Payment problems keep doctors from vaccinating kids

Pediatricians and other family care physicians have been complaining for years that the prices they're charged for childhood vaccines and the amounts they're reimbursed by insurers for giving the shots puts them in a financial bind.
About 85 percent of children in the U.S. are vaccinated in pediatricians' offices, although some vaccines for lower income and uninsured kids come from a stockpile purchased by the federal government.
High costs associated with buying and giving vaccines have forced some pediatricians to stop administering some of the most expensive serums, although the scope of the problem has been unclear.
A pair of new studies published online Monday by the journal Pediatrics shows that while few physicians have actually considered no longer providing vaccines, many are price sensitive.
A survey of nearly 1,000 pediatricians and family physicians done by researchers at the University of Michigan Health System found that 11 percent had considered no longer providing vaccines to privately insured children, but about half (49 percent) said they'd delayed the purchase of some vaccines for financial reasons.
Like the findings in a survey done by the American Academy of Pediatrics in 2006, less than half of the physicians in the new survey felt reimbursement for vaccines from either private or public health insurers was adequate.
Cost and physician reimbursement for vaccines were among the obstacles to full immunization for American children cited in a Scripps Howard News Service investigation earlier this year.
"Physicians have a laundry list of complaints about the cost of buying and administering vaccines, everything from having a freezer where they can store serum to having to wait weeks to months to find out if insurance will even cover immunization,'' said Dr. Jerome Klein, a professor of pediatrics at Boston University who studies vaccine financing issue, but was not involved in the Pediatrics studies.
According to the AAP, it's common for even pediatric practices with only a handful of doctors to have $100,000 or more worth of vaccines stored in their offices at any given moment.
But in a second study involving 76 practices in five states (California, Georgia, Michigan, New York and Texas), the researchers from Michigan found that what doctors are paying for vaccines varies widely from office to office. For instance, the per-dose price of one brand of hepatitis B vaccine ranged from as little as $4.26 to as much as $13.06.
Reimbursement rates also varied greatly. The payment for one of the recommended series of shots against measles, mumps and rubella (MMR) ranged from as little as $16.77 to as much as $59.02.
"Until now, no one knew what anyone was paying,'' said Dr. Gary Freed, director of the Child Health Evaluation and Research Unit at the University of Michigan's Mott Children's Hospital and lead author of the studies. "This information will change the way in which physicians negotiate prices."
Until recently, Freed was also chairman of the National Vaccine Advisory Committee, the government panel that recommends which vaccines children and adults should receive and at what intervals.
That list has been steadily expanding. In 1980, it cost about $59 in today's dollars to buy the seven shots and four oral doses recommended for a child from birth to age 18. Today, that menu includes 37 shots and three oral doses, at a cost of as much as $1,600 if the patient is female and gets three doses of the new vaccine to protect against viruses that cause cervical cancer.
"It's hard to imagine parents skipping vaccines for their children because they -- or even their doctor -- can't afford to pay for them, but it certainly is part of the problem we're facing it getting full immunization coverage,'' Klein said.
Freed said part of the answer is that "physicians need to be better business people, and negotiate better prices and payments,'' perhaps by setting up or joining cooperatives to get better rates.
On the Net: http:/www.aap.org
www.cdc.gov/vaccines/

(E-mail Lee Bowman at bowmanl(at)shns.com. Distributed by Scripps Howard News Service, http://www.scrippsnews.com)