Less than a third of surveyed primary care physicians currently stock all 11 recommended adult vaccines, according to a study conducted by the Vaccine Policy Collaborative Initiative and published in the Annals of Internal Medicine.
Although almost all of the 607 family physician and internist respondents inquire about patients' immunization status annually, a growing majority refer their patients to public health clinics or pharmacies to receive them--most often citing financial barriers to providing the immunizations themselves.
Thirty-six percent of general internists and 41 percent of family physicians said the cost of stocking and administering the vaccines was problematic in light of inadequate reimbursement for vaccine purchase and administration, according to Ob.Gyn. News. Meanwhile 55 percent and 62 percent, respectively, cited lack of insurance coverage for vaccines and large up-front costs to purchase vaccines. These challenges were most pronounced in private practices or those with fewer than five physicians, according to researchers, as well as those who served a large number of Medicare Part D patients.
Healthcare consultant, practice administrator and blogger Mary Pat Whaley told FiercePracticeManagement that she has seen physicians moving away from providing vaccines onsite for adults. In particular, she described a recently opened cash-based practice that determined it would not include flu shots in annual fees because they were expensive for offices and readily available elsewhere. "That's a big change," Whaley said. "We're seeing this dichotomy of practices saying we want to be your one-stop shop and do everything, and on the other hand saying we're only going to do our core competency, and anything we either lose money on, can't make money on or can be provided by somebody else just as well, we're going to outsource that."
Although practices owners may think these changes make good business sense, referring uncovered patients for vaccines may increase their out-of-pocket costs, because "changes in the federal 317 rules [of the Public Health Service Act] prohibit adult patients who are insured from receiving vaccines without charge through public health agencies," Jonathan Temte, M.D., chair of the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, told OGN.