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Saturday, June 11, 2011

Compulsory Vaccination: Monetary vs. Altruistic

Many assume physician practices make a lot of money off vaccines. Maybe there is a lot of profit for some doctors. I am naive as to how they are making the vaccine profit (that makes them so stubborn). I know the manufacturer gets the product sale, but I am not sure what drives the Pediatrician to be so insistent on the full vaccine schedule. Capitalism motivates and perhaps that's why it is so hard to find doctors who are flexible with vaccine choice. Or is it really the fixed-firm altruistic belief that the complete schedule saves lives. ( I realize I am really putting myself out there....)

I'd like to consider the financial incentive:

Medicaid distributes vaccines to participating pediatricians (I think), but I am not a part of that program. I don't know much about it. Is there incentive for the provider to push?

The physician gets to bill for the office visit, but that's the office visit and not the immunization. Would some visits be lost if there would be no vaccination administered. Sure, there would be. But that's the families choice and I am not responsible if they don't choose to see me (It should be clear if you are missing appointments without mutual agreement, I am not repsonsible for after hours care.).  In my practice situation, many still come in for the recommended visits for questions, concerns, education, breastfeeding, nutrition without the pressure to vaccinate and the reassurance in having my emergency availability. The visits equal out. At least for me it does not make a case.

I have never been given (or even offered) a bonus or any kind of incentive for vaccination children. If I've been indirectly offered a bonus for vaccinating adults, I am oblivious to it and focused on what I am (not) doing. I am not eating their free-lunch either. I'd rather  have my smoothie.

I am not saying these incentives are or aren't out there. I am just not sure.

Perhaps it's in the volume. Maybe in bigger, multi-physician practices the financial incentive is in the quantity. I am just relatively small volume seeing patients of all ages in the mix. "Vaccine-volume" doesn't work to my benefit. We don't have one nurse dedicated to vaccines all day.

Health Insurance reimburses for administration. They do not reimburse for these items regarding vaccines.

Refrigeration (including keeping cool during storms)
Needles & Syringes
Staffing & Training
Extra time needed for chart-work
Production of Forms for the Chart
Education of Families
Expired Products (if anything expires, its a complete wash-out)
Our purchase (and reproduction) and distribution of School Forms
Follow-up phone calls regarding side-effects and complaints. (Fortunately, I don't get many of these calls).

Quite honestly from an overhead standpoint it would be just as well if you did not vaccinate at all and I can simply document DECLINE VACCINATION on the office visit note. 

I like to disclose this. Because it's not what you'd expect.

Perhaps, without significant financial incentive to my small practice, it is easier to be opened-minded to accept patients in my practice who do not fully vaccinate because it's a monetarily neutral decision. Let me just say, maybe I'd even come out ahead in overhead if I did less immunization (My nurses might like it too.). Really, it would be very hard to truly analyze this.  I am just glad I am able to offer flexibility and feel good about it.


The Natural Mama said...

To keep your Medicaid benefits you must do the scheduled doctor check-ups as they require, whether a vaccination happens to occure during that visit or not. So the doc gets to bill for that office visit, and in the first year it is every three months or more. Do they get to bill more if they do vaccinate? Nolan has had three peds since his birth. All respected my decision not to vaccinate, but when they asked me why, and I said, "Can you prove that vaccines are 100% safe and effective?", they stumbled over those questions. If you visit the CDC website, there is a place to click on to report and adverse effect. And there are ALOT of reports!!! safe and effective....?hmmmm

Denise Punger MD IBCLC said...

I did not know to keep medicaid you had to keep your appts. But I understand it from my own perspective -- if you want my availability and understanding, I do need to get to know you.

I do not know either if there is a financial incentive to vaccinate for pediatricians. The limited straight medicaid I see in Family Medicine is not influenced by that. It's never come up.

Thank you for sharing your perspective.

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