Pediatricians subsidize vaccinations that keep healthy children and prevent pandemics. They shouldn’t have to

My uncle looked exhausted when he told me one of his greatest challenges as a pediatrician – the one who had nothing to do with medical problems. “I spend about half a million per year on vaccines,” he said. “After all, it is said and done, I’m not even sure I even breaks on them.” After providing children’s care in Virginia for 25 years, my uncle described a financial trap that undermines the pediatricians of our country.

Vaccines regularly make headlines these days. But this broken financial model, in which the pediatricians Front The enormous costs and absorb an incredible risk just to inoculate their patients, is a silent threat to infant vaccination programs in the United States – and all children, families and communities that benefit from it.

An impossible burden

Vaccines are incredibly expensive. They represent the second expenditure for pediatric practices after the wages of the staff. Let’s start at the start: buy the vaccine. Each vaccine has a price that is not transparent: it depends on many factors, such as the loyalty of manufacturers and distributors, your scale as a practice, your ability to obtain the right contracts in the first place and the time of the year. These prices are constantly changing, so you always adapt.

Then, as a small independent practice, you must buy between $ 50,000 and $ 100,000 in a vaccine inventory per month. You must risk either having too much and taking too much cash flow and risk of inventory, or have too little and have to divert the patients. When you maintain your inventory, you need to follow the manufacturer’s batches, expiration dates and temperature in real time to make sure that patients receive safe and high quality vaccinations.

During all this time, you have to face the long documentation process. Different vaccines go to different patients, and sometimes it is not easy to determine who is who. In some cases, patients with the same exact insurance company will need a different vaccine depending on the plan in which they are. Once this is sorted, you must document the entire process – including the inventory that has been used – in your own files, while reporting information in the state. And these critical recordings which serve as proof of vaccination are often not transferred between states, or even between cities of a single state. So if the patient has recently moved, you have to find and enter everything from scratch.

Finally, you must make sure that the insurance companies reimburse you. Different insurance companies and different plans have different rules on how to subject complaints. Any minor problem can give you a denial that best delays the three -month process, and at worst is a radiation for the vaccine that you have already paid. And this is only the beginning. The obstacles are everywhere: newborns who do not yet have legally insurance, families with several insurance plans, recent job changes that affect insurance status, you call it. Even if everything is going well, insurance reimbursements can be lower than what you paid for the vaccine in the first place.

Rinse and repeat, more than 15 times a day, per doctor.

What is most revealing, however, is when you realize that no part of this ruthless system has something to do with medicine or science. It is the optimization of the supply chain, not pediatric medicine.

With that, it should not surprise that 36% of pediatricians have stopped or plan to stop offering vaccines completely Academic pediatrics. It is a particularly alarming figure given the list of important challenges that already weigh pediatricians. They constitute one of the categories of doctors who are the least well remunerated in the country. Their time is increasingly devoted to administrative work – on average 15 hours per week, compared to nine hours per week in 2012, according to the annual remuneration report of Meddscape doctors. Pediatricians spend hundreds of hours a week in the basis of care that prevents our health system from collapsing under the weight of avoidable diseases.

It is absurd that we ask the doctors responsible to prevent epidemics of measles and polio resurgences to subsidize these efforts from their own pockets. The Vaccines for Children program was instituted in 1994 to help solve this problem for Medicaid and not insured patients – but there, the process is more complex and the margins are even thinner.

Effects of dangerous undulations

This unsustainable model is particularly harmful given the disturbing national trends. Vaccination rates decrease, while vaccination hesitation is increasing. When I speak to pediatricians how to cope with the increase in parents of vaccine life, I hear the same thing at all levels: they need more time for education, advice and thoughtful checks with patients. However, each additional minute spent with a parent concerned can lead to a more in -depth practice. It is a vicious circle where everyone loses.

Is it worth asking: the reason why people have more questions than ever about vaccines because there is really more uncertainty than before? Or because the experts they ask simply don’t have time to answer in a thoughtful and carefully?

What I learned by working every day with pediatricians across the country is that most people in medicine do not naturally think of economic effects. And why should they? Pediatricians spend more than a decade learning to provide exceptional medical care, without studying the management of cash flows or optimization of insurance reimbursement.

A new path to follow

It should not be so. I saw what is possible when we get things correctly. Pediatricians are less congested, parents receive better advice, children get better care and communities remain protected. The technology and expertise necessary to solve this problem already exists – we just need the desire to implement solutions that throw the status quo and put the health of children first.

We can continue to ask pediatricians to subsidize the prevention of diseases from their own pockets, and to monitor the number of doctors who specialize in the care of children continue to fall while those who remain in practice suffer financially. Or we can build a system where doing the right thing for children’s health also has a financial meaning for their health care providers. The choice is ours. I know what future I work with.

Photo: Geber86, Getty Images

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