A significant percentage of the nation’s pediatricians are carrying necessary vaccines at their own expense, Athenahealth, Inc. recently announced. The announcement accompanied the launch of the company’s new VaccineViewSM, a program designed to shed light on the impact of vaccine reimbursement costs on U.S. pediatric practices.
“Nearly 50 percent of the time, pediatricians in this country are not being made whole by payers for carrying sometimes expensive but necessary vaccines in their inventory,” said Jonathan Bush, CEO and Chairman of athenahealth, in a press release accompanying the launch.
“The domino effect of under-reimbursing pediatricians for vaccinations will be that fewer will order, carry and administer the very things necessary to prevent disease and to control the spread of seasonal illness. As it is, some five percent have stopped already, or are rerouting toddlers to public health clinics for immunizations where follow-ups plummet drastically,” continued Bush.
In analyzing vaccine payments posted on the athenaNet network from January 2009 through December 2010, the VaccineView program found that certain vaccinations are being under-reimbursed nearly half the time (47 percent) when the total cost to the physician, beyond the cost of acquisition of a specific vaccine, is considered.
The specific goal of the VaccineView program is to understand insurance reimbursement to pediatricians for the direct and indirect costs of vaccines, and more broadly to create a full picture of the marketplace that lends transparency and clarity to reimbursement trends where they are otherwise lacking.
In a post on the Athenahealth blog, Dr. Jason V. Terk, Medical Director for Cook Children’s Physicians Network, noted that “as physicians who care for children, we recognize that the provision of vaccines to our patients is perhaps the most important service we can provide. This is because vaccines protect both the patient we are seeing in our office at the point of care as well as the entire community through the effect of herd immunity.”
He went on to say, however, that “the sustainability of this service is greatly threatened by the financial reality that so many vaccine providers (mostly pediatricians who are already at the bottom of the income food chain) are losing money trying to do this important public health mission.”
According to Athenahealth, direct vaccine costs are only part of the burden pediatricians have to bear. Other factors, both direct and indirect, include personnel costs for ordering and inventory, storage costs, insurance against loss of the vaccine, and recovery of costs attributable to inventory shrinkage, wastage and nonpayment.