Some Doctors May Halt Vaccinations
The costs that health care providers are charged and reimbursed for childhood vaccines vary widely, and about ten percent of doctors who vaccinate privately insured children are considering dropping the service because they are losing money, according to a pair of new studies from the University of Michigan Health System.
The survey, which came as a surprise to even some doctors, revealed startling differences between what doctors pay for vaccines and what private health insurers reimburse.
For instance, one in 10 doctors lost money on one recommended infant vaccine, while others made almost $40 per dose on the same vaccine.
The findings suggest that many physicians appear to be paying too much and receiving too little reimbursement. However, researchers say they can use this new data to help improve both areas.
"Physicians need to be better business people, and negotiate better prices and payments," said lead author Gary L. Freed, chief of the Division of General Pediatrics and director of the Child Health Evaluation and Research Unit at the University of Michigan’s Mott Children’s Hospital.
With vaccines for children enrolled in Medicaid funded by the public sector through the federal Vaccines for Children Program, prices are negotiated annually with vaccine manufacturers by the Centers for Disease Control and Prevention (CDC). But the data from the new studies suggest that costs and reimbursements are widely variable in private practices.
"Until now, nobody knew what anyone was paying," Freed said.
"This information will change the way in which physicians negotiate prices."
The studies found that the price-per-dose of one brand of hepatitis B vaccine ranged from $4.26 to $13.06 at different medical practices. Meanwhile, reimbursements of the MMR (measles, mumps and rubella) vaccine ranged from $16.77 to $59.02. Many physicians who participated in the survey were displeased with the price and reimbursement levels of vaccines.
But the good news is that physicians can form purchasing cooperatives in which they join together to get a better group rates than they would as individuals, according to Freed. Additionally, physicians who are paying more for vaccines can follow the lead of their peers who have negotiated prompt-pay and volume discounts.
While few physicians in the survey said they had considered no longer providing all vaccines to privately insured children (11 percent overall; 5 percent of pediatricians and 21 percent of family physicians), about half of them reported that they had delayed the purchase of some vaccines for financial reasons and experienced a decline in profit margins from immunizations.
While the study did not specifically consider the effect on costs to patients, Freed said that most vaccines are not associated with out-of-pocket expenses for insured families or for those on Medicaid.
According to experts, the financial problem has been getting worse in recent years as new vaccines reach the market. Some, such as the cervical cancer vaccine Gardisil, have been unusually expensive, at about $375 for the three-shot series.
A government advisory panel looking at the financial burden of vaccines is expected to propose changes in reimbursement practices to federal health officials next year.
The studies appear in the December issue of the journal Pediatrics.
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Image Caption: A young man receives a vaccination. The cost and reimbursement levels of vaccines vary widely, according to new studies from the University of Michigan Health System. Credit: Scott Soderberg, University of Michigan
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