metsfan Posted September 9, 2009 Share #1 Posted September 9, 2009 Health care providers say insurers don't reimburse them enough for essential vaccinations, so they're not offering them. By Parija B. Kavilanz, CNNMoney.com senior writer Last Updated: September 8, 2009: 1:16 PM ET Doctors say their bottom lines are hurting due to the cost of vaccinations. NEW YORK (CNNMoney.com) -- Parents who bring their kids to Dr. G. Andrew McIntosh for the chicken pox vaccine are out of luck. The family physician, who has a solo practice in Uniontown, Ohio, doesn't offer that shot because he can't afford it. Most insurers won't sufficiently cover the cost. "It doesn't do me any good. I am losing money on [them]," he said. The chicken pox vaccine runs about $115, but insurers only cover between $68 to $83 of that. McIntosh has also cut back on a handful of other critical childhood vaccines for the same reason -- including the measles, mumps and rubella, known as the MMR vaccine. It costs him about $58 to buy an MMR shot, he said, while insurers pay about about $40. So McIntosh keeps a lot less of the MMR on hand. If a patient needs the shot and he doesn't have it, he sends them to a nearby public health clinic. "I'm not happy to do that," he said. "The clinic is far, the service isn't great and my patients aren't happy to go there." Although he says he "feels compelled" to take care of people, he adds, "I can't save the world and pay for my staff," he said. "As we say, 'no margin, no mission.'" "I've lost a fair number of kids [at the practice] because I've had to send them elsewhere for their shots," he said. Alarming numbers It's not clear exactly how widespread vaccine cutbacks are, but in a recent industry survey, 5% of pediatricians and 11% of physicians indicated that they're seriously considering no longer offering immunizations. Currently there are about 350,000 pediatricians and family physicians in the U.S. "These are fantastically alarming numbers," said Dr. Richard Lander, a Livingston N.J.-based pediatrician who chairs a committee on administration and practices at the American Academy of Pediatricians. (AAP) "It's an example of how health care is being driven by managed care in the United States," Lander said. Doctors have to absorb any costs that insurance doesn't cover because in most states insurance contracts prohibit providers from charging patients the difference. Dr. Jim King, a family physician in Selmer, Tenn. is another medical professional who is dropping expensive vaccines because of "insufficient" reimbursement from insurers. "The vaccine for shingles is fairly expensive, about $75 to $150 per vaccine," said King, who is also board chair of the American Academy of Family Physicians. "The profit margin on it is very small, so we're not giving that. If we lose money on one, we need to administer nine to break even," he said. Like McIntosh, doctors at King's practice are referring patients to public clinics for shots that they no longer administer. The economics work a little better in the case of influenza vaccines, which can cost between $7 to about $33 per vaccine, according to the Center for Medicare and Medicaid Services. So King is stocking up on the flu vaccine. The threat to public health Public health experts are particularly worried about doctors dropping vaccinations. Dr. Lance Rodewald, head of the Immunization Services Division at the Centers for Disease Control and Prevention, points to the consequences this trend has had on public health in the past. "Between 1989 to 1991, a number of doctors stopped providing vaccinations to children because of financing issues," he said. Instead, doctors referred patients to public health clinics for shots like the MMR. But many parents failed to follow up on those shots, Rodewald said, and their toddlers were never immunized. The result: The situation led to 55,000 cases of measles, 11,000 hospitalizations and 123 toddler deaths. The CDC found that more than half of the children who had contracted the measles had not been vaccinated, even though many of them had seen a health care provider. "This is why we are taking attitudes of doctors very seriously when they say they are delaying buying vaccines pending insurance coverage, or that they could stop vaccinating because of declining revenues," Rodewald said. The CDC maintains that vaccination rates for most child and adolescent vaccines are currently about 80% in the United States. Hidden costs Vaccines of all kinds represent the largest operating expense for some doctors, according to the AAP. The problem: Most insurers pay providers just the base cost of the vaccine. So if it costs $120 to buy a particular vaccine, insurance would pay back $120. But Lander points out that there are a lot more expenses that go into providing a vaccine, including the refrigeration, electricity and insurance required to store the shots. On average, doctors keep $100,000 to $150,000 worth of vaccines on hand each year. The AAP estimates that the actual cost to providers to acquire vaccines could be 17% to 28% above the price of the vaccine itself. "This is America. Running a private practice is a business," said Lander. "It's not $120 but closer to $140 for me to break even," said Lander. The insurance industry acknowledged that "there is always a natural tension between health plans and providers about payment," said Susan Pisano, spokeswoman for America's Health Insurance Plans (AHIP). Then there's the cost to doctors of the office visit to administer a shot. Lander maintains that a majority of insurers are inadequately paying doctors for this service, too. "When a patient comes to my practice for shots, a nurse will explain what shots will be given, hand out pamphlets and complete paperwork," he said. Reimbursements for administration fees range anywhere between 60% to 100% of the cost depending on a doctor's contract with the insurer. "Managed care had decreased [overall] access to health care because of poor pay to providers," Lander said. McIntosh agreed. "I enjoy seeing kids. It's joyful to see a baby and watch them grow up healthy," McIntosh said. "But I am giving that up because I can't give them the shots they need." He said more of his patients now are the elderly. "It makes me sad how the dynamics of my practice have changed," he said. http://money.cnn.com/2009/09/08/news/economy/health_care_vaccinations/index.htm ------------------------------------------------------------ Gee, all the sudden Obama's plan to fully subsidize vaccinations looks like the brilliant idea it has been all along. - A Link to comment Share on other sites More sharing options...
CPBO Posted September 9, 2009 Share #2 Posted September 9, 2009 wow.....I think this is a call for Obama to get involved.......shots for everyone!!! O man get these people backs!! I think under his plan thou.....if your life expectancy is cut short by not getting the shot he will authorize this......too many people on SS......we need to curb the population. :eek: Link to comment Share on other sites More sharing options...
lilbluefoxie Posted September 9, 2009 Share #3 Posted September 9, 2009 wow.....I think this is a call for Obama to get involved...... Yea thats the last thing I want. Link to comment Share on other sites More sharing options...
SubwayGuy Posted September 9, 2009 Share #4 Posted September 9, 2009 That's insurance and corporations for you... What does US history show...let businesses do what they want and you get the Stock Market Crash of 1929, labor abuses, the robber baron age, and now you get the Great Recession... Just another day at the office makin bills screwing America... Take the insurers profits out of the picture by forcing them to compete vs the govt and things will look a bit better... Not like public libraries put Barnes and Noble outta business or the US Postal Service put UPS on the fritz, but hey what do I know? You don't see communism and socialism in those industries now do you? Didn't think so... Link to comment Share on other sites More sharing options...
INDman Posted September 9, 2009 Share #5 Posted September 9, 2009 That's insurance and corporations for you... What does US history show...let businesses do what they want and you get the Stock Market Crash of 1929, labor abuses, the robber baron age, and now you get the Great Recession... Just another day at the office makin bills screwing America... Take the insurers profits out of the picture by forcing them to compete vs the govt and things will look a bit better... Not like public libraries put Barnes and Noble outta business or the US Postal Service put UPS on the fritz, but hey what do I know? You don't see communism and socialism in those industries now do you? Didn't think so... But public libraries and the USPS are not the only option out there. If everything in a certain sector was controlled by the government, then yes that would be socialism. There needs to be the option of government services as well as private ones in the same market place. Link to comment Share on other sites More sharing options...
SubwayGuy Posted September 9, 2009 Share #6 Posted September 9, 2009 But public libraries and the USPS are not the only option out there. If everything in a certain sector was controlled by the government, then yes that would be socialism. There needs to be the option of government services as well as private ones in the same market place. Exactly 100% agreed. A public plan to compete with (not replace) the private ones would keep them honest. Link to comment Share on other sites More sharing options...
INDman Posted September 9, 2009 Share #7 Posted September 9, 2009 Exactly 100% agreed. A public plan to compete with (not replace) the private ones would keep them honest. While I agree, that is not Obama's plan. One of his goals was to get rid of private providers. Link to comment Share on other sites More sharing options...
SubwayGuy Posted September 9, 2009 Share #8 Posted September 9, 2009 While I agree, that is not Obama's plan. One of his goals was to get rid of private providers. Eh, I disagree on that. You can't trust what you hear on those Republican channels you listen to. I know you like Family Guy (which is the s___...I was actually talking to JH about it a little this weekend) but if you leave Fox on long enough to get to the news it will make you dumber... Link to comment Share on other sites More sharing options...
CPBO Posted September 9, 2009 Share #9 Posted September 9, 2009 lets see what the man has to say to congress and the public tonight...... Link to comment Share on other sites More sharing options...
lilbluefoxie Posted September 9, 2009 Share #10 Posted September 9, 2009 Exactly 100% agreed. A public plan to compete with (not replace) the private ones would keep them honest. Unfortunately the law of unintended consequences comes into play, if theres a government option that doesnt cost the companies anything, they will drop their private plan to cut costs, which if enough companies do that can put the private insurance out of business, and then we will have more jobs in the private sector lost. Link to comment Share on other sites More sharing options...
SubwayGuy Posted September 10, 2009 Share #11 Posted September 10, 2009 Unfortunately the law of unintended consequences comes into play, if theres a government option that doesnt cost the companies anything, they will drop their private plan to cut costs, which if enough companies do that can put the private insurance out of business, and then we will have more jobs in the private sector lost. Not true at all. They will have to compete or go out of business. If they drop coverage of too many, they lose premiums, they lose revenue, and go out of business. Or they can lower their charges, cut administrative costs (and yes, lay off a few administrative people who add nothing of value to the insurance recieved by those who have coverage), and remain profitable. No one intends to fail in business...it's "survival instincts" so they will do the latter. OH NOES TEH LOST JOBS!!! BUT - and this is a big but (not to be confused with a big butt) - who do you think is going to staff a public plan? Why, employees that will have to be hired. And I can guarantee it will actually result in job creation because more will be needed for the new plan than will be cut from private insurers. People are getting paranoid of fear that things will be bad with an overhaul, but they're already AWFUL. Everyone is terrified of government "rationing" of health care (even though that's not part of a public plan, it's spin put on a phrase in the bill that doesn't say that)...but yet, that's EXACTLY what you have under private insurers who deny coverage based on pre-existing conditions or drop it when you have something major happen. Read this...it explains a lot better than I could. http://www.usnews.com/money/blogs/flowchart/2009/08/26/the-case-for-postal-style-healthcare.html Read this...it explains a lot better than I could. Link to comment Share on other sites More sharing options...
Urbanfortitude Posted September 10, 2009 Share #12 Posted September 10, 2009 Not true at all. They will have to compete or go out of business. If they drop coverage of too many, they lose premiums, they lose revenue, and go out of business. Or they can lower their charges, cut administrative costs (and yes, lay off a few administrative people who add nothing of value to the insurance recieved by those who have coverage), and remain profitable. No one intends to fail in business...it's "survival instincts" so they will do the latter. OH NOES TEH LOST JOBS!!! BUT - and this is a big but (not to be confused with a big butt) - who do you think is going to staff a public plan? Why, employees that will have to be hired. And I can guarantee it will actually result in job creation because more will be needed for the new plan than will be cut from private insurers. People are getting paranoid of fear that things will be bad with an overhaul, but they're already AWFUL. Everyone is terrified of government "rationing" of health care (even though that's not part of a public plan, it's spin put on a phrase in the bill that doesn't say that)...but yet, that's EXACTLY what you have under private insurers who deny coverage based on pre-existing conditions or drop it when you have something major happen. Read this...it explains a lot better than I could. http://www.usnews.com/money/blogs/flowchart/2009/08/26/the-case-for-postal-style-healthcare.html Read this...it explains a lot better than I could. i need to hang out w/ you more. You know your stuff man. Link to comment Share on other sites More sharing options...
INDman Posted September 10, 2009 Share #13 Posted September 10, 2009 Eh, I disagree on that. You can't trust what you hear on those Republican channels you listen to. I know you like Family Guy (which is the s___...I was actually talking to JH about it a little this weekend) but if you leave Fox on long enough to get to the news it will make you dumber... Fox News can make you dumber, but MSNBC WILL make you dumber. I just hate Keith Olberman. I think this (the F'ed up state of our country) can mostly be fixed by severly limiting malpracticee suits agains doctors who are all scared shitless about getting sued. That would greatly lower the cost of health care. While where at it, lets get rid of all the D-bag, ambulance chasing lawyers out there. Some one getting $3 MILLION for slipping on ice out side of an apartment building or for getting hurt while they had there head up their ass is insane. Also, make people acountable for their actions, lets not dumb this place down so those who can't swim with the big fish don't get their feelings hurt. Link to comment Share on other sites More sharing options...
lilbluefoxie Posted September 10, 2009 Share #14 Posted September 10, 2009 Fox News can make you dumber, but MSNBC WILL make you dumber. I just hate Keith Olberman. I think this (the F'ed up state of our country) can mostly be fixed by severly limiting malpracticee suits agains doctors who are all scared shitless about getting sued. That would greatly lower the cost of health care. While where at it, lets get rid of all the D-bag, ambulance chasing lawyers out there. Some one getting $3 MILLION for slipping on ice out side of an apartment building or for getting hurt while they had there head up their ass is insane. Also, make people acountable for their actions, lets not dumb this place down so those who can't swim with the big fish don't get their feelings hurt. I agree with that, much of the costs built into medical care is to save the doctors butts from lawsuits Link to comment Share on other sites More sharing options...
SubwayGuy Posted September 10, 2009 Share #15 Posted September 10, 2009 Fox News can make you dumber, but MSNBC WILL make you dumber. I just hate Keith Olberman. I think this (the F'ed up state of our country) can mostly be fixed by severly limiting malpracticee suits agains doctors who are all scared shitless about getting sued. That would greatly lower the cost of health care. While where at it, lets get rid of all the D-bag, ambulance chasing lawyers out there. Some one getting $3 MILLION for slipping on ice out side of an apartment building or for getting hurt while they had there head up their ass is insane. Also, make people acountable for their actions, lets not dumb this place down so those who can't swim with the big fish don't get their feelings hurt. You already know I 100% agree with that. LIke I said get rid of all lawyers except DA's and criminal defense lawyers and the cost of living in the US drops AT LEAST 30% over night. And don't be fooled. FOX news AND MSNBC will both make you equally dumb in opposite directions. And those that think listening to both will balance out and not make you dumb, it will actually make you 3x as dumb. Link to comment Share on other sites More sharing options...
INDman Posted September 10, 2009 Share #16 Posted September 10, 2009 And don't be fooled. FOX news AND MSNBC will both make you equally dumb in opposite directions. And those that think listening to both will balance out and not make you dumb, it will actually make you 3x as dumb. Thats why I only read the Onion. Link to comment Share on other sites More sharing options...
SubwayGuy Posted September 10, 2009 Share #17 Posted September 10, 2009 Thats why I only read the Onion. Nice. Link to comment Share on other sites More sharing options...
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