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

[Guest guest]

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 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 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 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 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.

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