Healthcare News & Insights

athenahealth: Docs under-reimbursed for vaccines in nearly half of cases

Vaccinations can be a big expense for doctors with a low return on investment. And, according to a recent report, the problem has only gotten worse recently.

athenahealth, a provider of practice management and EHR software, recently launched its new VaccineView program, which analyzes the cost of providing vaccines for pediatricians and how much they’re reimbursed by payers.

The results of the study, which looked at 158,983 charge lines submitted from January 2009 through December 2010: When the total costs of providing a vaccine are taken into account, doctors are reimbursed less than what they payed 47% of the time.

In addition to the actual price of the vaccine, that total cost includes:

  1. Personnel costs for ordering and inventory
  2. Storage costs
  3. Insurance against the loss of the vaccine
  4. Costs associated with inventory shrinkage and nonpayment, and
  5. Lost opportunities for doctors.

When only the vaccine price is considered, athenahealth found just a 4% underpayment rate, but the costs of those other items can be significant.

In fact, the losses incurred by providing vaccines has convinced some physicians to avoid offering them altogether, instead directing patients to public health clinics, where follow-ups are much less common.

To help fix the problem, athenahealth will continue to analyze the data through its VaccineView program in order to create greater transparency in the vaccine reimbursement process.

In the meantime, athenahealth also offers practices these tips for saving on the costs of vaccines:

  1. Order vaccines in smaller quantities more frequently, to avoid waste
  2. Use electronic health records to make processes more efficient
  3. Be sure all bills for vaccines are paid on time, and
  4. Take advantage of special offers made by vaccine manufacturers.

To read more, download athenahealth’s report here.

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