Trends in the Use and Cost of Chiropractic Spinal Manipulation Under Medicare Part B
Whedon JM, Song Y, Davis MA.
The Dartmouth Institute for Health Policy and Clinical Practice,
Dartmouth College, 30 Lafayette St,
Lebanon, NH 03756
BACKGROUND CONTEXT: Concern about improper payments to chiropractic physicians prompted the US Department of Health and Human Services to describe chiropractic services as a “significant vulnerability” for Medicare, but little is known about trends in the use and cost of chiropractic spinal manipulation provided under Medicare.
PURPOSE: To quantify the volume and cost of chiropractic spinal manipulation services for older adults under Medicare Part B and identify longitudinal trends.
STUDY DESIGN/SETTING: Serial cross-sectional design for retrospective analysis of administrative data.
PATIENT SAMPLE: Annualized nationally representative samples of 5.0 to 5.4 million beneficiaries.
OUTCOME MEASURES: Chiropractic users, allowed services, allowed charges, and payments.
METHODS: Descriptive statistics were generated by analysis of Medicare administrative data on chiropractic spinal manipulation provided in the United States from 2002 to 2008. A 20% nationally representative sample of allowed Medicare Part B fee-for-service claims was merged, based on beneficiary identifier, with patient demographic data. The data sample was restricted to adults aged 65 to 99 years, and duplicate claims were excluded. Annualized estimates of outcome measures were extrapolated, per beneficiary and per user rates were estimated, and volumes were stratified by current procedural terminology code.
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