Why your doctor doesn't give a shot (the actual first headline link!)

[Guest guest]

whatever it takes...................

Sheri

<http://money.cnn.com/2009/09/08/news/economy/health_care_vaccinations/index.htm\

>http://money.cnn.com/2009/09/08/news/economy/health_care_vaccinations/index.htm

In the money section, natch. I love this article--made my day:

" It doesn't do me any good. " " This is America. Running a private

practice is a business. " And isn't that what it's about? Not health,

but profits.

Winnie

Doctors slash vaccines due to rising costs

Health care providers say insurers don't reimburse them enough for

essential vaccinations, so they're not offering them.

By

<http://money.cnn.com/2009/09/08/news/economy/health_care_vaccinations/mailto:pa\

rija.bhatnagarturner>Parija

B. Kavilanz, CNNMoney.com senior writer

Last Updated: September 8, 2009: 1:16 PM ET

NEW YORK (CNNMoney.com) -- Parents who bring their kids to Dr. G.

McIntosh for the chicken pox vaccine are out of luck.

The family physician, who has a solo practice in Uniontown, Ohio,

doesn't offer that shot because he can't afford it. Most insurers

won't sufficiently cover the cost.

" It doesn't do me any good. I am losing money on [them], " he said.

The chicken pox vaccine runs about $115, but insurers only cover

between $68 to $83 of that.

McIntosh has also cut back on a handful of other critical childhood

vaccines for the same reason -- including the measles, mumps and

rubella, known as the MMR vaccine.

It costs him about $58 to buy an MMR shot, he said, while insurers

pay about about $40.

So McIntosh keeps a lot less of the MMR on hand. If a patient needs

the shot and he doesn't have it, he sends them to a nearby public

health clinic.

" I'm not happy to do that, " he said. " The clinic is far, the service

isn't great and my patients aren't happy to go there. "

Although he says he " feels compelled " to take care of people, he

adds, " I can't save the world and pay for my staff, " he said. " As we

say, 'no margin, no mission.' "

" I've lost a fair number of kids [at the practice] because I've had

to send them elsewhere for their shots, " he said.

Alarming numbers

It's not clear exactly how widespread vaccine cutbacks are, but in a

recent industry survey, 5% of pediatricians and 11% of physicians

indicated that they're seriously considering no longer offering

immunizations. Currently there are about 350,000 pediatricians and

family physicians in the U.S.

" These are fantastically alarming numbers, " said Dr. Lander,

a Livingston N.J.-based pediatrician who chairs a committee on

administration and practices at the American Academy of Pediatricians. (AAP)

" It's an example of how health care is being

<http://money.cnn.com/2009/08/27/news/economy/barriers_health_care.fortune/index\

..htm?postversion=2009082714>driven

by managed care in the United States, " Lander said.

Doctors have to absorb any costs that insurance doesn't cover because

in most states insurance contracts prohibit providers from charging

patients the difference.

Dr. Jim King, a

<http://money.cnn.com/2009/07/16/news/economy/healthcare_doctors_shortage/index.\

htm?postversion=2009071807>family

physician in Selmer, Tenn. is another medical professional who is

dropping expensive vaccines because of " insufficient " reimbursement

from insurers.

" The vaccine for shingles is fairly expensive, about $75 to $150 per

vaccine, " said King, who is also board chair of the American Academy

of Family Physicians.

" The profit margin on it is very small, so we're not giving that. If

we lose money on one, we need to administer nine to break even, " he

said. Like McIntosh, doctors at King's practice are referring

patients to public clinics for shots that they no longer administer.

The economics work a little better in the case of influenza vaccines,

which can cost between $7 to about $33 per vaccine, according to the

Center for Medicare and Medicaid Services. So King is stocking up on

the flu vaccine.

The threat to public health

Public health experts are particularly worried about doctors dropping

vaccinations.

Dr. Lance Rodewald, head of the Immunization Services Division at the

Centers for Disease Control and Prevention, points to the

consequences this trend has had on

<http://money.cnn.com/2009/09/04/news/economy/public_option_hacker.fortune/index\

..htm?postversion=2009090412>public

health in the past.

" Between 1989 to 1991, a number of doctors stopped providing

vaccinations to children because of financing issues, " he said.

Instead, doctors referred patients to public health clinics for shots

like the MMR. But many parents failed to follow up on those shots,

Rodewald said, and their toddlers were never immunized.

The result: The situation led to 55,000 cases of measles, 11,000

hospitalizations and 123 toddler deaths.

The CDC found that more than half of the children who had contracted

the measles had not been vaccinated, even though many of them had

seen a health care provider.

" This is why we are taking attitudes of doctors very seriously when

they say they are delaying buying vaccines pending insurance

coverage, or that they could stop vaccinating because of declining

revenues, " Rodewald said.

The CDC maintains that vaccination rates for most child and

adolescent vaccines are currently about 80% in the United States.

Hidden costs

Vaccines of all kinds represent the largest operating expense for

some doctors, according to the AAP.

The problem: Most insurers pay providers just the base cost of the

vaccine. So if it costs $120 to buy a particular vaccine, insurance

would pay back $120. But Lander points out that there are a lot more

expenses that go into providing a vaccine, including the

refrigeration, electricity and insurance required to store the shots.

On average, doctors keep $100,000 to $150,000 worth of vaccines on

hand each year.

The AAP estimates that the actual cost to providers to acquire

vaccines could be 17% to 28% above the price of the vaccine itself.

" This is America. Running a private practice is a business, " said

Lander. " It's not $120 but closer to $140 for me to break even, " said Lander.

The insurance industry acknowledged that " there is always a natural

tension between health plans and providers about payment, " said

Pisano, spokeswoman for America's Health Insurance Plans (AHIP).

Then there's the cost to doctors of the office visit to administer a

shot. Lander maintains that a majority of insurers are inadequately

paying doctors for this service, too.

" When a patient comes to my practice for shots, a nurse will explain

what shots will be given, hand out pamphlets and complete paperwork, " he said.

Reimbursements for administration fees range anywhere between 60% to

100% of the cost depending on a doctor's contract with the insurer.

" Managed care had decreased [overall] access to health care because

of poor pay to providers, " Lander said.

McIntosh agreed. " I enjoy seeing kids. It's joyful to see a baby and

watch them grow up healthy, " McIntosh said. " But I am giving that up

because I can't give them the shots they need. "

He said more of his patients now are the elderly. " It makes me sad

how the dynamics of my practice have changed, " he said.

Talkback: Have you or a doctor that you know left the medical

profession mid-career to start a new career outside of the health

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Sheri Nakken, R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Washington State, USA

Vaccines - http://www.nccn.net/~wwithin/vaccine.htm or

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[Guest guest]

I LOVE IT!! I'll go to him! that's terrific. I have said many times, it's a

consumer driven affair and if the consumers stop buying them, they'll stop

making them.. well it seems doctors are also consumers huh? this is just

proof.. it is about the money.

Nita (crew chief) and the crew: 16, Jon 14, 12, 10,

7, Christian (7/16/03 to 8/22/04), 3 and Isaac, 1

http://momof6.dotphoto.com <http://momof6.dotphoto.com/> for not

necessarily current pictures

http://nitasspot.blogspot.com

Learn from the mistakes of others. Trust me... you can't live long enough

to make them all yourself.

[Guest guest]

I just hope the taxpayers don't end up footing the bill for some new Save the

Doctor's Bank Accounts program. We already do in some for free vaccine programs.

Winnie

RE: Why your doctor doesn't give a shot (the actual

first headline link!)

Vaccinations

> I LOVE IT!! I'll go to him! that's terrific. I have said many

> times, it's a

> consumer driven affair and if the consumers stop buying them,

> they'll stop

> making them.. well it seems doctors are also consumers huh?

> this is just

> proof.. it is about the money.

>

>

>

> Nita (crew chief) and the crew: 16, Jon 14, 12,

> 10,

> 7, Christian (7/16/03 to 8/22/04), 3 and Isaac, 1

> http://momof6.dotphoto.com for not

> necessarily current pictures

>

> http://nitasspot.blogspot.com

> Learn from the mistakes of others. Trust me... you can't live

> long enough

> to make them all yourself.

>

>

>

>

>