2 Classic Comments

[Guest guest]

I know this is preaching to the choir, but always interesting to see what we are up against.

 

Locke, MD

 

 

http://www.ama-assn.org/amednews/2010/11/22/bil31122.htm

 

Insurers' profits rise as they spend less on care

Plans say there is no reason to lower premium increases because they expect patient traffic to pick up. But analysts aren't so sure.

 But insurers agree that there is no reason to reduce their premium increases or increase spending on care, including bumping up physician pay, even as they face minimum medical-loss ratios in 2011 mandated by the health system reform law.

Net earnings for the third quarter of 2010 rose for all but one of the seven largest publicly traded health plans, compared with the same period in 2009. At some of the largest plans, the percentage year-over-year increases were well into the double-digits -- like their price increases in many states, particularly in the individual market.

=======================

http://www.ama-assn.org/amednews/2010/11/22/gvsc1122.htm

Medicaid vaccination rates tied to flu shot pay levels

When physician payment goes up, the rate of full vaccinations in children also rises, a new study finds.

Medicaid pay for administering pediatric influenza vaccines is associated with the percentage of poor children who are fully vaccinated, according to a recent study.

Increasing Medicaid flu vaccine administration fees by $10 -- from the typical state fee of $8 to the highest state rate of $18 -- was associated with overall vaccination rate increases of six to nine percentage points among poor children between 2005 and 2007, according to a study published in the November Pediatrics. Article authors compared state vaccination rates and state Medicaid fees for administering flu shots.

The percentage of poor children who received the full slate of shots recommended by the Centers for Disease Control and Prevention was 11.7% in 2006, 11.6% in 2007 and 18.8% in 2008. State rates vary widely, from 53% in Vermont to 4% in Iowa. Poor children are those in families earning less than the federal poverty level, or $18,310 for a family of three.

Most state Medicaid programs pay physicians less than their costs of giving flu shots to children, said Byung-Kwang Yoo, MD, PhD, assistant professor, Dept. of Community and Preventive Medicine at the University of Rochester Medical Center in New York. " This may create an obvious disincentive when physicians' offices lose money every time they give a flu shot, even though vaccines are provided for free. "

For example, physician practices cover the expenses of storing the vaccines at specific temperatures, ordering and monitoring vaccine stocks, and insurance against the loss of vaccines.

Administering a single vaccine to a child younger than age 8 costs physicians $21.76 on average, according to Medicare relative value unit calculations by Centers for Medicare & Medicaid Services. Meanwhile, state-level physician Medicaid pay for giving flu shots ranged from $2 to $18 in 2007, with an average of $9.

Most state Medicaid programs pay physicians less than their costs of giving flu shots to children.

However, the study found that low payment didn't always mean that vaccination rates were low.

For example, Colorado, Connecticut and Hawaii paid physicians $2 to administer pediatric flu shots in 2007 -- the lowest rate in the nation.

snip/snip

======================

Locke, MD