PURPOSE: The American health care financing and delivery system is changing at a rapid pace. As part of recent reform of payment systems for physician services, Medicare has adopted a resource-based relative value scale (RBRVS) that is becoming a national standard. Research has now documented characteristics of physicians' work and the overhead for providing specific health services for most medical specialties and disciplines. This information is being used to develop service descriptions (billing codes) and reimbursement levels. No such data exist relative to chiropractic, which may hinder chiropractic's efforts to be included in evolving reimbursement schemes. RBRVS and its relevance to chiropractic is reviewed, information on work levels and practice costs is discussed, chiropractic practice is reviewed and a research and policy agenda for documenting chiropractic work, overhead and service descriptions is provided.

METHODOLOGY: A manual systemic review of available recent and relevant medical and chiropractic literature was undertaken to characterize how the RBRVS system for reimbursement of physician services was developed and implemented. Payer and trade association literature was used to determine what established work value and practice costs for DCs there are. Published payment scales from governmental commissions were also obtained.

CONCLUSIONS: Resources are urgently needed to survey levels of work by chiropractors in providing their various health services. The methodology should be the one used by the Health Care Financing Administration to assess other specialties. A range of generic manipulation codes should be developed and tested in a similar fashion for submission for inclusion in Physician's Current Procedural Terminology (CPT). A seed range of descriptions is presented. A systematic collection of practice overhead costs and malpractice risk should be undertaken and documented using standardized methodology.

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