New AAP vaccine policy calls for ways to cover costs better

When pediatrician Herschel R. Lessin, MD, began working at his Poughkeepsie, N.Y., practice in 1982, the Centers for Disease Control and Prevention recommended three series of vaccines for children younger than 2 years. Physicians could purchase each dose for $10 or less.

Today, the number of recommended immunizations has more than doubled, and some of the vaccines cost $120 or more per dose. Dr. Lessin knows pediatricians who stopped immunizing children due to high vaccine costs and what they consider inadequate payments from public programs and private insurers.

In a revised policy statement on immunization, the American Academy of Pediatrics acknowledged that pediatricians and family physicians face challenges trying to meet the Healthy People 2010 vaccination goals. Those challenges include the growing number and rising costs of vaccines, unanticipated manufacturing and delivery problems, and the public anti-vaccination movement.

In the policy, published online May 31 in Pediatrics, the AAP calls on private insurers and public programs not only to cover physicians' costs for buying, storing and administering immunizations, but also to provide doctors a financial incentive to vaccinate patients. The academy urges manufacturers to maintain an adequate supply of childhood vaccine, and it recommends that doctors extend office hours, when possible, to expand immunization opportunities.

The revision marks a shift from the policy statement issued in 2003 that focused largely on changes physicians could make to improve their practices' effectiveness in vaccinating children.

"If you completely ignore the economic aspects of this, you can put yourself out of business," said Dr. Lessin, co-lead statement author and a member of the AAP's Committee on Practice and Ambulatory Medicine, which developed the policy. He is vice president of a 20-pediatrician practice in New York.

The policy highlights a study in the December 2008 Pediatrics that surveyed 597 U.S. pediatricians and family physicians on vaccine financing issues. Researchers found that 49% of the doctors practiced in an office that had delayed purchasing a new vaccine due to financial concerns. Five percent of pediatricians and 21% of family doctors said their practice seriously considered discontinuing the immunization of privately insured patients in the past year because of vaccine costs, and administration and payment issues.

"It's fair to say that doctors don't view delivery of vaccines as a significant source of profit within the practice. On the other hand, doctors can't be expected to provide the service and lose money on it," said California pediatrician Lawrence D. Hammer, MD, lead author of the policy statement. He also is chair of the AAP's Committee on Practice and Ambulatory Medicine.

Despite the challenges, child vaccine rates have improved since the AAP issued its 2003 immunization policy. That year, 72.5% of children age 19 to 35 months received the full set of vaccines recommended by CDC. In 2007, 77.4% of children completed the same vaccine series.

Still, the academy said the nation's child vaccination rates fall short of the Healthy People 2010 target of at least 80% coverage for the full set of vaccines.

Meeting the goals for immunization of adolescents is an even greater challenge, because teens have fewer doctor's office visits than children do, meaning less opportunities to give vaccines, Dr. Hammer said.

"Another barrier is that some vaccines recommended for adolescents tend to be very expensive, and [patients'] source of care may have difficulty providing the vaccine," said Dr. Hammer, professor of pediatrics at the Stanford University School of Medicine in California. He also is medical director for ambulatory care services at the Lucile Packard Children's Hospital at Stanford.

The AAP recommends expanding immunization opportunities by making vaccinations available during visits for minor illnesses. Practices also should maintain up-to-date records of immunizations received by each patient and implement reminder systems to alert patients when they are due for a recommended vaccine.