Increasing Financial Incentives: The Providers Perspective

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Increasing Financial Incentives The Providers
Perspective

• Robert Siegel, MD

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The Goal

• 100 immunization rate
• Maintaining continuity of care
• Staying in business

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What does it take?

• Access
• Using all opportunities
• Adequate vaccine supply
• Belief/ education
• Adequate compensation

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Barriers

• Supply problems
• Lack of time
• Disagreement with recommendations
• Patient/family beliefs
• News media
• In adequate compensation

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What do Pediatricians and Rock Stars have in
common?
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Economics Bobs Model

• If you recover
• Cost of vaccine
• Cost of equipment
• Plus a little bit extra
• You are doing OK

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Real Economics Micks Model

• If you recover
• Variable costs
• Vaccine
• Administrative/Billing
• Clinical staff time
• Any contribution to fixed costs
• Rent, Heat etc
• Then it pays to immunize

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The Cost of Giving Childhood Vaccinations
Differences Among Provider Types

• Judith Galzner et al
• Pediatrics, June 2004

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Methods

• 12 practices in Colorado-CRSP
• 2 rural practices
• 2 Community Health Centers
• 4 rural health departments
• 4 urban pediatric practices

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Data

• Forms recording time spent
• 1 month for rural practices
• 1 week for pediatric practices
• Interviews of time spent
• Labor costs based on averages
• Non-labor costs
• Syringes, needles, alcohol wipes, cotton balls,
  bandages

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Routine Nursing Activities

• Consent
• Providing educational materials
• Review history
• Complete vaccination log
• Fill out patients shot record
• Draw and give vaccine

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Non-routine Activities

• Order vaccine
• Inventory vaccine
• Provide vaccine records to requesters
• Answer telephone questions
• Attend continuing education
• Registry issues
• Screening
• Updating

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Billing Activities

• Update information on patients billing record
• Receive payment
• Obtain billing information on new patient
• Mail bills
• Post payments
• Make bill adjustments

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Cost of administration(excluding vaccine cost)

• variable fixed
• Public Health Agency 5.41 NA
• Family Medicine 5.79 1.79
• Pediatricians 8.27 2.52

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Time per shot-minutes

• Family Physician 0.8
• Pediatrician 2.8
• FP nurse 5.8
• Pedi nurse 3.4
• HD nurse 7.5

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Total cost of administration (excluding
vaccine)and reimbursement

• total cost reimbursement
• Public Health Agency 5.41 no bill
• Family Medicine 7.57 6.68
• Pediatricians 10.67 8.27
• does not include fixed cost

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Estimating medical practice expenses from
administrating adult influenza vaccinations

• Coleman et al, Vaccine in press

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Methods

• 20 Clinics
• Rochester, NY (8)
• Albuquerque, NM (6)
• San Diego, CA (6)
• Office Manager Survey
• Occupational checklist of encounters

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Cost per shot-scheduled visit

• Practice Size per-shot cost expense gap
• Solo 50.43 -32.76
• Small 34.56 -20.00
• Medium 27.77 -12.60
• Large 25.22 -9.82
• Corporate 19.58 -3.67

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Cost per shot-walk in30 per hour

• Practice Size per-shot cost expense gap
• Solo 43.37 -25.70
• Small 28.34 -10.67
• Medium 23.46 -5.79
• Large 21.03 -3.36
• Corporate 15.12 2.55

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Conclusions

• In most circumstances there is no economic
  incentive to administer vaccinations
  
• This may encourage practitioners to refer
  patients to settings outside of their medical
  home
  
• Vaccination reimbursement should be considered
  with public policy decisions