Because of inadequate or late insurance reimbursements, doctors increasingly are referring patients to counties' public-health departments for some or all of their vaccines.(Photo: Getty Images)
It is becoming more of a hassle each year for parents to get their children vaccinated for school, as complications with insurance reimbursements are driving pediatricians to quit providing the service.
Because of inadequate or late insurance reimbursements, doctors increasingly are referring patients to counties' public-health departments for some or all of their vaccines.
Children are vaccinated for free through county safety-net systems, intended for the poorest residents who have nowhere else to go.
The county may be reimbursed, depending on the parents' insurance plans. But often, the county is not reimbursed the full amount or at all, meaning the publicly funded system is left to figure out the costs.
Fewer children also may be getting immunized because of the growing inconvenience for parents. Kids are among the most susceptible populations for disease, so fewer child vaccinations means a greater risk children will catch and spread contagious diseases that can lead to outbreaks, public-health officials say.
A new state advisory committee created to examine the problem held its first meeting Friday. Over the next four months, it will come up with recommendations to address the problem, including how to encourage physicians to resume full vaccination services.
The committee, formed through legislation, must send recommendations to the Governor's Office by mid-December for them to be considered for the 2015 legislative session. The panel's members include health-care professionals, public-health officials, insurers and vaccine manufacturers.
A combination of changes in local, state and federal policies have made immunization funding increasingly complex in recent years. As a result, it is more difficult for providers and public-health clinics to afford to vaccinate children.
Arizona's public-health officials, doctors and insurers have struggled with the problem for at least eight years. More states are finding themselves in the same predicament, bringing the issue to national attention.
In 2013, 10 percent of children vaccinated at Maricopa County's immunization clinics already were covered by private insurance that would normally allow them to be inoculated at a private physician's office. That is up from about 3.5 percent in 2009.
Parents in counties that do not have immunization clinics are driving up to two hours to other counties for vaccinations.
"We need to fix it somehow, because I need these private doctors in business giving vaccines, because I can't possibly do it for the whole community," said Dr. Bob England, Maricopa County's public-health director.
"If we try to do it for the whole community through public health, we're going to wind up screwing the health-care system's ability to provide ongoing, preventive care in other ways."
Dr. Amy Shoptaugh, a Tempe pediatrician, said increasing dependence on public-health clinics is not a long-term solution.
It burdens the public-health system and does not give patients an opportunity to learn about other aspects of preventive care.
"Vaccines are also a way ... to educate parents at the same time, as well as give something that's extremely important to the public in general," Shoptaugh said.
But vaccinating is expensive. Local pediatricians and family-medicine doctors estimate 44 percent of their vaccine costs are tied to expenses unrelated to administering the shots — things like stocking, record-keeping, inventory and overhead costs.
For private doctors to sustain the business model, insurance reimbursements need to be about 120 percent of the cost of the vaccine itself.
Yet insurance-reimbursement rates are not catching up to increasing vaccine costs. Public-health clinics and private doctors continue to see lag times of six to 18 months in insurance payments.
From October 2012 to January 2013, it cost Maricopa County's public-health clinics $202,849.43 to administer vaccines to privately insured kids. By March 2013, private health plans had reimbursed the county just half of that cost, or $102,457.66.
A concern among parents is the number of times children are poked to get the required vaccines for school. To address that, manufacturers are coming up with vaccine combinations to reduce the number of shots. But those new medication combinations are expensive, and doctors end up losing money.
That has led some providers to offer individual vaccines so they can charge insurers more administrative fees. Giving 10 individual shots costs less than five combination shots.
Dr. Andrew Carroll, a Chandler family physician, chooses to administer combination vaccines, considered safer and less painful for kids. Insurance companies take six to 12 months to reimburse him at higher rates that come with new medications. During that time, "it's going to be a money loser," he said.
"We're going to lose money because vaccine companies continue to increase their prices — it doesn't go down, it rarely goes down — on a regular basis."
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