Financial impact to providers using pediatric combination vaccines

Angela K. Shen, Elizabeth Sobczyk, Lone Simonsen, Farid Khan, Allahna Esber, Margie C. Andreae

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger. METHODS: Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study. RESULTS: Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1:1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received $23 less from commercial payers and $13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for agespecific Current Procedural Terminology IA codes 90465 and 90466 than for non-age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid. CONCLUSIONS: Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines.

Original languageEnglish (US)
Pages (from-to)1087-1093
Number of pages7
JournalPediatrics
Volume128
Issue number6
DOIs
StatePublished - Dec 2011
Externally publishedYes

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Combined Vaccines
Vaccines
Pediatrics
Immunization
Medicaid
Prussia
Fee Schedules
Current Procedural Terminology
Physicians' Offices
Private Practice
Managed Care Programs
Contracts
Insurance
Economics
Vaccine

Keywords

  • Combination vaccine
  • Commercial insurer
  • Immunization administration
  • Medicaid
  • Vaccine financing

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Arts and Humanities (miscellaneous)

Cite this

Shen, A. K., Sobczyk, E., Simonsen, L., Khan, F., Esber, A., & Andreae, M. C. (2011). Financial impact to providers using pediatric combination vaccines. Pediatrics, 128(6), 1087-1093. https://doi.org/10.1542/peds.2011-0025

Financial impact to providers using pediatric combination vaccines. / Shen, Angela K.; Sobczyk, Elizabeth; Simonsen, Lone; Khan, Farid; Esber, Allahna; Andreae, Margie C.

In: Pediatrics, Vol. 128, No. 6, 12.2011, p. 1087-1093.

Research output: Contribution to journalArticle

Shen, AK, Sobczyk, E, Simonsen, L, Khan, F, Esber, A & Andreae, MC 2011, 'Financial impact to providers using pediatric combination vaccines', Pediatrics, vol. 128, no. 6, pp. 1087-1093. https://doi.org/10.1542/peds.2011-0025
Shen AK, Sobczyk E, Simonsen L, Khan F, Esber A, Andreae MC. Financial impact to providers using pediatric combination vaccines. Pediatrics. 2011 Dec;128(6):1087-1093. https://doi.org/10.1542/peds.2011-0025
Shen, Angela K. ; Sobczyk, Elizabeth ; Simonsen, Lone ; Khan, Farid ; Esber, Allahna ; Andreae, Margie C. / Financial impact to providers using pediatric combination vaccines. In: Pediatrics. 2011 ; Vol. 128, No. 6. pp. 1087-1093.
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