Payments from all types of payers did not cover pediatric vaccine delivery costs, many survey respondents from private, single-specialty practices said in 2011, reported Mandy A. Allison, MD, of the University of Colorado at Denver, Aurora, and her associates.

Using the American Academy of Pediatrics’ recommended level of payment for first vaccine administration at that time – $25 – more than three-quarters of the practices surveyed said that all payer types paid less than the cost of vaccine administration, the researchers noted.

In surveys returned by 128 pediatric and 85 family physician single-specialty practices between April and September 2011, the “proportion of practices saying that payment for vaccine purchase was 100% or more of purchase price” was 79% for private fee for service (FFS) insurance, 77% for PPOs, 68% for managed care organizations (MCOs)/HMOs, and 61% for the Children’s Health Insurance Program (CHIP).

Those reporting that payment for vaccine administration was $11 or more was 74% for FFS, 74% for PPOs, 57% for MCOs/HMOs, 37% for CHIP, and 34% for Medicaid, the investigators reported.

In terms of how profit margins for vaccine delivery had changed in the last 3 years, an increase was reported by 25% of pediatric practices (Ped) and 15% of family physician practices (FP), no change was reported by 38% of Ped and 49% of FP, and a decrease by 37% of Ped and 36% of FP practices.

Of those practices that used strategies to reduce vaccine purchase cost or increase payment, 81% Ped and 36% FP used online purchasing discounts, 78% Ped and 49% FP used prompt pay discounts, 65% Ped and 49% FP used bulk order discounts, 69% Ped and 42% FP used group purchasing, and 69% Ped and 33% FP used promotional pricing.

Fewer than half of the practices said that they negotiated with private insurers regarding payment for vaccines (44% Ped, 33% FP) and administration fees (44% Ped, 35% FP).

When asked if they had stopped purchasing one or more pediatric vaccines for financial reasons, the answer was “yes” for 12% of Ped and 23% of FP, “no, but have seriously considered” for 24% of Ped and 26% of FP, and “no” for 64% of Ped and 51% of FP, reported Dr. Allison and her colleagues.

Read more in Academic Pediatrics (2017. doi: 10.1016/j.acap.2017.06.001 ).


You May Also Like

Low-volume surgeons have most complications with mesh slings

FROM JAMA SURGERY The 10-year incidence of serious complications after mesh-sling surgery for stress ...

FDA panel set to vet Essure safety

On Sept. 24, the Food and Drug Administration’s Obstetrics and Gynecology Devices Panel will ...

Business associate agreements

Revision of the Health Insurance Portability and Accountability Act (HIPAA) rules has prompted numerous ...