Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 Vaccines are a hassle (for a variety of reasons) I'm trying to get better organized about. Some on the list seem to have done well pricewise by shopping around and getting better prices from different sources. Personally I've tried to keep it simple for now and order them through my McKesson rep except for those one must get directly from the manufacturer. I've got to keep track of the supply on hand better as a few times I've wanted to give a shot and at the last minute realized I hadn't ordered a new batch -- other day I gave Pediarix and Prevnar to a 2 month old but didn't have Hib so I'm ordering it and will have to bring her back in a week or two... I don't think the parent cared (I've known the family a long time so trust is there) but honestly I am tougher on myself than others are on me most of the time. Anyway, getting a good frig/freezer without paying through the nose is important. Then you gotta keep track of the temp... I'm considering getting the thermometer discussed a couple months ago that follows the average temp better than the simple ones I got now that I have to check by opening the doors. Then you must consider the upfront costs and hope the insurers pay well enough. So, yeah, it can be a hassle and everyone has to plan how they deal with vaccines. Convenience for patients/families is important as having them go to health department shots clinics may be an option but likely increases the risk kids will be behind in shots, etc. I'm sure others on the list will have good pointers and most of them have more experience behind them than I do (open just 7 months). Overall I like giving shots ... and I think it's funny when a patient says something like, " I didn't know you could give a shot " , which has happened a couple times! To think there are things only nurses do and doctors can't is interesting to me, but I guess that is what the medical world has shaped over the years since patients simply don't see the doc doing such things most of the time. Patients have made similar comments when I take vital signs too. Good luck with your plans down in Duchess County... pretty area. Tim > I recently joined your group and have been learning alot from reading > the posts. I am planning to join a solo doc in Dutchess County, > NY,in a few months with the idea of taking over his practice in the > next year or so. I would say he meets the type of practice you all > follow: he is by himself with a part-time front desk person. > He currently limits his practice to 5 year olds and up. He says > vaccines are the issue for younger children. I was wondering what you > guys are all doing in terms of vaccines. The town his practice is in > does not have any providers for infants/toddlers so I was hoping this > could be a market to capture (plus I love seeing kids). I could see > how vaccines could affect this in terms of cost to buy, storage/upkeep > issues, time to administer without nursing help, etc. Thanks for any > help on this issue. I am sure I will have plenty of more > questions/calls for help in the next few months. > Margaret Coughlan M.D. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 Re vaccines and survival. 1) Check your EOB statements. * very quickly we found that we were GIVING AWAY many vaccines for LESS THAN COST once we looked at this closely. * don't expect insurers to tell you about this. You need to price your vaccines OVER the reimbursed cost in order to be sure you get all the insurer will pay you. * buy from the manufacturer whenever possible. We started buying from Sanofi-Pasteur for dT, Hep B, Menactra when our local PSS rep " couldn't get " Menactra and kept delaying our order, as well as the other supplier we had been using. Costs went down 5% or more and delivery was easier, using on-line ordering. 2) You may not be able to supply vaccines without preordering once you see pts. * Menactra now has to be ordered in 5 lot groups. Last time I ordered with manufacturer, cost was over $400; we order in groups of 5 and call pts in to get vaccines. Reimbursement is surprisingly good once we checked with each of our insurers, but I didn't want to keep out that much money at a time, so we kept a list (public relations was good here, since there was a shortage in the summer), and called pts back. 3) Vaccine inventory is a financial risk. * For this end of 2nd year of my practice, I chose again NOT to order ANY vaccine for flu. Buying something that I won't possibly get until after season just isn't cost effective for me. * On contrary, we keep Hep B, dT (nope, no dTap yet, as reimbursement is NOT worked out yet), and Pneumovax on hand, as these are cost effective now. So, I don't do routine 5 and under care now. Tough choice for me, but the Peds groups (all hospital supported almost without exception around my area) see most of kids now, and I see them when they get to later years. Not the best, but what I've found works for me. We all have to make our choices, and this is one forced on me. Dr Matt Levin Pittsburgh, PA (Greensburg, actually, just 30 miles east of Pittsburgh) Solo since Dec 2004 In practice since 1988, working for others until Dec 2004 SOAPware EMR 2.5 FTE Re: Children's Vaccines > Vaccines are a hassle (for a variety of reasons) I'm trying to get better > organized about. Some on the list seem to have done well pricewise by > shopping around and getting better prices from different sources. > Personally I've tried to keep it simple for now and order them through my > McKesson rep except for those one must get directly from the manufacturer. > I've got to keep track of the supply on hand better as a few times I've > wanted to give a shot and at the last minute realized I hadn't ordered a > new batch -- other day I gave Pediarix and Prevnar to a 2 month old but > didn't have Hib so I'm ordering it and will have to bring her back in a > week or two... I don't think the parent cared (I've known the family a > long time so trust is there) but honestly I am tougher on myself than > others are on me most of the time. > > Anyway, getting a good frig/freezer without paying through the nose is > important. Then you gotta keep track of the temp... I'm considering > getting the thermometer discussed a couple months ago that follows the > average temp better than the simple ones I got now that I have to check by > opening the doors. > > Then you must consider the upfront costs and hope the insurers pay well > enough. > > So, yeah, it can be a hassle and everyone has to plan how they deal with > vaccines. Convenience for patients/families is important as having them > go to health department shots clinics may be an option but likely > increases the risk kids will be behind in shots, etc. > > I'm sure others on the list will have good pointers and most of them have > more experience behind them than I do (open just 7 months). > > Overall I like giving shots ... and I think it's funny when a patient says > something like, " I didn't know you could give a shot " , which has happened > a couple times! To think there are things only nurses do and doctors > can't is interesting to me, but I guess that is what the medical world has > shaped over the years since patients simply don't see the doc doing such > things most of the time. Patients have made similar comments when I take > vital signs too. > > Good luck with your plans down in Duchess County... pretty area. > Tim > >> I recently joined your group and have been learning alot from reading >> the posts. I am planning to join a solo doc in Dutchess County, >> NY,in a few months with the idea of taking over his practice in the >> next year or so. I would say he meets the type of practice you all >> follow: he is by himself with a part-time front desk person. >> He currently limits his practice to 5 year olds and up. He says >> vaccines are the issue for younger children. I was wondering what you >> guys are all doing in terms of vaccines. The town his practice is in >> does not have any providers for infants/toddlers so I was hoping this >> could be a market to capture (plus I love seeing kids). I could see >> how vaccines could affect this in terms of cost to buy, storage/upkeep >> issues, time to administer without nursing help, etc. Thanks for any >> help on this issue. I am sure I will have plenty of more >> questions/calls for help in the next few months. >> Margaret Coughlan M.D. >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 Re vaccines and survival. 1) Check your EOB statements. * very quickly we found that we were GIVING AWAY many vaccines for LESS THAN COST once we looked at this closely. * don't expect insurers to tell you about this. You need to price your vaccines OVER the reimbursed cost in order to be sure you get all the insurer will pay you. * buy from the manufacturer whenever possible. We started buying from Sanofi-Pasteur for dT, Hep B, Menactra when our local PSS rep " couldn't get " Menactra and kept delaying our order, as well as the other supplier we had been using. Costs went down 5% or more and delivery was easier, using on-line ordering. 2) You may not be able to supply vaccines without preordering once you see pts. * Menactra now has to be ordered in 5 lot groups. Last time I ordered with manufacturer, cost was over $400; we order in groups of 5 and call pts in to get vaccines. Reimbursement is surprisingly good once we checked with each of our insurers, but I didn't want to keep out that much money at a time, so we kept a list (public relations was good here, since there was a shortage in the summer), and called pts back. 3) Vaccine inventory is a financial risk. * For this end of 2nd year of my practice, I chose again NOT to order ANY vaccine for flu. Buying something that I won't possibly get until after season just isn't cost effective for me. * On contrary, we keep Hep B, dT (nope, no dTap yet, as reimbursement is NOT worked out yet), and Pneumovax on hand, as these are cost effective now. So, I don't do routine 5 and under care now. Tough choice for me, but the Peds groups (all hospital supported almost without exception around my area) see most of kids now, and I see them when they get to later years. Not the best, but what I've found works for me. We all have to make our choices, and this is one forced on me. Dr Matt Levin Pittsburgh, PA (Greensburg, actually, just 30 miles east of Pittsburgh) Solo since Dec 2004 In practice since 1988, working for others until Dec 2004 SOAPware EMR 2.5 FTE Re: Children's Vaccines > Vaccines are a hassle (for a variety of reasons) I'm trying to get better > organized about. Some on the list seem to have done well pricewise by > shopping around and getting better prices from different sources. > Personally I've tried to keep it simple for now and order them through my > McKesson rep except for those one must get directly from the manufacturer. > I've got to keep track of the supply on hand better as a few times I've > wanted to give a shot and at the last minute realized I hadn't ordered a > new batch -- other day I gave Pediarix and Prevnar to a 2 month old but > didn't have Hib so I'm ordering it and will have to bring her back in a > week or two... I don't think the parent cared (I've known the family a > long time so trust is there) but honestly I am tougher on myself than > others are on me most of the time. > > Anyway, getting a good frig/freezer without paying through the nose is > important. Then you gotta keep track of the temp... I'm considering > getting the thermometer discussed a couple months ago that follows the > average temp better than the simple ones I got now that I have to check by > opening the doors. > > Then you must consider the upfront costs and hope the insurers pay well > enough. > > So, yeah, it can be a hassle and everyone has to plan how they deal with > vaccines. Convenience for patients/families is important as having them > go to health department shots clinics may be an option but likely > increases the risk kids will be behind in shots, etc. > > I'm sure others on the list will have good pointers and most of them have > more experience behind them than I do (open just 7 months). > > Overall I like giving shots ... and I think it's funny when a patient says > something like, " I didn't know you could give a shot " , which has happened > a couple times! To think there are things only nurses do and doctors > can't is interesting to me, but I guess that is what the medical world has > shaped over the years since patients simply don't see the doc doing such > things most of the time. Patients have made similar comments when I take > vital signs too. > > Good luck with your plans down in Duchess County... pretty area. > Tim > >> I recently joined your group and have been learning alot from reading >> the posts. I am planning to join a solo doc in Dutchess County, >> NY,in a few months with the idea of taking over his practice in the >> next year or so. I would say he meets the type of practice you all >> follow: he is by himself with a part-time front desk person. >> He currently limits his practice to 5 year olds and up. He says >> vaccines are the issue for younger children. I was wondering what you >> guys are all doing in terms of vaccines. The town his practice is in >> does not have any providers for infants/toddlers so I was hoping this >> could be a market to capture (plus I love seeing kids). I could see >> how vaccines could affect this in terms of cost to buy, storage/upkeep >> issues, time to administer without nursing help, etc. Thanks for any >> help on this issue. I am sure I will have plenty of more >> questions/calls for help in the next few months. >> Margaret Coughlan M.D. >> >> >> >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 I take it New York doesn't have a Vaccines for Children program?Insurers here don't reimburse for anything other than the costs of administration, but if you register with the state program and jump through their temperature log hoops, the vaccines are free for patients under 19.They did give out a great set of thermometers recently, Tim - the probe is in a small bottle of liquid in the frig and freezer, but the remote box mounts on the wall. They are very stable, do have alarms if you want and seem much more accurate than the others I tried. This is what they look like:http://www.control3.com/4127p.htmOn Oct 22, 2006, at 7:56 AM, Malia, MD wrote:Vaccines are a hassle (for a variety of reasons) I'm trying to get betterorganized about. Some on the list seem to have done well pricewise byshopping around and getting better prices from different sources.Personally I've tried to keep it simple for now and order them through myMcKesson rep except for those one must get directly from the manufacturer.I've got to keep track of the supply on hand better as a few times I'vewanted to give a shot and at the last minute realized I hadn't ordered anew batch -- other day I gave Pediarix and Prevnar to a 2 month old butdidn't have Hib so I'm ordering it and will have to bring her back in aweek or two... I don't think the parent cared (I've known the family along time so trust is there) but honestly I am tougher on myself thanothers are on me most of the time.Anyway, getting a good frig/freezer without paying through the nose isimportant. Then you gotta keep track of the temp... I'm consideringgetting the thermometer discussed a couple months ago that follows theaverage temp better than the simple ones I got now that I have to check byopening the doors.Then you must consider the upfront costs and hope the insurers pay wellenough.So, yeah, it can be a hassle and everyone has to plan how they deal withvaccines. Convenience for patients/families is important as having themgo to health department shots clinics may be an option but likelyincreases the risk kids will be behind in shots, etc.I'm sure others on the list will have good pointers and most of them havemore experience behind them than I do (open just 7 months).Overall I like giving shots ... and I think it's funny when a patient sayssomething like, "I didn't know you could give a shot", which has happeneda couple times! To think there are things only nurses do and doctorscan't is interesting to me, but I guess that is what the medical world hasshaped over the years since patients simply don't see the doc doing suchthings most of the time. Patients have made similar comments when I takevital signs too.Good luck with your plans down in Duchess County... pretty area.Tim> I recently joined your group and have been learning alot from reading> the posts. I am planning to join a solo doc in Dutchess County,> NY,in a few months with the idea of taking over his practice in the> next year or so. I would say he meets the type of practice you all> follow: he is by himself with a part-time front desk person.> He currently limits his practice to 5 year olds and up. He says> vaccines are the issue for younger children. I was wondering what you> guys are all doing in terms of vaccines. The town his practice is in> does not have any providers for infants/toddlers so I was hoping this> could be a market to capture (plus I love seeing kids). I could see> how vaccines could affect this in terms of cost to buy, storage/upkeep> issues, time to administer without nursing help, etc. Thanks for any> help on this issue. I am sure I will have plenty of more> questions/calls for help in the next few months.> Margaret Coughlan M.D.>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 I take it New York doesn't have a Vaccines for Children program?Insurers here don't reimburse for anything other than the costs of administration, but if you register with the state program and jump through their temperature log hoops, the vaccines are free for patients under 19.They did give out a great set of thermometers recently, Tim - the probe is in a small bottle of liquid in the frig and freezer, but the remote box mounts on the wall. They are very stable, do have alarms if you want and seem much more accurate than the others I tried. This is what they look like:http://www.control3.com/4127p.htmOn Oct 22, 2006, at 7:56 AM, Malia, MD wrote:Vaccines are a hassle (for a variety of reasons) I'm trying to get betterorganized about. Some on the list seem to have done well pricewise byshopping around and getting better prices from different sources.Personally I've tried to keep it simple for now and order them through myMcKesson rep except for those one must get directly from the manufacturer.I've got to keep track of the supply on hand better as a few times I'vewanted to give a shot and at the last minute realized I hadn't ordered anew batch -- other day I gave Pediarix and Prevnar to a 2 month old butdidn't have Hib so I'm ordering it and will have to bring her back in aweek or two... I don't think the parent cared (I've known the family along time so trust is there) but honestly I am tougher on myself thanothers are on me most of the time.Anyway, getting a good frig/freezer without paying through the nose isimportant. Then you gotta keep track of the temp... I'm consideringgetting the thermometer discussed a couple months ago that follows theaverage temp better than the simple ones I got now that I have to check byopening the doors.Then you must consider the upfront costs and hope the insurers pay wellenough.So, yeah, it can be a hassle and everyone has to plan how they deal withvaccines. Convenience for patients/families is important as having themgo to health department shots clinics may be an option but likelyincreases the risk kids will be behind in shots, etc.I'm sure others on the list will have good pointers and most of them havemore experience behind them than I do (open just 7 months).Overall I like giving shots ... and I think it's funny when a patient sayssomething like, "I didn't know you could give a shot", which has happeneda couple times! To think there are things only nurses do and doctorscan't is interesting to me, but I guess that is what the medical world hasshaped over the years since patients simply don't see the doc doing suchthings most of the time. Patients have made similar comments when I takevital signs too.Good luck with your plans down in Duchess County... pretty area.Tim> I recently joined your group and have been learning alot from reading> the posts. I am planning to join a solo doc in Dutchess County,> NY,in a few months with the idea of taking over his practice in the> next year or so. I would say he meets the type of practice you all> follow: he is by himself with a part-time front desk person.> He currently limits his practice to 5 year olds and up. He says> vaccines are the issue for younger children. I was wondering what you> guys are all doing in terms of vaccines. The town his practice is in> does not have any providers for infants/toddlers so I was hoping this> could be a market to capture (plus I love seeing kids). I could see> how vaccines could affect this in terms of cost to buy, storage/upkeep> issues, time to administer without nursing help, etc. Thanks for any> help on this issue. I am sure I will have plenty of more> questions/calls for help in the next few months.> Margaret Coughlan M.D.>>>>>> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 NY does have VFC, but only for those who meet strict eligibility requirements. Most kids go through insurance. This requires that we have two sets of vaccines, and in small offices we end up with bulk packs that go bad before we use them up. One of our options is to create a local vaccine cooperative, but we have to be sure to be part of a group, as the vaccine companies have been able to pass a law in NY that it is illegal for independent practices to share vaccines. Gordon At 10:49 AM 10/22/2006, you wrote: I take it New York doesn't have a Vaccines for Children program? Insurers here don't reimburse for anything other than the costs of administration, but if you register with the state program and jump through their temperature log hoops, the vaccines are free for patients under 19. They did give out a great set of thermometers recently, Tim - the probe is in a small bottle of liquid in the frig and freezer, but the remote box mounts on the wall. They are very stable, do have alarms if you want and seem much more accurate than the others I tried. This is what they look like: http://www.control3.com/4127p.htm Vaccines are a hassle (for a variety of reasons) I'm trying to get better organized about. Some on the list seem to have done well pricewise by shopping around and getting better prices from different sources. Personally I've tried to keep it simple for now and order them through my McKesson rep except for those one must get directly from the manufacturer. I've got to keep track of the supply on hand better as a few times I've wanted to give a shot and at the last minute realized I hadn't ordered a new batch -- other day I gave Pediarix and Prevnar to a 2 month old but didn't have Hib so I'm ordering it and will have to bring her back in a week or two... I don't think the parent cared (I've known the family a long time so trust is there) but honestly I am tougher on myself than others are on me most of the time. Anyway, getting a good frig/freezer without paying through the nose is important. Then you gotta keep track of the temp... I'm considering getting the thermometer discussed a couple months ago that follows the average temp better than the simple ones I got now that I have to check by opening the doors. Then you must consider the upfront costs and hope the insurers pay well enough. So, yeah, it can be a hassle and everyone has to plan how they deal with vaccines. Convenience for patients/families is important as having them go to health department shots clinics may be an option but likely increases the risk kids will be behind in shots, etc. I'm sure others on the list will have good pointers and most of them have more experience behind them than I do (open just 7 months). Overall I like giving shots ... and I think it's funny when a patient says something like, " I didn't know you could give a shot " , which has happened a couple times! To think there are things only nurses do and doctors can't is interesting to me, but I guess that is what the medical world has shaped over the years since patients simply don't see the doc doing such things most of the time. Patients have made similar comments when I take vital signs too. Good luck with your plans down in Duchess County... pretty area. Tim > I recently joined your group and have been learning alot from reading > the posts. I am planning to join a solo doc in Dutchess County, > NY,in a few months with the idea of taking over his practice in the > next year or so. I would say he meets the type of practice you all > follow: he is by himself with a part-time front desk person. > He currently limits his practice to 5 year olds and up. He says > vaccines are the issue for younger children. I was wondering what you > guys are all doing in terms of vaccines. The town his practice is in > does not have any providers for infants/toddlers so I was hoping this > could be a market to capture (plus I love seeing kids). I could see > how vaccines could affect this in terms of cost to buy, storage/upkeep > issues, time to administer without nursing help, etc. Thanks for any > help on this issue. I am sure I will have plenty of more > questions/calls for help in the next few months. > Margaret Coughlan M.D. > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 22, 2006 Report Share Posted October 22, 2006 I have only an occasional child under 5 that I need to vaccinate. So far, I have bought vaccine from the other family doc in the area and we are trying to share. She just called me to share Prevnar but I have no use. I had to buy the IPV as it’s a multidose vial and 8 doses will probably be wasted. I plan the meningococcal vaccine by running a report of 17-19 year olds and then we call to see who is going to college and order “just enough”. This year I couldn’t get it in a timely manner and we are playing catch up. Since the shelf life of the Menactra is about 2 years I will keep some on hand as it shouldn’t go to waste. Like Matt I try to stay 1 vial ahead on Pneumovax (only 5 doses) and Decavac and I have given 9 doses of Dtap. I did get 150 doses of Influenza vaccine and am only giving it to the “high risk” letting others get it wherever. I will probably order more next year as I have found if I let my patients know whether or not I am getting it they will come to me for it as “cheaper” than ShopRite for them. Only have trouble getting reimbursed from Horizon Blue Cross Blue Shield as many plans apparently don’t cover it and the patient’s don’t know; yes, even if medically necessary. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 I just found out that a local pharmacy has some vaccines. We wrote a prescription (MMR). The patient picked it up and we administered it. I do not want to buy 10 at a time or beg other practices in the area ( I have done that but not my preference) nor do I wish to store it. We offer this option to keep the patient happy that we can at least meet their needs.Kathy Saradarian wrote: I have only an occasional child under 5 that I need to vaccinate. So far, I have bought vaccine from the other family doc in the area and we are trying to share. She just called me to share Prevnar but I have no use. I had to buy the IPV as it’s a multidose vial and 8 doses will probably be wasted. I plan the meningococcal vaccine by running a report of 17-19 year olds and then we call to see who is going to college and order “just enough”. This year I couldn’t get it in a timely manner and we are playing catch up. Since the shelf life of the Menactra is about 2 years I will keep some on hand as it shouldn’t go to waste. Like Matt I try to stay 1 vial ahead on Pneumovax (only 5 doses) and Decavac and I have given 9 doses of Dtap. I did get 150 doses of Influenza vaccine and am only giving it to the “high risk” letting others get it wherever. I will probably order more next year as I have found if I let my patients know whether or not I am getting it they will come to me for it as “cheaper” than ShopRite for them. Only have trouble getting reimbursed from Horizon Blue Cross Blue Shield as many plans apparently don’t cover it and the patient’s don’t know; yes, even if medically necessary. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 I just found out that a local pharmacy has some vaccines. We wrote a prescription (MMR). The patient picked it up and we administered it. I do not want to buy 10 at a time or beg other practices in the area ( I have done that but not my preference) nor do I wish to store it. We offer this option to keep the patient happy that we can at least meet their needs.Kathy Saradarian wrote: I have only an occasional child under 5 that I need to vaccinate. So far, I have bought vaccine from the other family doc in the area and we are trying to share. She just called me to share Prevnar but I have no use. I had to buy the IPV as it’s a multidose vial and 8 doses will probably be wasted. I plan the meningococcal vaccine by running a report of 17-19 year olds and then we call to see who is going to college and order “just enough”. This year I couldn’t get it in a timely manner and we are playing catch up. Since the shelf life of the Menactra is about 2 years I will keep some on hand as it shouldn’t go to waste. Like Matt I try to stay 1 vial ahead on Pneumovax (only 5 doses) and Decavac and I have given 9 doses of Dtap. I did get 150 doses of Influenza vaccine and am only giving it to the “high risk” letting others get it wherever. I will probably order more next year as I have found if I let my patients know whether or not I am getting it they will come to me for it as “cheaper” than ShopRite for them. Only have trouble getting reimbursed from Horizon Blue Cross Blue Shield as many plans apparently don’t cover it and the patient’s don’t know; yes, even if medically necessary. Kathy Saradarian, MD Branchville, NJ Solo low-staff practice since 4/03 In practice since 9/90 Practice Partner User since 5/03 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 Thank you all for your input. Margaret Coughlan I have only an occasional child under 5 that I need to vaccinate. So far, I have bought vaccine from the other family doc in the area and we are trying to share. She just called me to share Prevnar but I have no use. I had to buy the IPV as it's a multidose vial and 8 doses will probably be wasted. > > I plan the meningococcal vaccine by running a report of 17-19 year olds and then we call to see who is going to college and order " just enough " . This year I couldn't get it in a timely manner and we are playing catch up. Since the shelf life of the Menactra is about 2 years I will keep some on hand as it shouldn't go to waste. > > Like Matt I try to stay 1 vial ahead on Pneumovax (only 5 doses) and Decavac and I have given 9 doses of Dtap. I did get 150 doses of Influenza vaccine and am only giving it to the " high risk " letting others get it wherever. I will probably order more next year as I have found if I let my patients know whether or not I am getting it they will come to me for it as " cheaper " than ShopRite for them. Only have trouble getting reimbursed from Horizon Blue Cross Blue Shield as many plans apparently don't cover it and the patient's don't know; yes, even if medically necessary. > > Kathy Saradarian, MD > Branchville, NJ > Solo low-staff practice since 4/03 > In practice since 9/90 > Practice Partner User since 5/03 > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 Vaccines = major hassle, poor reimbursement, take a lot of time, will often expire before you use them all. I no longer give the childhood shots. > > > Date: 2006/10/21 Sat PM 09:36:04 EDT > To: > Subject: Children's Vaccines > > I recently joined your group and have been learning alot from reading > the posts. I am planning to join a solo doc in Dutchess County, > NY,in a few months with the idea of taking over his practice in the > next year or so. I would say he meets the type of practice you all > follow: he is by himself with a part-time front desk person. > He currently limits his practice to 5 year olds and up. He says > vaccines are the issue for younger children. I was wondering what you > guys are all doing in terms of vaccines. The town his practice is in > does not have any providers for infants/toddlers so I was hoping this > could be a market to capture (plus I love seeing kids). I could see > how vaccines could affect this in terms of cost to buy, storage/upkeep > issues, time to administer without nursing help, etc. Thanks for any > help on this issue. I am sure I will have plenty of more > questions/calls for help in the next few months. > Margaret Coughlan M.D. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 Hello, I am new to the group but wanted to chime in early with regards to childhood vaccines. I started my " micro-practice " in November 2005 and am still just beginning to figure out all the ins and outs. I have always enjoyed the nature of " Family Practice " ESPECIALLY when it comes to seeing the littlest ones in a family. Vaccines are part of what we provide as family physicians BUT indeed they are a hassle! Even large pediatric groups do not break even on the cost of childhood vaccines. One option that I have chosen (so as to not limit the demographics of my patients) is to accept patients from one medical assistance plan. Their vaccines are supplied by the federal VFC program at no cost to the office. You charge and collect only the administration fee from the payer. In addition, any vaccines that are not covered by a patient's private insurance payer are also covered under VFC. Finally, if I need a vaccine for a private payer patient, I can " borrow " from the VFC stock and replenish going forward. This is a procedure that large pediatric groups in my area have done for years. Since the VFC is a national program, I imagine it is available in all states though the rules might differ. Thanks. Ramona Seidel, MD Children's Vaccines > > I recently joined your group and have been learning alot from reading > the posts. I am planning to join a solo doc in Dutchess County, > NY,in a few months with the idea of taking over his practice in the > next year or so. I would say he meets the type of practice you all > follow: he is by himself with a part-time front desk person. > He currently limits his practice to 5 year olds and up. He says > vaccines are the issue for younger children. I was wondering what you > guys are all doing in terms of vaccines. The town his practice is in > does not have any providers for infants/toddlers so I was hoping this > could be a market to capture (plus I love seeing kids). I could see > how vaccines could affect this in terms of cost to buy, storage/upkeep > issues, time to administer without nursing help, etc. Thanks for any > help on this issue. I am sure I will have plenty of more > questions/calls for help in the next few months. > Margaret Coughlan M.D. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 We have been sending folks to the pharmacy across the street for vaccines (as well as tb tines, depo, etc). They can pretty much get anything if we call it in 24hrs in advance and haven't had any complaints from patients yet. They just swing by and pick it up on the way to their appt and we administer it. Kari Children's Vaccines I recently joined your group and have been learning alot from reading the posts. I am planning to join a solo doc in Dutchess County, NY,in a few months with the idea of taking over his practice in the next year or so. I would say he meets the type of practice you all follow: he is by himself with a part-time front desk person.He currently limits his practice to 5 year olds and up. He says vaccines are the issue for younger children. I was wondering what you guys are all doing in terms of vaccines. The town his practice is in does not have any providers for infants/toddlers so I was hoping this could be a market to capture (plus I love seeing kids). I could see how vaccines could affect this in terms of cost to buy, storage/upkeep issues, time to administer without nursing help, etc. Thanks for any help on this issue. I am sure I will have plenty of more questions/calls for help in the next few months.Margaret Coughlan M.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 We have been sending folks to the pharmacy across the street for vaccines (as well as tb tines, depo, etc). They can pretty much get anything if we call it in 24hrs in advance and haven't had any complaints from patients yet. They just swing by and pick it up on the way to their appt and we administer it. Kari Children's Vaccines I recently joined your group and have been learning alot from reading the posts. I am planning to join a solo doc in Dutchess County, NY,in a few months with the idea of taking over his practice in the next year or so. I would say he meets the type of practice you all follow: he is by himself with a part-time front desk person.He currently limits his practice to 5 year olds and up. He says vaccines are the issue for younger children. I was wondering what you guys are all doing in terms of vaccines. The town his practice is in does not have any providers for infants/toddlers so I was hoping this could be a market to capture (plus I love seeing kids). I could see how vaccines could affect this in terms of cost to buy, storage/upkeep issues, time to administer without nursing help, etc. Thanks for any help on this issue. I am sure I will have plenty of more questions/calls for help in the next few months.Margaret Coughlan M.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 Who pays for those shots? If you do, are you sure you are not losing money on them? Re: Children's Vaccines We have been sending folks to the pharmacy across the street for vaccines (as well as tb tines, depo, etc). They can pretty much get anything if we call it in 24hrs in advance and haven't had any complaints from patients yet. They just swing by and pick it up on the way to their appt and we administer it. Kari Children's Vaccines I recently joined your group and have been learning alot from reading the posts. I am planning to join a solo doc in Dutchess County, NY,in a few months with the idea of taking over his practice in the next year or so. I would say he meets the type of practice you all follow: he is by himself with a part-time front desk person. He currently limits his practice to 5 year olds and up. He says vaccines are the issue for younger children. I was wondering what you guys are all doing in terms of vaccines. The town his practice is in does not have any providers for infants/toddlers so I was hoping this could be a market to capture (plus I love seeing kids). I could see how vaccines could affect this in terms of cost to buy, storage/upkeep issues, time to administer without nursing help, etc. Thanks for any help on this issue. I am sure I will have plenty of more questions/calls for help in the next few months. Margaret Coughlan M.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 Who pays for those shots? If you do, are you sure you are not losing money on them? Re: Children's Vaccines We have been sending folks to the pharmacy across the street for vaccines (as well as tb tines, depo, etc). They can pretty much get anything if we call it in 24hrs in advance and haven't had any complaints from patients yet. They just swing by and pick it up on the way to their appt and we administer it. Kari Children's Vaccines I recently joined your group and have been learning alot from reading the posts. I am planning to join a solo doc in Dutchess County, NY,in a few months with the idea of taking over his practice in the next year or so. I would say he meets the type of practice you all follow: he is by himself with a part-time front desk person. He currently limits his practice to 5 year olds and up. He says vaccines are the issue for younger children. I was wondering what you guys are all doing in terms of vaccines. The town his practice is in does not have any providers for infants/toddlers so I was hoping this could be a market to capture (plus I love seeing kids). I could see how vaccines could affect this in terms of cost to buy, storage/upkeep issues, time to administer without nursing help, etc. Thanks for any help on this issue. I am sure I will have plenty of more questions/calls for help in the next few months. Margaret Coughlan M.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 The pt is paying for them at the pharmacy Children's Vaccines I recently joined your group and have been learning alot from reading the posts. I am planning to join a solo doc in Dutchess County, NY,in a few months with the idea of taking over his practice in the next year or so. I would say he meets the type of practice you all follow: he is by himself with a part-time front desk person.He currently limits his practice to 5 year olds and up. He says vaccines are the issue for younger children. I was wondering what you guys are all doing in terms of vaccines. The town his practice is in does not have any providers for infants/toddlers so I was hoping this could be a market to capture (plus I love seeing kids). I could see how vaccines could affect this in terms of cost to buy, storage/upkeep issues, time to administer without nursing help, etc. Thanks for any help on this issue. I am sure I will have plenty of more questions/calls for help in the next few months.Margaret Coughlan M.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 23, 2006 Report Share Posted October 23, 2006 The pt is paying for them at the pharmacy Children's Vaccines I recently joined your group and have been learning alot from reading the posts. I am planning to join a solo doc in Dutchess County, NY,in a few months with the idea of taking over his practice in the next year or so. I would say he meets the type of practice you all follow: he is by himself with a part-time front desk person.He currently limits his practice to 5 year olds and up. He says vaccines are the issue for younger children. I was wondering what you guys are all doing in terms of vaccines. The town his practice is in does not have any providers for infants/toddlers so I was hoping this could be a market to capture (plus I love seeing kids). I could see how vaccines could affect this in terms of cost to buy, storage/upkeep issues, time to administer without nursing help, etc. Thanks for any help on this issue. I am sure I will have plenty of more questions/calls for help in the next few months.Margaret Coughlan M.D. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2006 Report Share Posted October 24, 2006 I'm a pediatrician that has always been in an employed situation looking to go solo-solo which is why I joined this group. In my first practice, we all drew up and gave our own shots. It wasn't hard, actually and it gave the parents time to think if there were any more questions.There were a lot less back then though as well as virtually no documentation requirements. Some tips and pointers. Get a refrigerator that has a separate freezer component. Fill the freezer with every ice pack you can find--it keeps it much colder. You can get these ice packs free--they come with every vaccine order. We only need two freezer shelves for vaccines and our freezer is completely full. I'm not positive, but I think one of the vaccine companies will give you good refrigerator/freezer thermometers. The thermometer is digital and magnetically attaches to the front door. We have one for the fridge and one for the freezer. We log the refrigerator temperature and freezer temperature AM and PM. If either is out of range we re-log 20 minutes later. We keep separate supplies of VFC and private vaccine. They are easily identified by circular colored labels, one with a $ and one with VFC. Vaccines can be profitable with the newer CPT codes for giving vaccines under age 7. These codes refer to counselling for the vaccines (Give pt a VIS sheet to read and have them sign it = counselling. We keep our VIS sheets in a binder--we don't hand them out, saves a lot of money as well as ink and paper.) They carry substantially increased reimbursement. More and more pediatric vaccines are coming out in prefilled syringes--Prevnar, Pediarix, and flu for the 3 and under crowd--saves time and syringes. Hope this helps. > > Vaccines are a hassle (for a variety of reasons) I'm trying to get better > organized about. Some on the list seem to have done well pricewise by > shopping around and getting better prices from different sources. > Personally I've tried to keep it simple for now and order them through my > McKesson rep except for those one must get directly from the manufacturer. > I've got to keep track of the supply on hand better as a few times I've > wanted to give a shot and at the last minute realized I hadn't ordered a > new batch -- other day I gave Pediarix and Prevnar to a 2 month old but > didn't have Hib so I'm ordering it and will have to bring her back in a > week or two... I don't think the parent cared (I've known the family a > long time so trust is there) but honestly I am tougher on myself than > others are on me most of the time. > > Anyway, getting a good frig/freezer without paying through the nose is > important. Then you gotta keep track of the temp... I'm considering > getting the thermometer discussed a couple months ago that follows the > average temp better than the simple ones I got now that I have to check by > opening the doors. > > Then you must consider the upfront costs and hope the insurers pay well > enough. > > So, yeah, it can be a hassle and everyone has to plan how they deal with > vaccines. Convenience for patients/families is important as having them > go to health department shots clinics may be an option but likely > increases the risk kids will be behind in shots, etc. > > I'm sure others on the list will have good pointers and most of them have > more experience behind them than I do (open just 7 months). > > Overall I like giving shots ... and I think it's funny when a patient says > something like, " I didn't know you could give a shot " , which has happened > a couple times! To think there are things only nurses do and doctors > can't is interesting to me, but I guess that is what the medical world has > shaped over the years since patients simply don't see the doc doing such > things most of the time. Patients have made similar comments when I take > vital signs too. > > Good luck with your plans down in Duchess County... pretty area. > Tim > > > I recently joined your group and have been learning alot from reading > > the posts. I am planning to join a solo doc in Dutchess County, > > NY,in a few months with the idea of taking over his practice in the > > next year or so. I would say he meets the type of practice you all > > follow: he is by himself with a part-time front desk person. > > He currently limits his practice to 5 year olds and up. He says > > vaccines are the issue for younger children. I was wondering what you > > guys are all doing in terms of vaccines. The town his practice is in > > does not have any providers for infants/toddlers so I was hoping this > > could be a market to capture (plus I love seeing kids). I could see > > how vaccines could affect this in terms of cost to buy, storage/upkeep > > issues, time to administer without nursing help, etc. Thanks for any > > help on this issue. I am sure I will have plenty of more > > questions/calls for help in the next few months. > > Margaret Coughlan M.D. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2006 Report Share Posted October 24, 2006 I'm a pediatrician that has always been in an employed situation looking to go solo-solo which is why I joined this group. In my first practice, we all drew up and gave our own shots. It wasn't hard, actually and it gave the parents time to think if there were any more questions.There were a lot less back then though as well as virtually no documentation requirements. Some tips and pointers. Get a refrigerator that has a separate freezer component. Fill the freezer with every ice pack you can find--it keeps it much colder. You can get these ice packs free--they come with every vaccine order. We only need two freezer shelves for vaccines and our freezer is completely full. I'm not positive, but I think one of the vaccine companies will give you good refrigerator/freezer thermometers. The thermometer is digital and magnetically attaches to the front door. We have one for the fridge and one for the freezer. We log the refrigerator temperature and freezer temperature AM and PM. If either is out of range we re-log 20 minutes later. We keep separate supplies of VFC and private vaccine. They are easily identified by circular colored labels, one with a $ and one with VFC. Vaccines can be profitable with the newer CPT codes for giving vaccines under age 7. These codes refer to counselling for the vaccines (Give pt a VIS sheet to read and have them sign it = counselling. We keep our VIS sheets in a binder--we don't hand them out, saves a lot of money as well as ink and paper.) They carry substantially increased reimbursement. More and more pediatric vaccines are coming out in prefilled syringes--Prevnar, Pediarix, and flu for the 3 and under crowd--saves time and syringes. Hope this helps. > > Vaccines are a hassle (for a variety of reasons) I'm trying to get better > organized about. Some on the list seem to have done well pricewise by > shopping around and getting better prices from different sources. > Personally I've tried to keep it simple for now and order them through my > McKesson rep except for those one must get directly from the manufacturer. > I've got to keep track of the supply on hand better as a few times I've > wanted to give a shot and at the last minute realized I hadn't ordered a > new batch -- other day I gave Pediarix and Prevnar to a 2 month old but > didn't have Hib so I'm ordering it and will have to bring her back in a > week or two... I don't think the parent cared (I've known the family a > long time so trust is there) but honestly I am tougher on myself than > others are on me most of the time. > > Anyway, getting a good frig/freezer without paying through the nose is > important. Then you gotta keep track of the temp... I'm considering > getting the thermometer discussed a couple months ago that follows the > average temp better than the simple ones I got now that I have to check by > opening the doors. > > Then you must consider the upfront costs and hope the insurers pay well > enough. > > So, yeah, it can be a hassle and everyone has to plan how they deal with > vaccines. Convenience for patients/families is important as having them > go to health department shots clinics may be an option but likely > increases the risk kids will be behind in shots, etc. > > I'm sure others on the list will have good pointers and most of them have > more experience behind them than I do (open just 7 months). > > Overall I like giving shots ... and I think it's funny when a patient says > something like, " I didn't know you could give a shot " , which has happened > a couple times! To think there are things only nurses do and doctors > can't is interesting to me, but I guess that is what the medical world has > shaped over the years since patients simply don't see the doc doing such > things most of the time. Patients have made similar comments when I take > vital signs too. > > Good luck with your plans down in Duchess County... pretty area. > Tim > > > I recently joined your group and have been learning alot from reading > > the posts. I am planning to join a solo doc in Dutchess County, > > NY,in a few months with the idea of taking over his practice in the > > next year or so. I would say he meets the type of practice you all > > follow: he is by himself with a part-time front desk person. > > He currently limits his practice to 5 year olds and up. He says > > vaccines are the issue for younger children. I was wondering what you > > guys are all doing in terms of vaccines. The town his practice is in > > does not have any providers for infants/toddlers so I was hoping this > > could be a market to capture (plus I love seeing kids). I could see > > how vaccines could affect this in terms of cost to buy, storage/upkeep > > issues, time to administer without nursing help, etc. Thanks for any > > help on this issue. I am sure I will have plenty of more > > questions/calls for help in the next few months. > > Margaret Coughlan M.D. > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2006 Report Share Posted October 24, 2006 Can you be more specific regarding cpt codes you are using for counseling? rocky --- freethinker4 wrote: > I'm a pediatrician that has always been in an employed situation > looking to go solo-solo which is why I joined this group. In my > first > practice, we all drew up and gave our own shots. It wasn't hard, > actually and it gave the parents time to think if there were any more > questions.There were a lot less back then though as well as virtually > no documentation requirements. > > Some tips and pointers. Get a refrigerator that has a separate > freezer component. Fill the freezer with every ice pack you can > find--it keeps it much colder. You can get these ice packs > free--they > come with every vaccine order. We only need two freezer shelves for > vaccines and our freezer is completely full. I'm not positive, but I > think one of the vaccine companies will give you good > refrigerator/freezer thermometers. The thermometer is digital and > magnetically attaches to the front door. We have one for the fridge > and one for the freezer. We log the refrigerator temperature and > freezer temperature AM and PM. If either is out of range we re-log > 20 > minutes later. > > We keep separate supplies of VFC and private vaccine. They are > easily > identified by circular colored labels, one with a $ and one with VFC. > > Vaccines can be profitable with the newer CPT codes for giving > vaccines under age 7. These codes refer to counselling for the > vaccines (Give pt a VIS sheet to read and have them sign it = > counselling. We keep our VIS sheets in a binder--we don't hand them > out, saves a lot of money as well as ink and paper.) They carry > substantially increased reimbursement. > > More and more pediatric vaccines are coming out in prefilled > syringes--Prevnar, Pediarix, and flu for the 3 and under crowd--saves > time and syringes. > > Hope this helps. > > > > > > Vaccines are a hassle (for a variety of reasons) I'm trying to get > better > > organized about. Some on the list seem to have done well pricewise > by > > shopping around and getting better prices from different sources. > > Personally I've tried to keep it simple for now and order them > through my > > McKesson rep except for those one must get directly from the > manufacturer. > > I've got to keep track of the supply on hand better as a few times > I've > > wanted to give a shot and at the last minute realized I hadn't > ordered a > > new batch -- other day I gave Pediarix and Prevnar to a 2 month old > but > > didn't have Hib so I'm ordering it and will have to bring her back > in a > > week or two... I don't think the parent cared (I've known the > family a > > long time so trust is there) but honestly I am tougher on myself > than > > others are on me most of the time. > > > > Anyway, getting a good frig/freezer without paying through the nose > is > > important. Then you gotta keep track of the temp... I'm considering > > getting the thermometer discussed a couple months ago that follows > the > > average temp better than the simple ones I got now that I have to > check by > > opening the doors. > > > > Then you must consider the upfront costs and hope the insurers pay > well > > enough. > > > > So, yeah, it can be a hassle and everyone has to plan how they deal > with > > vaccines. Convenience for patients/families is important as having > them > > go to health department shots clinics may be an option but likely > > increases the risk kids will be behind in shots, etc. > > > > I'm sure others on the list will have good pointers and most of > them > have > > more experience behind them than I do (open just 7 months). > > > > Overall I like giving shots ... and I think it's funny when a > patient says > > something like, " I didn't know you could give a shot " , which has > happened > > a couple times! To think there are things only nurses do and > doctors > > can't is interesting to me, but I guess that is what the medical > world has > > shaped over the years since patients simply don't see the doc doing > such > > things most of the time. Patients have made similar comments when > I > take > > vital signs too. > > > > Good luck with your plans down in Duchess County... pretty area. > > Tim > > > > > I recently joined your group and have been learning alot from > reading > > > the posts. I am planning to join a solo doc in Dutchess County, > > > NY,in a few months with the idea of taking over his practice in > the > > > next year or so. I would say he meets the type of practice you > all > > > follow: he is by himself with a part-time front desk person. > > > He currently limits his practice to 5 year olds and up. He says > > > vaccines are the issue for younger children. I was wondering what > you > > > guys are all doing in terms of vaccines. The town his practice > is in > > > does not have any providers for infants/toddlers so I was hoping > this > > > could be a market to capture (plus I love seeing kids). I could > see > > > how vaccines could affect this in terms of cost to buy, > storage/upkeep > > > issues, time to administer without nursing help, etc. Thanks for > any > > > help on this issue. I am sure I will have plenty of more > > > questions/calls for help in the next few months. > > > Margaret Coughlan M.D. > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 24, 2006 Report Share Posted October 24, 2006 Can you be more specific regarding cpt codes you are using for counseling? rocky --- freethinker4 wrote: > I'm a pediatrician that has always been in an employed situation > looking to go solo-solo which is why I joined this group. In my > first > practice, we all drew up and gave our own shots. It wasn't hard, > actually and it gave the parents time to think if there were any more > questions.There were a lot less back then though as well as virtually > no documentation requirements. > > Some tips and pointers. Get a refrigerator that has a separate > freezer component. Fill the freezer with every ice pack you can > find--it keeps it much colder. You can get these ice packs > free--they > come with every vaccine order. We only need two freezer shelves for > vaccines and our freezer is completely full. I'm not positive, but I > think one of the vaccine companies will give you good > refrigerator/freezer thermometers. The thermometer is digital and > magnetically attaches to the front door. We have one for the fridge > and one for the freezer. We log the refrigerator temperature and > freezer temperature AM and PM. If either is out of range we re-log > 20 > minutes later. > > We keep separate supplies of VFC and private vaccine. They are > easily > identified by circular colored labels, one with a $ and one with VFC. > > Vaccines can be profitable with the newer CPT codes for giving > vaccines under age 7. These codes refer to counselling for the > vaccines (Give pt a VIS sheet to read and have them sign it = > counselling. We keep our VIS sheets in a binder--we don't hand them > out, saves a lot of money as well as ink and paper.) They carry > substantially increased reimbursement. > > More and more pediatric vaccines are coming out in prefilled > syringes--Prevnar, Pediarix, and flu for the 3 and under crowd--saves > time and syringes. > > Hope this helps. > > > > > > Vaccines are a hassle (for a variety of reasons) I'm trying to get > better > > organized about. Some on the list seem to have done well pricewise > by > > shopping around and getting better prices from different sources. > > Personally I've tried to keep it simple for now and order them > through my > > McKesson rep except for those one must get directly from the > manufacturer. > > I've got to keep track of the supply on hand better as a few times > I've > > wanted to give a shot and at the last minute realized I hadn't > ordered a > > new batch -- other day I gave Pediarix and Prevnar to a 2 month old > but > > didn't have Hib so I'm ordering it and will have to bring her back > in a > > week or two... I don't think the parent cared (I've known the > family a > > long time so trust is there) but honestly I am tougher on myself > than > > others are on me most of the time. > > > > Anyway, getting a good frig/freezer without paying through the nose > is > > important. Then you gotta keep track of the temp... I'm considering > > getting the thermometer discussed a couple months ago that follows > the > > average temp better than the simple ones I got now that I have to > check by > > opening the doors. > > > > Then you must consider the upfront costs and hope the insurers pay > well > > enough. > > > > So, yeah, it can be a hassle and everyone has to plan how they deal > with > > vaccines. Convenience for patients/families is important as having > them > > go to health department shots clinics may be an option but likely > > increases the risk kids will be behind in shots, etc. > > > > I'm sure others on the list will have good pointers and most of > them > have > > more experience behind them than I do (open just 7 months). > > > > Overall I like giving shots ... and I think it's funny when a > patient says > > something like, " I didn't know you could give a shot " , which has > happened > > a couple times! To think there are things only nurses do and > doctors > > can't is interesting to me, but I guess that is what the medical > world has > > shaped over the years since patients simply don't see the doc doing > such > > things most of the time. Patients have made similar comments when > I > take > > vital signs too. > > > > Good luck with your plans down in Duchess County... pretty area. > > Tim > > > > > I recently joined your group and have been learning alot from > reading > > > the posts. I am planning to join a solo doc in Dutchess County, > > > NY,in a few months with the idea of taking over his practice in > the > > > next year or so. I would say he meets the type of practice you > all > > > follow: he is by himself with a part-time front desk person. > > > He currently limits his practice to 5 year olds and up. He says > > > vaccines are the issue for younger children. I was wondering what > you > > > guys are all doing in terms of vaccines. The town his practice > is in > > > does not have any providers for infants/toddlers so I was hoping > this > > > could be a market to capture (plus I love seeing kids). I could > see > > > how vaccines could affect this in terms of cost to buy, > storage/upkeep > > > issues, time to administer without nursing help, etc. Thanks for > any > > > help on this issue. I am sure I will have plenty of more > > > questions/calls for help in the next few months. > > > Margaret Coughlan M.D. > > > > > > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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