Tackling Vaccine Financing Issues Immunization Initiatives Newsletter - August 2007
Immunizations are of great concern to a large number of pediatric practices due to an increasingly complex schedule, rising prices, and stagnant and inadequate payments. Immunizing is a public health benefit, yet is dependent upon the private sector as the primary delivery system. However, pediatricians cannot afford to subsidize immunizations and risk the financial sustainability of their practice. Immunizations continue to be a strategic priority of the Academy. In order to address this strategic priority, the AAP Task Force on Immunizations was formed. In February 2007, the Task Force brought together medical societies, private payers, manufacturers, and public health/government officials for the AAP/AMA Immunization Congress. After much consensus building, all parties present agreed upon 9 recommendations. Please visit www.aap.org/advocacy/ImmFinPosPaper.pdf for more information on the recommendations. Since the Immunization Congress, various groups have taken the lead on recommendations that most affect their members. AAP activities are described below. Private Provider Costs Private payers at the Congress indicated that they need data on the true cost of vaccinating in order to raise payment. Several studies are underway. The AAP is funding one such study, which will be replicable in other states. Many organizations expressed interest in obtaining data on vaccine payment from multiple payers in private practices. The AAP has signed a letter, encouraging members to participate in a study performed at the University of Michigan on this topic. Additional studies on the true cost of combination vaccines are underway. Kathy Cain, MD, FAAP of the Private Payer Advocacy Advisory Committee will co-lead a group of organizations in educating payers about these true costs.
Manufacturer Payment Terms Member concerns recently led to a new pricing policy by Merck (www.aap.org/securemoc/immunizations/MerckLetter0407.pdf). Pediatricians will be immediately notified of price increases and will be given 30 days to buy vaccine at the old prices. When Wyeth announced a price increase in Prevnar, it also allowed a 60-day extension of the current price to customers who had a standing order in place. Wyeth is open to continuing this approach with new vaccines, if they receive positive feedback. The AAP, led by Thomas McInerny, MD, FAAP and Richard Lander, MD, FAAP will approach all manufacturers with the “AAP Wish List,” published in the July 2007 issue of AAP News, for how manufacturers can further help the practicing pediatrician.
Definition of CPT Codes for Administration Fees The Committee on Coding and Nomenclature (COCN) will bring immunization administration codes to RUC for refinement. If revised inputs are accepted, it will result in revised relative value units on the Medicare RBRVS starting 1/1/09. COCN continues to look at the need for a different CPT code structure for administration fees and has recently begun discussions with the National Vaccine Advisory Committee.
Best Business Practices AAP staff will work with committee/section leadership to develop an online module about immunization best business practices, helping the small practice find ways to cut the costs of immunizing while maintaining efficient and effective care. The September issue of AAP News will feature an insert on calculating and reducing vaccine costs in pediatric practices.
Private Payer Advocacy As the Task Force works to achieve their goals, the AAP Private Payer Advocacy Advisory Committee is busy working with payers to resolve reported issues such as bundling vaccines and immunization administration. If you are having problems with payers, please consider filling out a hassle factor form, available at: http://practice.aap.org/content.aspx?aid=1316&nodeID=2013. The AAP has sent letters to carriers on behalf of members, requesting fair payment for vaccines and their administration, consistent with The Business Case for Pricing Vaccines www.cispimmunize.org. These letters, as well as sample appeal letters that the AAP members can use to send to their payers are accessible on the AAP Member Center, private payer advocacy page at: www.aap.org/moc/reimburse/default.cfm. PPAAC also recently completed a Pedialink module on Contract Negotiations with Payers. While the Academy cannot negotiate pricing on behalf of its members due to federal anti-trust restrictions (http://aapnews.aappublications.org/cgi/content/full/26/9/40), we can educate members about how to enhance their negotiation skills. Access to the Pedialink module on contract negotiations is at: www.pedialink.org/cme/_coursefinder/CMEdetail.cfm?aid=31177&area=liveCME. Media Relations The AAP also created a press release (www.aap.org/advocacy/releases/apr07vaccinecosts.htm), which has been picked up by several major news carriers, including the Washington Post. Previous stories have been aired by the Today Show and printed in the New York Times. Consider contacting the media in your area to continue to get the word out that pediatricians are at the breaking point. Talking points are available at http://practice.aap.org/content.aspx?aid=1692. Our media department is also available to help you by emailing commun@aap.org. Some of these approaches are short-term solutions until longer-term solutions are available. The AAP Task Force on Immunization and AAP leadership are committed to exploring options that promote access to immunizations for all children while ensuring the financial viability of pediatricians. Should you have any questions about the Task Force on Immunization, please contact esobczyk@aap.org. Should you have any questions about Private Payer Advocacy, please contact lterranova@aap.org. |
