Combo vaccines may cost doctors money

Combination vaccines that protect patients against multiple diseases are easier on kids and less of a hassle for parents. But according to a study led by Angela Shen of the Department of Health and Human Services in Washington, DC, "combination vaccines can result in a financial loss for physicians" because doctors may get less reimbursement for combination vaccines than for individual shots. On average, the study found that physicians were reimbursed $20 less by commercial payers and $13 less by Medicaid for administering vaccine combos instead of single shots.

"Although the practice expense of administering 1 vaccine might be less than that associated with 5 vaccines, the work of reviewing the record, discussing risks and benefits, and documenting must be done for each component in a combination vaccine," the authors explained.

New immunization administration codes were introduced this year to correct the problem, and most commercial payers have adjusted their reimbursement to reflect the changes. But the Centers for Medicare and Medicaid Services policy holds that providers shouldn't bill for individual components of the vaccines they administer. CMS operates the Vaccines for Children (VFC) program, through which half of the country's kids get their early vaccines. The study authors said denying providers the opportunity to file individual claims for combination vaccines could interfere with kids getting all their recommended shots.

In an article published in Pediatrics, the authors concluded that changing reimbursement policies to favor combination vaccines could boost childhood vaccine coverage.

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