Financing of Vaccine Delivery in Primary Care Practices

Abstract

Objectives Vaccines represent a significant portion of primary care practices’ expenses. Our objectives were to determine among Pediatric (Ped) and Family Medicine (FM) practices: 1) payment for vaccine purchase and administration and estimated profit margin by payer type, 2) strategies used to reduce vaccine purchase costs and increase payment, and 3) whether practices have stopped providing vaccines due to financial concerns. Methods A national survey from April to September 2011 among Ped and FM private, single-specialty practices not in Universal Purchase states. Results The response rate was 51% (221/430). Depending on payer type, 61% to 79% of practices reported that payment for vaccine purchase was at least 100% of purchase price and 34% to 74% reported that payment for vaccine administration was at least $11. Common strategies to reduce vaccine purchase cost were online purchasing (81% Ped, 36% FM), prompt pay (78% Ped, 49% FM), and bulk order (65% Ped, 49% FM) discounts. Few practices used strategies to increase payment, reporting rarely/never negotiating with health plans for payment for vaccines (56% Ped, 67% FM) or administration fees (56% Ped, 65% FM). When asked if they had stopped purchasing vaccines due to financial concerns, 12% of Ped and 23% of FM responded ‘yes’, and 24% of Ped and 26% of FM responded ‘no, but have seriously considered’. Conclusions Physicians report variable payment for vaccination services from different payer types. Physicians, especially FM, may benefit from increased use of strategies to reduce vaccine purchase costs and increase payment for vaccine delivery.

Vaccine Hesitancy in Pediatric Primary Care Practices

“…Our results demonstrate that practice finances can be negatively impacted when primary care providers spend extra time per visit with vaccine-hesitant families, when practices are not reimbursed for nurse-only follow-up immunization visits, and when quality measures for immunizations are not met for maximum reimbursements. While previous studies have focused on the finances of purchasing, storing, and administering vaccines in primary care (Allison et al, 2017; Freed, Cowan, & Clark, 2008; Lindley, Shen, Orenstein, Rodewald, & Birkhead, 2009; O’Leary et al, 2014), no studies have explored the financial cost to practices of vaccine hesitancy in primary care. Understanding the financial cost of vaccine hesitancy related to physician and clinical staff time, vaccine storage, and vaccine wastage will allow for a deeper understanding of how practices are impacted financially by vaccine hesitancy.…”

Reimbursement for HPV Vaccine Cost in the Private Sector: A Comparison Across Specialties

“…The financial and operational challenges of stocking vaccines by family physicians documented in the literature corroborate these findings. [6][7][8] We also report that the return margin is positively correlated with the number of HPV vaccine doses administered by practitioners. For instance, changing HPV vaccine reimbursement to the AAP-recommended level ($263.74, ie, a net return of +$40), could translate to an estimated 18,643 additional HPV vaccine doses administrated by pediatricians, 4,041 additional doses by family physicians, and 433 doses by "other" specialty in 2017-2018.…”

Strategies for the Elimination of Hepatitis C Virus Infection as a Public Health Threat in the United States

“…Although the initial investment for the federal government would be large, the long-term cost savings could be considerable and would allow many patients to be treated [9]. Alternative strategies to address the costs of DAA treatments might include seeking discounts for bulk or pooled purchases [57, 58] or obtaining DAA regimens through the 340B Drug Discount Program, which provides medications at greatly-discounted prices to safety net providers caring for uninsured or low-income patients [59].…”