Cost of adult vaccinations prohibiting some docs

Slim profits and even financial losses have caused many physician practices to curb their offerings for adult vaccines. And according to a new article from the New York Times, pediatricians in small and solo practices are increasingly facing the same dilemma.

Part of the problem is that the cost of vaccines have skyrocketed, with the average cost to fully vaccinate a child with private insurance to the age of 18 now at $2,192, up from $100 in 1986, according to data from the Centers for Disease Control and Prevention obtained by the newspaper. And although the Affordable Care Act requires insurance companies to cover vaccines at no cost to patients, health plans' payments to physicians often aren't enough to cover the cost to purchase, store and administer the shots, the article noted.

Practices can even lose money on overhead associated with vaccines they receive at no cost as part of the Vaccines for Children (VFC) program, which is federally funded but controlled by individual states, according to Medical Economics. "There are a lot of costs involved with the VFC that are not included [reimbursed] because the physician can't mark up the vaccine," said Edward Zissman, M.D., of Altamonte Pediatric Associates in offices north of Orlando, Florida.

As a result, a 2010 survey of family practice doctors published in the Annals of Family Medicine revealed that about one-third were considering not giving immunizations because of the cost, and that 40 percent of family physicians already ceased offering some recommended childhood immunizations.

Physician practices that don't offer vaccines often refer patients to local pharmacies or health clinics to obtain them, but patients may struggle to find sources that will vaccinate children and/or accept their particular insurance. One San Antonio, Texas, mother told the NYT that she had to call 10 pediatricians before she found one that would vaccinate her son who was entering kindergarten.

The problem is also seeping into obstetrics, according to the NYT. Despite two infant deaths from whooping cough in San Antonio last year, some physicians say they can't afford to give their pregnant patients the vaccine. Although a physician not offering the vaccine is just one reason women may forego immunization, less than 10 percent of pregnant women in the United States are getting this recommended shot.

To learn more:
- read the article from the New York Times
- read the article from Medical Economics
- see the study