成人患者就诊的医疗机构中的疫苗筹资和计费：一项后续调查。
Vaccine financing and billing in practices serving adult patients: A follow-up survey.
机构信息
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, CO, USA; Division of General Internal Medicine, Denver Health, Denver, CO, USA.
出版信息
Vaccine. 2018 Feb 14;36(8):1093-1100. doi: 10.1016/j.vaccine.2018.01.015.
BACKGROUND
Financial concerns are often cited by physicians as a barrier to administering routinely recommended vaccines to adults. The purpose of this study was to assess perceived payments and profit from administering recommended adult vaccines and vaccine purchasing practices among general internal medicine (GIM) and family medicine (FM) practices in the United States.
METHODS
We conducted an interviewer-administered survey from January-June 2014 of practices stratified by specialty (FM or GIM), affiliation (standalone or ≥ 2 practice sites), and level of financial decision-making (independent or larger system level) in FM and GIM practices that responded to a previous survey on adult vaccine financing and provided contact information for follow-up. Practice personnel identified as knowledgeable about vaccine financing and billing responded to questions about payments relative to vaccine purchase price and payment for vaccine administration, perceived profit on vaccination, claim denial, and utilization of various purchasing strategies for private vaccine stocks. Survey items on payment and perceived profit were assessed for various public and private payer types. Descriptive statistics were calculated and responses compared by physician specialty, practice affiliation, and level of financial decision-making.
RESULTS
Of 242 practices approached, 43% (n = 104) completed the survey. Reported payment levels and perceived profit varied by payer type. Only for preferred provider organizations did a plurality of respondents report profiting on adult vaccination services. Over half of respondents reported losing money vaccinating adult Medicaid beneficiaries. One-quarter to one-third of respondents reported not knowing about Medicare Part D payment levels for vaccine purchase and vaccine administration, respectively. Few respondents reported negotiating with manufacturers or insurance plans on vaccine purchase prices or payments for vaccination.
CONCLUSIONS
Practices vaccinating adults may benefit from education and technical assistance related to vaccine financing and billing and greater use of purchasing strategies to decrease upfront vaccine cost.
背景
医师常将财务方面的考虑视为向成人常规推荐疫苗接种的障碍。本研究旨在评估美国普通内科（GIM）和家庭医学（FM）实践中，管理常规推荐成人疫苗接种的感知支付和利润，以及疫苗采购实践。
方法
我们于 2014 年 1 月至 6 月，对之前成人疫苗融资调查中回复过、且提供了后续联系方式的 FM 和 GIM 实践，根据专业（FM 或 GIM）、附属机构（独立或≥2 个实践地点）和财务决策权级别（独立或更大系统级别）进行分层，进行了采访者管理的调查。对疫苗融资和计费有一定了解的实践人员回答了与疫苗购买价格和疫苗接种管理相关的支付、接种疫苗的感知利润、拒付索赔以及私人疫苗库存各种采购策略的使用等问题。针对各种公共和私人付款人类型，对支付和感知利润的调查项目进行了评估。计算了描述性统计数据，并根据医生专业、实践附属机构和财务决策级别比较了响应。
结果
在 242 家接触的实践中，有 43%（n=104）完成了调查。报告的支付水平和感知利润因付款人类型而异。只有在首选提供商组织中，多数受访者报告在成人疫苗接种服务中获利。超过一半的受访者报告在为成年医疗补助受益接种疫苗时赔钱。四分之一到三分之一的受访者报告分别不了解医疗保险部分 D 对疫苗购买和疫苗接种管理的支付水平。很少有受访者报告在疫苗采购价格或接种疫苗的付款方面与制造商或保险公司进行谈判。
结论
为成人接种疫苗的实践可能受益于疫苗融资和计费方面的教育和技术援助，以及更多使用采购策略来降低疫苗的前期成本。
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