Report highlights the financial strain, opportunities in adult vaccination

August 20, 2018

Most practices aren’t aware of the many options for payment and reimbursement available for adult vaccines, according to a new report.

Clinicians are often reminded that adult patients have poor compliance when it comes to receiving recommended vaccines. But are additional efforts to promote these vaccines worth the cost? A new study investigated how practices get paid for adult vaccines, and how clinicians can make sure the work is worth it.

While the importance of vaccines can’t be underestimated, clinicians often struggle to find the time-and reimbursement-to cover all of their efforts in a quick office visit. A recent study, published in Vaccine, found that clinicians are not very well informed when it comes to getting reimbursement for their efforts when it comes to adult vaccines, and that this may hinder their willingness to promote immunizations in this population.

In fact, the study found that more than half of the practices surveyed for the report reported losing money on vaccinating adult patients covered by Medicaid, and that one-quarter to one-third of practices were unaware of Medicare Part D coverage for adult vaccines and administration. Very few of the practices studied reported ever negotiating with payers or manufacturers on adult vaccine payments, according to the report.

Megan Lindley, MPH, of the CDC’s National Center for Immunization and Respiratory Diseases and lead author of the report, said perceptions of the profitability of adult vaccination services in physician practices varies by payer, and the financial feasibility of providing routinely recommended vaccines to adults really depends on the practice’s payer mix.

“Over a decade after implementation of the Medicare Part D program, which covers routinely recommended adult vaccines not included in Medicare Part B, a significant proportion of physician practices still lack awareness about Part D payments for vaccination services,” Lindley said. “Fewer than half of practices responding to our survey reported billing Part D for vaccines provided to adults. The belief that providing adult vaccines is not profitable for clinicians may contribute to suboptimal uptake of recommended vaccines among U.S. adults.”

Clinicians and their office staff can work with payers that include Medicare Part D plans accepted by their practice to better understand the vaccination benefits that are provided under these plans, including required patient cost-sharing and payment levels for adult vaccinations.
“Practices can consider gathering information on the costs of providing adult vaccines to assist in negotiations with insurance plans, either on their own or in conjunction with academic, professional, or government partners,” Lindley said. “Clinicians that do not currently participate in vaccine purchasing groups may want to consider it since group purchasers may be able to acquire vaccines at lower costs.”

Reminding hesitant adults to receive immunizations takes time and effort, and purchasing and stocking vaccines for a population that doesn’t always comply with recommendations can be costly, Lindley admits, but that shouldn’t be a reason to skip providing immunizations altogether.

“Clinicians who treat adults should assess patient vaccination status and strongly recommend and offer needed vaccines at every patient encounter, as well as documenting receipt of vaccinations by adult patients,” she said. “Clinicians in practices that are unable to stock all recommended adult vaccines should provide referrals to other sites where patients can receive needed vaccines.”

There are many options available to help adult patients who are unable to receive vaccines for financial reasons, Lindley said. Some vaccine manufacturers offer free programs to patients who meet certain criteria, and some states also offer low- or no-cost programs for adult immunizations. Modeled after the Vaccines for Children program, Lindley said these programs are very effective in helping adult patients get the vaccines they need but can’t afford. Clinicians should learn about programs like these and any others offered by local health departments, and share that information with patients in need, she said.

“Clinicians can help their adult patients by reaching out to the immunization program in their state or local area to learn about programs available to help patients with financial barriers to vaccination and informing patients about their options,” Lindley said. “Clinicians may also wish to ask the manufacturers that supply them with vaccines for adults about the availability of patient assistance programs.”

Lindley said she hopes the report will encourage physicians to expand efforts in their practices to promote vaccination in adults, billing Medicare Part D when they can, and educating patients on other cost-savings program when Medicare isn’t an option.

“We hope this research will highlight the various strategies and resources available to clinicians who have concerns about billing for adult vaccination services and will encourage clinicians to assess for and strongly recommend all needed adult vaccines during every patient encounter,” she said.