Managing Vaccines

A SECTION ON ADMINISTRATION AND PRACTICE MANAGEMENT E-MAIL LIST SUMMARY

This document is a summary of a peer-to-peer survey distributed over the Pediatric Practice Manager Association e-mail list and the results collected using SurveyMonkey. This particular survey addressed trends in pediatric practices related to managing vaccines, such as safe handling techniques, disaster preparedness, vaccine purchasing, and the effects of inadequate payment on vaccine administration.

Overview

The American Academy of Pediatrics (AAP) Pediatric Practice Manager Association (PPMA) implemented a survey in December 2008, requesting information from PPMA members related to vaccine management in their practices. The survey consisted of 17 questions, with a total of 55 individuals from 21 different states completing at least a portion of the survey. The majority of respondents (40%) were from practices with 4 to 8 full-time equivalent (FTE) physicians. The remaining respondents were split between practices with 3 or fewer FTE physicians (27%) and 9 or more FTE physicians (33%). (Q1 & Q2)

Summary of Results

All the practices that answered the survey have a procedure in place to ensure the appropriate storage temperature is maintained for their vaccine supply and have a thermometer in the storage unit. (Q3 & Q4) Most maintain a temperature log (97%) and have an intake procedure with one person responsible for receiving and appropriately storing all vaccines (89%). A much smaller group have an alarm system on the storage unit that indicates when the temperature has gone out of the acceptable range (30%). Only a very small number of practices (4%) use vaccines for which the container itself has an indicator that notifies when the vaccine has fallen out of the appropriate temperature range. (Q4)

With regard to protecting their vaccine supply, practices responded differently. Only 85% have a procedure in place to protect their vaccine supply in the event of a power loss. (Q5) Some have alternative storage plans (73%), while 43% have a storage unit that has an alternative power supply (ie, backup generator). Some practices (28%) have an alarm that triggers an outside company to contact the designated staff within the practice, should a power outage occur. (Q6) In the event of a disaster, more than half of the practices (55%) have a separate storage facility to protect their vaccine supply. For several, this means storing the vaccines at a physician or staff member’s house. Some practices have arrangements with another local practice (14%) or hospital (21%) to assist with storage. Finally, 17% of practices do not have a plan for storage in the event of a disaster. (Q7) Practices are also insuring their vaccines to protect against loss (83%). (Q8) The majority of the practices (88%) have a rider on their current insurance policy. (Q9) Practices indicated that their insurance policies will cover loss in the event of power outage (87%), natural disaster (83%), human error (40%), and acts of war or terrorism (23%). More than half of the practices (53%) indicated that their policy limits the dollar amount that is covered. (Q10)

Practices were also asked to provide information about the types of vaccine programs in which they participate. Most (79%) participate in private purchase and Vaccines for Children (VFC); 19% provide only privately purchased vaccines, and only 1 practice provides VFC vaccines exclusively. (Q11) For those that participate in both programs, more than half (58%) indicated that the VFC portion makes up less than 25% of their vaccine stock. Twenty-one percent stated that VFC vaccines account for 26% to 50% of their supply; 15% said that VFC vaccines make up 51% to 75% of their supply; and 6% indicated that VFC is a significant portion of their supply, at 76% to 99%. (Q12) In terms of obtaining vaccines, the majority (71%) participate in a group purchasing organization. Some (40%) also purchase directly from the manufacturer of the vaccine, and 38% obtain their vaccines through VFC. Two practices participate in a hospital network that purchases the vaccines for them. (Q13)

Vaccine costs continue to rise and payments are not often adequate. Approximately one third (33%) of the practices who responded indicated that they choose not to provide certain vaccines because of poor payment (Q14). Sometimes this is related to new vaccines that have not yet been adopted by payers, such as Pentacel, which 42% of respondents indicated they are not providing. Pediarix and FluMist were the next vaccines most often not provided because of poor payment (25% and 33%, respectively). Hepatitis A and diphtheria, tetanus, and acellular pertussis (DTaP) were the only 2 vaccines that practices did not indicate they have chosen not to provide. (Q15) Other reasons that practices did not provide certain vaccines included concerns about higher incidence of fever with some combination vaccines and concerns about complications that arise when patients have to migrate from 1 vaccine to another (eg, rotavirus from RotaTeq, 2 doses versus 3 doses of hepatitis A). (Q16)

Additional Resources for Better Vaccine Management

Finally, respondents were asked to provide feedback on what additional support they needed to better manage vaccines in their practices. The most common answer was assistance in advocating for better payment, in particular for getting payment by antigen rather than by injection. Practices are required to discuss the risks of each antigen, so some payment should be provided for that time. Another suggestion included the development of a vaccine inventory program that would ensure more accurate billing. One practice also felt it would help with quality to have vaccines color-coded to reduce the time needed to verify which vaccines are being given. Finally, benchmark data on what amount of inventory to keep on site were also identified as a need. (Q17)

Lessons Learned

This survey went smoothly. However, question 15 (which lists out various types of vaccines and asks practices to indicate which they did not provide due to inadequate payment) will be broken into 2 parts next time—new vaccines and all other vaccines. Many new vaccines may not be provided right away until payers have incorporated them into their payment systems. This skews the overall numbers and points to a different issue (ie, prompt adoption of new vaccines into payer systems is necessary).

Additional Information

“The Business Case for Pricing Vaccines and Immunization Administration”

http://practice.aap.org/content.aspx?aid=1808

Coding for the Product & Administration of Influenza Vaccine

http://practice.aap.org/content.aspx?aid=2559

CLICK HERE to see the data collected from the survey, outlined by question.

Note: The comments in this article are the views and opinions of those who stated them and may not represent American Academy of Pediatrics policy.