The costs of chiropractic care in Minnesota

Objective: To determine the costs of delivering chiropractic services among Chiropractic Care of Minnesota, Inc.'s providers in Minnesota. Design: Cross-sectional survey. Subjects: Primary chiropractic providers in the Chiropractic Care of Minnesota, Inc. (CCMI) provider network. Methods: A 14-item survey was used to collect 2004 chiropractic practice information. Sections included Practice structure and location (4 questions), Chiropractic treatment activity (4 questions), Employees (1 table), Annual expenses (1 table), Equipment (1 table) and Income (1 question). The survey was approved by CCMI. One hundred and fifty chiropractors' names were randomly drawn from CCMI's provider roster. Surveys were distributed and returned anonymously by mail, with up to three mail contacts made to each chiropractor. Respondents were paid US$ 100 for a completed survey. Visit costs per patient were calculated by summing the total staff expenses plus the total annual clinic expenses, then dividing by the annual number of patients seen, using a 50-week working year. The average chiropractor's annual income from the Bureau of Labor Statistics was used to estimate the visit cost per patient that included a primary chiropractor's income. Results: The final response rate was 80.5% (120/149). The majority of respondents work in solo practices (66.1%), urban areas (73%), and work full-time (61.7%). CCMI providers treat an average of 102 patients per week (median = 90). The average clinic costs are about US$ 205,000, with substantial variation. Costs tend to be higher in larger practices, especially those in multispecialty arrangements. The higher associated costs in group practice settings do not reflect a cost savings in the costs per patient. The moderate volume offices had the lowest costs per patient. Excluding any income for the primary chiropractor, the cost of a chiropractic patient visit is US$ 29.94 (mean, all clinics, 2004 dollars). To achieve an average chiropractor's income, the per visit cost would need to be US$ 60.09. Conclusions: On average, CCMI providers have clinic costs of US$ 205,000 per year. We did not find economies of scale in group/multispecialty settings. The lowest costs per patient were seen in the moderate volume clinics.