demographics suggested that the survey population was representative of the general population of chiropractors. CONCLUSIONS: This study generated valid and reliable estimates of the work performed by chiropractors in providing E/M and SMT services. Work is one of three components used in the development of RBRVS, the method of physician reimbursement that is currently the industry standard. By quantifying the work required in providing services, chiropractors can now develop RBRVS. Additionally, the evidence-based data on work collected here can be used for a comparison with the work of similar services provided by other specialists. This can facilitate the use or modification of service description codes for use by chiropractic physicians.


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