Vaccines: A Survival Guide for Pediatricians
2009
Do you know if vaccines are providing an operating margin or a loss to your practice? If you have not run the numbers recently, consider the exercise below. As the price of vaccines increases and the schedule becomes more complex, vaccines have become a loss leader for many pediatric practices. In order to effectively negotiate with private payers, pediatricians need to know exactly how much vaccines are costing them. Total the costs listed below to calculate the true cost of immunizing for your practice (see figure 1).
Visit the interactive Vaccine Cost Calculators to learn the practice cost of administering 1 dose of vaccine for a 3 month timeframe. Participating in a Group Purchasing Organization Group purchasing organizations (GPOs) are able to combine orders from practices, hospitals, nursing homes, and other medical facilities in order to receive volume discounts from specific vendors. Vaccine purchasing programs are one type of GPO. While the AAP does not have access to the lists of GPOs that may work with pediatric practices, pediatricians may wish to further investigate the following types of groups. Health Industry Group Purchasing Association (HIGPA): This member organization includes GPOs, manufacturers, and distributors. Contact HIGPA or link directly to members by visiting this Web site: www.higpa.org/member_orgs/Member_Orgs.asp. Pediatrician-led Groups: Some groups are exclusive to pediatricians or pediatric products. While these groups may not be as large as those from HIGPA, they may meet more of pediatricians’ needs. Learn more about one pediatrician-led group at www.pediafed.com/vpp. Distributors with GPO Component: Some distributors offer pediatric-specific GPOs. Visit www.cispimmunize.org/pro/manufacturers.html for a list of distributors to call. Practice Management Groups: In addition to other consulting services, practice management groups may offer a vaccine purchasing agreement. Hospitals or Nursing Homes: These groups in your area may have their own vaccine purchasing agreements. If you are affiliated with the hospital, they may allow you to order through them.
Most GPOs require that you order all vaccines through them, although they may only contract with 2 or 3 manufacturers. Make sure the GPO you choose contracts with all of the vaccine manufacturers whose products you wish to use. Negotiating Contracts A new PediaLink education module has been developed to help pediatricians negotiate the best possible contract with private payers. The Contract Negotiations With Payers module presents techniques and processes to confidently conduct successful negotiations. Key topics include technical considerations, model contracts, negotiation styles, and a 4-phase negotiation process model. This 5-hour module is targeted to pediatricians and their staff who have limited experience in negotiating payer contracts or who need a refresher course in this area. Contract Negotiations With Payers is available at: www.pedialink.org/cme/_coursefinder/CMEdetail.cfm?aid=31177&area=liveCME. Some tips from the module are below: Review the carrier contract for provisions on vaccine and immunization administration payments. Insist that there be provisions to address payment for new vaccines, vaccine price increases, and new immunization recommendations in a timely manner by the payer. See the Vaccine Addendum at www.aap.org/securemoc/reimburse/VaccineAddendumtoPayerContracts.pdf. If your practice is efficient and effective with high immunization rates then the health plan benefits as well with a higher HEDIS score. This is a good strategy for negotiation. Participate in your chapter’s Pediatric Council to educate payers about true costs. Fill out an AAP Hassle Factor form on payers who perform poorly. See the Hassle Factor form at www.aap.org/moc/reimburse/hasslefactor. Currently, many parents are having difficulty obtaining HPV vaccine for their adolescent girls due to high capital outlay for pediatricians coupled with low payment by insurers. These parents are complaining to their insurers and employers, creating dissatisfied customers. It is in the insurers’ and employers’ best interests to pay for immunizations fairly to maintain customer satisfaction.
Vaccine Financing Resources General Resources For questions about immunization, please contact esobczyk@aap.org. For questions about private payer advocacy, please contact lterranova@aap.org. | 
