A practice’s immunization program requires constant attention and oversight. Here are seven best practices to consider.
With value-based care now a reality, here are some tips to keep your immunization program on track to benefit patients and your practice.
A weekly inventory count can keep the appropriate amount of vaccine in your refrigerator. This count should take 10 minutes or less. A simple grid on a clipboard is all that is needed.
The employee designated to place orders should use the inventory sheet to place weekly orders. That person can use a simple spreadsheet to calculate orders, based on historical usage. Orders should be placed online to capture any available online order discounts. Orders are transcribed to an “order received” sheet on the front of the refrigerator, where staff members can log shipments from the manufacturer.
Vaccine administration varies among practices. Patients are screened for contraindications and precautions found on the package insert for each vaccine. After the vaccine information statement is given to the parent, and the physician explains the vaccines to be administered, the physician may administer the vaccine or delegate the task to medical assistants or appropriate staff members. You can subscribe to the CDC service that will notify you automatically when there are vaccine updates important to your practice.
In addition to the vaccine itself, practices bill for the administration code. Administration codes are based on physician review of the vaccine with the parent/patient, number of antigens and the patient’s age. Coding resources are available through most manufacturers. They also maintain departments that are responsible for interacting with insurance companies and can intercede on behalf of a practice regarding reimbursement problems.
When ordering directly from the manufacturer under a physician buying group contract, you should be eligible for 90-day payment terms. This means you should be able to administer the vaccine, bill the payer, and receive reimbursement before paying your vaccine invoice. Credit card payments are accepted, extending the actual payment another month.
Part of the value-based care initiative is based on successful vaccination numbers. If you have an EHR system that can perform a recall function, use it. You can also book all doses for vaccine series for older children/adolescents at one time to insure series completion for HPV and meningococcal vaccines. National statistics show a 40% or less completion rate for these adolescent vaccines, and series completion is receiving attention and resources to ensure improvement.
The success of your program depends on the quality and regularity of your review. At least twice a year, and preferably quarterly, you should conduct a formal review, comparing vaccine cost and vaccine overhead to the reimbursement provided. Perform this exercise with your top 10 contracted insurers. This allows you to act on inappropriate reimbursement. There are pediatric EHR systems, such as PCC, that can provide reporting assistance to keep your vaccine program optimal.
Participating in the vaccination process for your patients will provide you with necessary quality metrics and revenue for your practice. As we continue to focus on the best healthcare and outcomes for our patients, the role of excellent vaccination processes cannot be ignored.
The following statistics give a dollar value and a health value to immunization efforts;
• Among 78.6 million children born during 1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses, according to the CDC.
• Each year, approximately 42,000 deaths of children and 50,000 adult deaths in the United States are prevented by immunizations, according to CMS.
• A 2014 study published in Pediatrics indicates that every dollar spent on pediatric vaccines saves $10.20. In fact, the U.S. saves almost $70 billion in direct and indirect costs each year as a result of the pediatric vaccination program.
Alan Johnson, MD, FAAP, has been a practicing pediatrician for SF Bay Pediatrics in San Francisco for 40 years. He completed an immunology fellowship from the University of California, San Francisco and is a clinical professor of pediatrics at UCSF and a consultant in infectious disease. He has led the Pediatric Federation community from its inception.
Kathy Chebib, BS, MT, a trained medical technologist, has been a pediatric business manager and practice administrator for more than 30 years. She works for Golden Gate Pediatrics in San Francisco, and helps with the cooperative endeavors of Pediatric Federation.