RE: Re: which vaccines giving in office to over 5

[Guest guest]

Dispose of PPD after 30 days? What brand are you using? I think mine is good

for a year or so.

>

>

> Date: 2006/11/25 Sat PM 04:46:06 EST

> To: < >

> Subject: Re: which vaccines giving in office to over 5

>

> RE no vaccines in office

>

> My area (east of Pittsburgh, PA) hasn't moved to getting vaccines in

pharmacies yet, but was interested in others who have.

>

> We have the dubious " pleasure " of now having PA/NPs who are working

" semiautonomously " with a doc from SOMEWHERE giving support on basic dx/rx from

elsewhere, and am not sure if pts will be able to " walk in " and get dT booster

without seeing one of these people.

>

> I've been seeing kids over 5, so no early childhood immunizations -- do a

little DPA work, and send them to health dept although am not sure if any have

actually gotten their shots (only 1 family so far).

>

> Chose not to give ANY flu shots since opening Dec 2004 as unreliable delivery,

but our area ran out of flu shots this year, and despite now being " plentiful, "

somehow noone is promoting. Plan to keep a list of pts end of summer this

coming year, as have a source to order a short supply, and will precert to be

sure we get paid up-front for those who are eligible. Had about 50 pts call for

them.

>

> Pneumovax I keep stocked -- fair Medicare reimbursement on this.

> Hep B still keep a couple on hand, I think.

> Tdap haven't bothered, as dT is still available, and I've been wanting to keep

on hand for elderly, as they often come in after wound to my office. Tdap isn't

certified for over 64, or under 11, so see no reason for me to have this on hand

and have to buy 5-10 doses at a time.

> Menactra last summer I ordered in the mandatory " 5 at a time " and we checked

all insurances, ordering ONLY when had 5 to give. Remember there was shortage,

but now is advised for the 11-12 year old checkups, or prior to college age if

they hadn't gotten it. Except for the upfront cost, reimbursement's not really

that bad.

>

> I also have PPD at office, low cost, but reimbursement would only cover 1

shot, and must dispose after 30 days, so my usual reimbursement of under $4/shot

doesn't really pay. However, cost of exam will make it work out.

>

> Are people giving the Gardisil with people paying up-front, and what about the

Shingles vaccine? Thought that coverage was very limited right now and $150+

per vaccine seems too steep for me to keep in inventory so if pt wants it,

considering " purchase ahead " and get for them. Other thoughts??

>

> Dr Matt Levin

> FP, solo since Dec 2004

> Pittsburgh east suburbs, PA

>

> PATIENT CHECK OUT SHEET

> >

> >

> >

> > Here it is! I simply write my instructions like exrecise 3 x week,

> > do yoga. Take your BP, meds etc... then I circle which category

> > they are in (uncontrolled chronic, controlled chronic, no issues)

> > and I circle FU interval and explain why. I explain my goal for

> > everyone is to advance to the no issues category. I review HCM

> > deficits before they leave at each visit and I have the phone #

> > displayed for the county healthdept for vaccines (since I do not

> > given them in my office) and it has been an incredible asset to

> > our communication. I have a separate FU sheet for DM and Asthma

> > and I'll forward them next f yall want to check themout. Oh, and I

> > print these up on colorful fun paper (like with balloons around the

> > perimeter) and it sort of looks like an invitation to a party but it

> > is really just an invite to their next appt. I fit 2 on each page when

> > I copy them.

> >

> > Pamela

> >

> > _____________________________________

> >

> > Special Instructions:

> >

> > Follow Up Appointment: _____________________ or please call

> >

> > ___ Uncontrolled chronic issues 1 wk 2 wk 3 wk 4 wk

> > ___ Controlled chronic issues 2 mo 3 mo 4 mo 6 mo

> > ___ No issues seeya in a year !

> >

> > Health Care Maintenance:

> > complete physical pap mammogram dental exam vision exam

> > labs cholesterol prostate thyroid other___________________

> > colonoscopy (more fun than it sounds)

> > immunizations (Tetanus, Tdap, Influenza, Pnemoccocal, Hep A, Hep B

> > Meningococcal, Varicella, MMR, ____________ ) 682-4041 LCPHD

> >

> > Please ensure you have enough medications until your next visit

> >

>

>

>

>

>

[Guest guest]

I buy my PPD from Aventis, but from what I

understand, it is standard that they have a 30 day shelf life after opening.

The expiration before opening is much longer.

Kathy Saradarian, MD

Branchville, NJ

Solo low-staff practice since

4/03

In practice since 9/90

Practice Partner User since 5/03

[Guest guest]

That's news to me. I'll have to read the insert on my PPD. But, if true I will

stop offering PPD because I am lucky to do one in 30 days on average.

>

>

> Date: 2006/11/25 Sat PM 07:01:04 EST

> To: < >

> Subject: RE: Re: which vaccines giving in office to

over 5

>

> I buy my PPD from Aventis, but from what I understand, it is standard

> that they have a 30 day shelf life after opening. The expiration before

> opening is much longer.

>

>

>

> Kathy Saradarian, MD

>

> Branchville, NJ

>

> Solo low-staff practice since 4/03

>

> In practice since 9/90

>

> Practice Partner User since 5/03

>

>

>

>

>

[Guest guest]

RE Cost of doing business

I feel that absorbing the cost of a PPD makes alot more sense than absorbing the cost of a flu shot...

Consider doing physicals for whatever cost, additional testing, finding chronic care issues to do ongoing follow up on. Isn't this worth the PPD cost?

Also, many people do NOT have coverage for a "work physical" so the FULL cost of the PPD can be charged to them (whatever you set it at), not the insured discount cost.

I'll keep the PPD, but dump the idea of Tdap.

My opinion.

Dr Matt Levin

FP, solo since Dec 2004

RE: Re: which vaccines giving in office to over 5> > I buy my PPD from Aventis, but from what I understand, it is standard> that they have a 30 day shelf life after opening. The expiration before> opening is much longer.> > > > Kathy Saradarian, MD> > Branchville, NJ> > Solo low-staff practice since 4/03> > In practice since 9/90> > Practice Partner User since 5/03> > > > >

[Guest guest]

But I would be absorbing the cost of nearly an entire bottle of PPD, not just

one shot, because they would expire. Flu shots do not expire in 30 days.

>

>

> Date: 2006/11/26 Sun AM 10:49:30 EST

> To: < >

> Subject: Re: Re: which vaccines giving in office to

over 5

>

> RE Cost of doing business

>

> I feel that absorbing the cost of a PPD makes alot more sense than absorbing

the cost of a flu shot...

>

> Consider doing physicals for whatever cost, additional testing, finding

chronic care issues to do ongoing follow up on. Isn't this worth the PPD cost?

>

> Also, many people do NOT have coverage for a " work physical " so the FULL cost

of the PPD can be charged to them (whatever you set it at), not the insured

discount cost.

>

> I'll keep the PPD, but dump the idea of Tdap.

>

> My opinion.

>

> Dr Matt Levin

> FP, solo since Dec 2004

>

>

> RE: Re: which vaccines giving in office to

over 5

> >

> > I buy my PPD from Aventis, but from what I understand, it is standard

> > that they have a 30 day shelf life after opening. The expiration before

> > opening is much longer.

> >

> >

> >

> > Kathy Saradarian, MD

> >

> > Branchville, NJ

> >

> > Solo low-staff practice since 4/03

> >

> > In practice since 9/90

> >

> > Practice Partner User since 5/03

> >

> >

> >

> >

> >

>

>

>

>

>

[Guest guest]

RE overhead costs.

Think of it this way -- a Flu shot vial costs, what, $120 minimum for 10 shots, and what if some say "insurance pays" and you get stiffed for the $25 fee, OK, so, if you should get, say $25/shot, x 10 shots, that's $250. So if you "get stiffed" for 5 doses, then you're in "the red" if you don't count cost of each syringe, alcohol wipe, etc.

Cost of 1 PPD I can get oh, $4 for insurance reimbursement. So I "eat" $25 - 4 = $21. But I get, say, $40 per physical, that the pt wouldn't even come to me for if I don't do PPD. So, $40 - $25 + $4 = $19. So, yes, for each pt who needs PE without PPD, I'd loose. But I can't get these people to come if I can't do the PPD.

I'd say I'd rather be "out" the $21 than the Flu shot, which in multiples of $120 is alot more out of my pocket than $25 for the PPD.

So, when I hear docs' offices unable to "use" 300 vials of Flu vaccine, I just cringe -- think of it this way:

$120 x 300 vials is $36,000!! THAT's alot to absorb!!

Next year, I figure that, say, 50 pts may want flu shots at my office.

That'll be 5 vials of vaccine = $600. So, in my area, most charge full cash for $25.

Say I pay $12/vaccine. 50 pts may net me $600 or thereabouts depending on cost of syringes, incidentals.

Is it worth it to me to put out 600 to get folks in the door to give the vaccine? Then some insurances want to pay me less if I "see" them that day.

Think I'll stick to PPDs, where I know that on a $40 physical, I'll take home $19. On a vial of flu shots, I may be out alot more money than the $21.

As others have said, depends on your population.

I have alot more problems justifying NOT having Menactra available -- $80/shot.

Dr Matt Levin

Pittsburg east suburbs

FP solo since Dec 2004

Break-even at 2 years for expenses, minimal income but think I'll give myself some back this month.

RE: Re: which vaccines giving in office to over 5> > > > I buy my PPD from Aventis, but from what I understand, it is standard> > that they have a 30 day shelf life after opening. The expiration before> > opening is much longer.> > > > > > > > Kathy Saradarian, MD> > > > Branchville, NJ> > > > Solo low-staff practice since 4/03> > > > In practice since 9/90> > > > Practice Partner User since 5/03> > > > > > > > > > > > > > >

[Guest guest]

Yeah, but flu shots save lives and prevent significant disease.

And pertussis causes a significant number of illness and sends a good

number of kids into the hospital every year... and they get the pertussis

from teens/adults ... keeping teens immunizations up-to-date for that will

help.

So, those shots can really help a lot of people.

Menactra and gardisil certainly help but not nearly as many people or

hospitalizations as flu shots and vaccinating for pertussis.

The really, really sad thing about this discussion is that we have to

consider the financial costs/payments for vaccinations which are proven to

save lives/ decrease illness and are universally recommended.

.... Larry, did you say something about the system being broken? Wow, the

American healthcare industry/system is really broken when it comes to

vaccinations!!!

.... fyi, the Monroe County (Rochester, NY and surrounding area) Health

Department's shots clinic, as of about 10 days ago, did not yet have flu

vaccine for 2006!!! How can this be possible?

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

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sender immediately by reply email and destroy all copies of the original

message, including attachments.

> RE overhead costs.

>

> Think of it this way -- a Flu shot vial costs, what, $120 minimum for 10

> shots, and what if some say " insurance pays " and you get stiffed for the

> $25 fee, OK, so, if you should get, say $25/shot, x 10 shots, that's

> $250. So if you " get stiffed " for 5 doses, then you're in " the red " if

> you don't count cost of each syringe, alcohol wipe, etc.

>

> Cost of 1 PPD I can get oh, $4 for insurance reimbursement. So I " eat "

> $25 - 4 = $21. But I get, say, $40 per physical, that the pt wouldn't

> even come to me for if I don't do PPD. So, $40 - $25 + $4 = $19. So,

> yes, for each pt who needs PE without PPD, I'd loose. But I can't get

> these people to come if I can't do the PPD.

>

> I'd say I'd rather be " out " the $21 than the Flu shot, which in

> multiples of $120 is alot more out of my pocket than $25 for the PPD.

>

> So, when I hear docs' offices unable to " use " 300 vials of Flu vaccine,

> I just cringe -- think of it this way:

>

> $120 x 300 vials is $36,000!! THAT's alot to absorb!!

>

> Next year, I figure that, say, 50 pts may want flu shots at my office.

> That'll be 5 vials of vaccine = $600. So, in my area, most charge full

> cash for $25. Say I pay $12/vaccine. 50 pts may net me $600 or

> thereabouts depending on cost of syringes, incidentals. Is it worth it

> to me to put out 600 to get folks in the door to give the vaccine? Then

> some insurances want to pay me less if I " see " them that day.

>

> Think I'll stick to PPDs, where I know that on a $40 physical, I'll take

> home $19. On a vial of flu shots, I may be out alot more money than the

> $21.

>

> As others have said, depends on your population.

>

> I have alot more problems justifying NOT having Menactra available --

> $80/shot.

>

> Dr Matt Levin

> Pittsburg east suburbs

> FP solo since Dec 2004

> Break-even at 2 years for expenses, minimal income but think I'll give

> myself some back this month.

>

>

> RE: Re: which vaccines giving in

> office to over 5

> > >

> > > I buy my PPD from Aventis, but from what I understand, it is

> standard that they have a 30 day shelf life after opening. The

> expiration before opening is much longer.

> > >

> > >

> > >

> > > Kathy Saradarian, MD

> > >

> > > Branchville, NJ

> > >

> > > Solo low-staff practice since 4/03

> > >

> > > In practice since 9/90

> > >

> > > Practice Partner User since 5/03

> > >

> > >

> > >

> > >

> > >

> >

> >

> >

> >

> >

>

>

>

>

[Guest guest]

Tim,

I agree with your sentiments exactly. The

question should not be how good is the reimbursement (which by the way I

definitely ask prior to giving any shot), but why are we having to worry about reimbursement

for something that is no question beneficial to our society. This would be a

great first step in some sort of health care system reform: pay for the

immunizations so the docs can distribute them to the needy as recommended by

the CDC. Giving immunizations is relatively easy but the current system of

distribution is so broken I would challenge anyone to realistically believe we

(the US) could actually mount some sort of effective response to an

epidemic if it occurred. That is unless we relied on Walmart and Walgreens to

do it for us. It is sad indeed.

Re: Re:

which vaccines giving in office to over 5

Yeah, but flu shots save lives and prevent significant disease.

And pertussis causes a significant number of illness and sends a good

number of kids into the hospital every year... and they get the pertussis

from teens/adults ... keeping teens immunizations up-to-date for that will

help.

So, those shots can really help a lot of people.

Menactra and gardisil certainly help but not nearly as many people or

hospitalizations as flu shots and vaccinating for pertussis.

The really, really sad thing about this discussion is that we have to

consider the financial costs/payments for vaccinations which are proven to

save lives/ decrease illness and are universally recommended.

.... Larry, did you say something about the system being broken? Wow, the

American healthcare industry/system is really broken when it comes to

vaccinations!!!

.... fyi, the Monroe County (Rochester, NY and surrounding area) Health

Department's shots clinic, as of about 10 days ago, did not yet have flu

vaccine for 2006!!! How can this be possible?

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

> RE overhead costs.

>

> Think of it this way -- a Flu shot vial costs, what, $120 minimum for 10

> shots, and what if some say " insurance pays " and you get stiffed

for the

> $25 fee, OK, so, if you should get, say $25/shot, x 10 shots, that's

> $250. So if you " get stiffed " for 5 doses, then you're in

" the red " if

> you don't count cost of each syringe, alcohol wipe, etc.

>

> Cost of 1 PPD I can get oh, $4 for insurance reimbursement. So I

" eat "

> $25 - 4 = $21. But I get, say, $40 per physical, that the pt wouldn't

> even come to me for if I don't do PPD. So, $40 - $25 + $4 = $19. So,

> yes, for each pt who needs PE without PPD, I'd loose. But I can't get

> these people to come if I can't do the PPD.

>

> I'd say I'd rather be " out " the $21 than the Flu shot, which in

> multiples of $120 is alot more out of my pocket than $25 for the PPD.

>

> So, when I hear docs' offices unable to " use " 300 vials of Flu

vaccine,

> I just cringe -- think of it this way:

>

> $120 x 300 vials is $36,000!! THAT's alot to absorb!!

>

> Next year, I figure that, say, 50 pts may want flu shots at my office.

> That'll be 5 vials of vaccine = $600. So, in my area, most charge full

> cash for $25. Say I pay $12/vaccine. 50 pts may net me $600 or

> thereabouts depending on cost of syringes, incidentals. Is it worth it

> to me to put out 600 to get folks in the door to give the vaccine? Then

> some insurances want to pay me less if I " see " them that day.

>

> Think I'll stick to PPDs, where I know that on a $40 physical, I'll take

> home $19. On a vial of flu shots, I may be out alot more money than the

> $21.

>

> As others have said, depends on your population.

>

> I have alot more problems justifying NOT having Menactra available --

> $80/shot.

>

> Dr Matt Levin

> Pittsburg east suburbs

> FP solo since Dec 2004

> Break-even at 2 years for expenses, minimal income but think I'll give

> myself some back this month.

>

>

> RE: Re: which vaccines

giving in

> office to over 5

> > >

> > > I buy my PPD from Aventis, but from what I understand, it is

> standard that they have a 30 day shelf life after opening. The

> expiration before opening is much longer.

> > >

> > >

> > >

> > > Kathy Saradarian, MD

> > >

> > > Branchville, NJ

> > >

> > > Solo low-staff practice since 4/03

> > >

> > > In practice since 9/90

> > >

> > > Practice Partner User since 5/03

> > >

> > >

> > >

> > >

> > >

> >

> >

> >

> >

> >

>

>

>

>

[Guest guest]

RE Being altruistic is fine, but you need to pay the bills.

OK, flu shot issues -- buy the vaccine, run the clinics, be altruistic, loose money?

Well, that's all fine and good, but you can be altruistic, and how long will you keep your doors open?

Work for the health department, then, or for some other community health center, and see how long you want to put up with the admin issues -- everyone has a master.

OK, dT vs Tdap -- cost per vaccine is barely covered by some if not most insurance.

I'd love to "do what's right" but I still have to purchase the vaccine, and, quite frankly, sometimes I just have to make those tough choices. dT is rated to give to 65+ and Tdap is not, so what am I going to do when I can't use all of it?

If you have a couple of hundred EXTRA dollars to throw my way, send it on!!

We can scream and holler about the shortages of flu vaccine and high costs, but honestly folks, make your choices and decide but consider the overheads here.

Maybe this coming year the vaccine lobby will finally realize that distributing to doc practices makes more sense than trying to get the Walmarts and drugstores to give it "at a loss." At least I expect this next year. Vaccine "clinics" this year were few and far between, so I suspect reimbursement was so low that it wasn't worth it for some, as well as the shortage issue.

Until the national health departments start sticking up for rationality, this will continue.

Quality vs economics continue, in many ways, to be incompatible. I'll just have to continue the quality issue for my pts, and little by little, make the economics tilt my way too. We're all aware of the edge of the margins being so tight on so many things that survival economically means hard choices.

Later,

Dr Matt Levin

RE: Re: which vaccines giving in> office to over 5> > >> > > I buy my PPD from Aventis, but from what I understand, it is> standard that they have a 30 day shelf life after opening. The> expiration before opening is much longer.> > >> > >> > >> > > Kathy Saradarian, MD> > >> > > Branchville, NJ> > >> > > Solo low-staff practice since 4/03> > >> > > In practice since 9/90> > >> > > Practice Partner User since 5/03> > >> > >> > >> > >> > >> >> >> >> >> >>>>>

[Guest guest]

Matt --

I'm actually with you on this. I didn't mean the problem is that we ARE

HAVING this discussion, but that the system is so broke that we ARE FORCED

TO HAVE this discussion because docs can be hurt financially for giving

universally recommended vaccinations. What I wrote was, " The really,

really sad thing about this discussion is that we have to

consider the financial costs/payments for vaccinations " . I think the

problem is the system or vaccination distribution.

I wish I knew the easy answer so I could get the shots that help the most

and do well financially, or at least not worry I'd lose money on it.

Tim

--

Malia, MD

Malia Family Medicine & Skin Sense Laser

6720 Pittsford-Palmyra Rd.

Perinton Square Mall

Fairport, NY 14450

(phone / fax)

www.relayhealth.com/doc/DrMalia

www.SkinSenseLaser.com

-- Confidentiality Notice --

This email message, including all the attachments, is for the sole use of

the intended recipient(s) and contains confidential information.

Unauthorized use or disclosure is prohibited. If you are not the intended

recipient, you may not use, disclose, copy or disseminate this

information. If you are not the intended recipient, please contact the

sender immediately by reply email and destroy all copies of the original

message, including attachments.

> RE Being altruistic is fine, but you need to pay the bills.

>

> OK, flu shot issues -- buy the vaccine, run the clinics, be altruistic,

> loose money?

> Well, that's all fine and good, but you can be altruistic, and how

> long will you keep your doors open? Work for the health department,

> then, or for some other community health center, and see how long

> you want to put up with the admin issues -- everyone has a master.

>

> OK, dT vs Tdap -- cost per vaccine is barely covered by some if not most

> insurance.

> I'd love to " do what's right " but I still have to purchase the

> vaccine, and, quite frankly, sometimes I just have to make those

> tough choices. dT is rated to give to 65+ and Tdap is not, so what

> am I going to do when I can't use all of it? If you have a couple

> of hundred EXTRA dollars to throw my way, send it on!!

>

> We can scream and holler about the shortages of flu vaccine and high

> costs, but honestly folks, make your choices and decide but consider the

> overheads here.

>

> Maybe this coming year the vaccine lobby will finally realize that

> distributing to doc practices makes more sense than trying to get the

> Walmarts and drugstores to give it " at a loss. " At least I expect this

> next year. Vaccine " clinics " this year were few and far between, so I

> suspect reimbursement was so low that it wasn't worth it for some, as

> well as the shortage issue.

>

> Until the national health departments start sticking up for rationality,

> this will continue.

>

> Quality vs economics continue, in many ways, to be incompatible. I'll

> just have to continue the quality issue for my pts, and little by

> little, make the economics tilt my way too. We're all aware of the edge

> of the margins being so tight on so many things that survival

> economically means hard choices.

>

> Later,

>

> Dr Matt Levin

>

>

> RE: Re: which vaccines giving in

> > office to over 5

> > > >

> > > > I buy my PPD from Aventis, but from what I understand, it is

> > standard that they have a 30 day shelf life after opening. The

> expiration before opening is much longer.

> > > >

> > > >

> > > >

> > > > Kathy Saradarian, MD

> > > >

> > > > Branchville, NJ

> > > >

> > > > Solo low-staff practice since 4/03

> > > >

> > > > In practice since 9/90

> > > >

> > > > Practice Partner User since 5/03

> > > >

> > > >

> > > >

> > > >

> > > >

> > >

> > >

> > >

> > >

> > >

> >

> >

> >

> >

>

>

>

>

[Guest guest]

In Washington State

the cost of the vaccination is covered by the state for anyone under 18.

They are currently a hassle to get. (You have to pick them up from the

health department and the hours are never quite the same and the staff is surly,

but it works.) They are transitioning to distribution via air mail from

the CDC soon. For state Medicaid pts we make $9.70 per shot

administered. I don’t think that covers the cost of paperwork, traveling

for the program, and administration of the shot, but we never lose money on

children’s vaccines expiring or the like. I am hopeful that the CDC

sending them directly to our office will decrease our administrative costs.

Just a point of light in the system.

Some states are working toward, at least, children’s immunizations.

Ernie

From: [mailto: ] On Behalf Of Levin

Sent: Sunday, November 26, 2006

10:50 PM

To:

Subject: Re: Re:

which vaccines giving in office to over 5

RE Being altruistic is fine, but you need to pay the bills.

OK, flu shot issues -- buy the vaccine, run the clinics, be

altruistic, loose money?

Well, that's all fine and good, but

you can be altruistic, and how long will you keep your doors open?

Work for the health department,

then, or for some other community health center, and see how long you want to

put up with the admin issues -- everyone has a master.

OK, dT vs Tdap -- cost per vaccine is barely covered by some

if not most insurance.

I'd love to " do what's

right " but I still have to purchase the vaccine, and, quite frankly,

sometimes I just have to make those tough choices. dT is rated to give to

65+ and Tdap is not, so what am I going to do when I can't use all of it?

If you have a couple of hundred

EXTRA dollars to throw my way, send it on!!

We can scream and holler about the shortages of flu vaccine

and high costs, but honestly folks, make your choices and decide but consider

the overheads here.

Maybe this coming year the vaccine lobby will finally

realize that distributing to doc practices makes more sense than trying to get

the Walmarts and drugstores to give it " at a loss. " At least I

expect this next year. Vaccine " clinics " this year were few and

far between, so I suspect reimbursement was so low that it wasn't worth it for

some, as well as the shortage issue.

Until the national health departments start sticking up for

rationality, this will continue.

Quality vs economics continue, in many ways, to be

incompatible. I'll just have to continue the quality issue for my pts,

and little by little, make the economics tilt my way too. We're all aware

of the edge of the margins being so tight on so many things that survival

economically means hard choices.

Later,

Dr Matt Levin

RE: Re: which vaccines

giving in

> office to over 5

> > >

> > > I buy my PPD from Aventis, but from what I understand, it is

> standard that they have a 30 day shelf life after opening. The

> expiration before opening is much longer.

> > >

> > >

> > >

> > > Kathy Saradarian, MD

> > >

> > > Branchville,

NJ

> > >

> > > Solo low-staff practice since 4/03

> > >

> > > In practice since 9/90

> > >

> > > Practice Partner User since 5/03

> > >

> > >

> > >

> > >

> > >

> >

> >

> >

> >

> >

>

>

>

>

[Guest guest]

figured we agreed -- just wanted to point out to others

RE: Re: which vaccines giving in> > office to over 5> > > >> > > > I buy my PPD from Aventis, but from what I understand, it is> > standard that they have a 30 day shelf life after opening. The> expiration before opening is much longer.> > > >> > > >> > > >> > > > Kathy Saradarian, MD> > > >> > > > Branchville, NJ> > > >> > > > Solo low-staff practice since 4/03> > > >> > > > In practice since 9/90> > > >> > > > Practice Partner User since 5/03> > > >> > > >> > > >> > > >> > > >> > >> > >> > >> > >> > >> >> >> >> >>>>>