Trends in the Use and Characteristics of Chiropractic Services in the Department of Veterans Affairs
SOURCE: J Manipulative Physiol Ther. 2016 (Jun); 39 (5): 381-6
Anthony J. Lisi, DC, Cynthia A. Brandt, MD, MPH
Chiropractic Section Chief,
VA Connecticut Healthcare System,
West Haven, CT;
Assistant Clinical Professor,
Yale Center for Medical Informatics,
Yale University School of Medicine,
New Haven, CT.
OBJECTIVES: The purpose of this study was to analyze national trends and key features of the Department of Veterans Affairs’ (VA’s) chiropractic service delivery and chiropractic provider workforce since their initial inception
METHODS: This was a serial cross-sectional analysis of the VA administrative data sampled from the first record of chiropractic services in VA through September 30, 2015. Data were obtained from VA’s Corporate Data Warehouse and analyzed with descriptive statistics.
RESULTS: From October 1, 2004, through September 30, 2015, the annual number of patients seen in VA chiropractic clinics increased from 4052 to 37349 (821.7%), and the annual number of chiropractic visits increased from 20072 to 159366 (693.9%). The typical VA chiropractic patient is male, is between the ages of 45 and 64, is seen for low back and/or neck conditions, and receives chiropractic spinal manipulation and evaluation and management services. The total number of VA chiropractic clinics grew from 27 to 65 (9.4% annually), and the number of chiropractor employees grew from 13 to 86 (21.3% annually). The typical VA chiropractor employee is a 45.9-year-old man, has worked in VA for 4.5 years, and receives annual compensation of $97860. VA also purchased care from private sector chiropractors starting in 2000, growing to 159533 chiropractic visits for 19435 patients at a cost of $11155654 annually.
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CONCLUSIONS: Use of chiropractic services and the chiropractic workforce in VA have grown substantially over more than a decade since their introduction.
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Introduction
The Department of Veterans Affairs (VA) operates the largest integrated health care system in the United States, including 144 hospitals, more than 1400 other health care facilities, and a workforce of more than 326,000. [1] More than 9 million of the approximately 22 million living US Veterans are enrolled in VA’s health care system. [2] Each year, approximately 7 million of those enrolled receive health care services at VA facilities, including more than 86 million outpatient visits and 700000 admissions. [3]
The VA recently began a 2-phased approach to introduce chiropractic care to its complement of health care services. In 1999, Public Law 106-117 [4] authorized VA to provide chiropractic care by purchasing these services from private sector chiropractors. VA Directive 2000-014, issued May 5, 2000, established VA’s first policy on chiropractic care and enabled VA facilities to begin purchasing chiropractic care. Subsequently, in 2001, Public Law 107-135 [5] added chiropractic care to the standard medical benefits available to all eligible VA patients and authorized VA to deliver these services on-site at a minimum of 21 medical facilities. VA Directive 2004–035, issued July 16, 2004, updated VA chiropractic policy and enabled VA facilities to begin delivering on-station chiropractic care by hiring and/or contracting with licensed doctors of chiropractic (DCs).
Since then, VA has expanded its delivery of chiropractic care [6]; but currently, little detail is known about the use of VA chiropractic services over time, details of these services, or characteristics of the VA chiropractic workforce. The purpose of this study was to analyze national trends and key features of VA’s chiropractic service delivery and chiropractic provider workforce since their initial inception.
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