For practices that do not routinely offer vaccinations or are struggling to maintain a successful program, we would like to offer a basic outline of the process our practice used.
For practices that do not routinely offer vaccinations or are struggling to maintain a successful program, we would like to offer a basic outline of the process our practice used. Adhering to this process should deliver healthier, vaccinated patients and increased revenue, and will represent an important step towards meeting the preventative health measures in value-based care.
The Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and many state health departments offer formal training guides to assist with setting up a successful and complete vaccination program for your practice.
Appoint an office vaccine coordinator with specific duties. As you practice medicine, there will be appropriate areas requiring routine oversight.
There are strict requirements regarding the refrigeration, temperature monitoring, and systems of storage to ensure the integrity of the vaccine. Each option has advantages and drawbacks (visit bit.ly/vaccine-storage for some good insight on this topic.) Review your general liability insurance with your broker to see if you need a rider to cover the vaccine you store. Practices providing vaccines for children to low-income patients should review those requirements from their state public health department.
Pediatric practices have two main options. GSK offers a combination vaccine with DTaP-Hep B-IPV. Pediatricians preferring that combination will build the remainder of their vaccine schedule with GSK products, filling in with products not available from GSK.
The second option is the Sanofi Pasteur combination, DTaP-HIB-IPV. Again, the remainder of the schedule is filled in with Sanofi Pasteur products, along with Merck products. Merck, Sanofi, and GSK set contractual purchase requirements to qualify for and maintain the highest contract discounts. Failure to meet the purchase requirements results in an increase in price for all under a GPO contract. After a science review, you can and should review vaccine cost.
There are a finite number of vaccines available. You should not pay any more than necessary for the schedule you prefer. Take the time to crunch your numbers, and understand the benefits and drawbacks of the various purchasing options. Ordering your vaccine from a distributor generally will result in the highest cost. Ordering direct from the manufacturer is a less expensive option. You may also order directly from the manufacturer under several contracted options.
Internal vaccine contracts. Merck offers a contract to single offices that meet the company’s purchasing requirements. PediaFed pricing is better than this internal contract because we return our admin fees in the form of rebate.
Large GPO contracts, usually found in hospitals. These are not vaccine directed and do not have the level of vaccine discounts found in other options, according to the manufacturers.
Physician buying groups (these usually receive the highest level of discount available.
Purchasing groups that return unspent administrative fees can significantly lower cost. You should be able to calculate the rebate your practice will receive by reviewing the buying group pricing grids. Careful attention to this part of the process should provide a cushion towards fluctuating insurance reimbursement rates and give your practice the lowest vaccine cost available.
This is a critical part of the process. The revenue derived from providing vaccinations should contribute appropriately towards your practice overhead. For help with this process, we recommend the “Business Case for Pricing Vaccine” guide from the American Academy of Pediatrics. This reference states that most practices will have overhead costs from routine immunization of between 17% and 28% over the cost of the vaccine.
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 usually 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 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 relevant 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. Manufacturers 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 electronic health record (EHR) 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 bring about 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 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 will provide you with necessary quality metrics and revenue. As we continue to focus on the best healthcare and outcomes for our patients, the role of excellent vaccination processes cannot be ignored.