Do Doctors Have Financial Inentive to Get their Patients Fully Vaccinated?

[Taximom5]

According to Doctor Sears, many do:

http://www.askdrsears.com/topics/vaccines/do-doctors-have-financial-incentive-get-their-patients-fully-vaccinated

"I get a lot of emails from people who wonder if doctors have any sort of financial incentive to get their patients vaccinated. Do we get any sort of bonus from the insurance companies that pay us? I’ve always thought that the answer to this question was no. I recently found out otherwise.

Now, if you count the fact that part of the income for a doctor’s office comes from providing vaccines themselves, and the checkups that go along with the vaccines, you could argue that that’s a financial incentive. Yes, doctors’ offices do make a little money on vaccines. But I don’t really count that as an actual incentive to try to talk any patients into getting vaccines or as a reason to kick a patient out of a practice if they don’t vaccinate. I don’t think any doctor would kick someone out just because the doctor isn’t going to be able to make as much money on an individual patient who doesn’t get vaccines. 

But I recently talked with two physicians in different states that told me the HMO plans that they contract with do chart reviews and patient surveys at the end of each year. If their office scores high enough on these reviews, the HMO plan gives them a several thousand dollar bonus. This bonus varies depending on the number of patients the doctor sees. One of the requirements for a patient’s chart to pass the test is that they are fully vaccinated. "

[Admin note: Edited to remove copyright violation. Please post 100 words or less as an excerpt and link to the rest of the content.]

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[WildKingdom]

I'm not a pediatrician, and I don't get bonuses for vaccinating adults.  Medicare does collect data about vaccination in adults- it collects data on pneumovax and flu vaccination.  If you collect a certain amount of data you can get a bonus.  However, the bonus is given just for collecting the data, not based on what the results are- they don't care how many of your patients are vaccinated, they just want the data.

How much is this princely sum?  For me, it's about $50/month.  Which is less that the cost of the labor that goes into actually collecting the data.  

Hardly enough to get a Lexus.

For the record, I drive a 2004 Honda Accord with 98,000 miles on it.

[purslaine]

I am not so sure.

I don't think most doctors are in it (giving out vaccines) for the money.  I think they genuinely believe vaccines are a good idea (for a variety of reasons).  I disagree with them, but overall, I think their intentions are solid.

I am less generous to Big Pharma and the like.  They are not front line workers, they have not taken a Hippocratic oath to do no harm, and their reputation is profit over people.  Their bottom line is the bottom line.

[vforba]

The sad thing is that people think all these appointments are necessary and they are not. You do not need to go for every wellbaby check. They are typically just to get you in so you will vaccinate your children. Unless there are concerns about the child's development, there is no need to go. Therefore no need for unnecessary confrontation.

[RedSamhain]

How often do you all think a perfectly healthy baby who is not getting vaccinated should go for a checkup?  My 3 month old has been in 3 times, she's perfect and we're not vaccinating, our doctor seems a little bit lost as to when to schedule her checkups he just goes for the routine number of visits on the normal time schedule - which is set up for vaccination - has anyone else had this issue?

[pers]

Originally Posted by vforba 

The sad thing is that people think all these appointments are necessary and they are not. You do not need to go for every wellbaby check. They are typically just to get you in so you will vaccinate your children. Unless there are concerns about the child's development, there is no need to go. Therefore no need for unnecessary confrontation.

Well baby visits are also to keep an eye on a baby's growth and health during a child's fastest period of growth and the vulnerable time when they can't talk for themselves.  Doctors can listen to the heart and lungs, check the ears, etc. and have the training to spot small signs of things going wrong that parents can miss before they become serious enough to be obvious. 

In the part of Canada I live in, doctors don't give shots.  Kids get taken to community health centers, not attached to any particular doctors office, where nurses give shots. But yet babies still have pretty much the same well-baby schedule for seeing doctors as in the states.  It's pretty annoying actually, since it means twice as many appointments - I wish the doctors would just do them. 

[Marnica]

While I don't think it is a universal thing, yes some docs do receive financial incentives for maintaining certain numbers for certain procedures or treatment compliance for certain disorders. This would include immunization rates. Often the incentive is coming from private insurance companies and Medicaid and Medicare plans are also big ones.  It's called Pay-for performance (P4P)

http://www.leapfroggroup.org/compendium_dt_home/4692933

here is an example:

Hudson Health Plan, a Medicaid managed care plan in New York that distributes rewards for childhood immunization and effective management of patients with diabetes.

[wookumus]

Big Pharm spends as much on marketing, including what they lavish upon MD's, as they do on research.  They do it for a reason.  There was a landmark study recently showing the profound impact of marketing (i.e. gifts!!) on MD prescribing patterns.  Everyone was shocked because MD's thought they were smarter and more ethical than that.  Don't think this influences vaccination rates?  Don't kid yourself.  Once again...follow the money.  Big Pharma wouldn't spend billions if it didn't work.

[prosciencemum]

Here in the UK I'm pretty sure there's no financial incentive for vaccination, although they do track the take-up rates, since as I understand it that's important for those in the community who are unable to have the vaccines (very young babies, people allergic to ingredients in vaccines etc.)

Also relevant to the discussion here - we have a lot less well baby checks - we can take the babies to a health clinic as often as we like and they will refer to a doctor if they see a need. But doctors here rarely see healthy children (I had my first in the US and second here in the UK, so I have experience with both systems).  

[vforba]

I think it's important for the first year. But I don't think going in every few weeks is necessary. Sure growth and development are important, BUT how many times and how many of you had a dr tell you your child is growing too slow, too fast etc... Then have them be totally wrong because

A. it's genetic

B. it's because your bf'ing?

C. you have a large child and they grow quickly

D. your child is a picky eater or has a high metabolism?

I know with my last dd. I choose not to vax at all. I have 4 kids. And when my son at around  a year had a huge reg hot lump on his leg from a shot and my dd at age of about 8yrs old had a huge lump on her arm almost the size of a tennis ball then yes. I felt that this was completely unnecessary to vax anymore. My youngest the only real issues she had was when she was teething. I hate it when drs tell you they don't get fevers when they get teeth, they don't get infections or inflammation when they get teeth. I had it down to a science depending upon whether she was getting uppers or lowers in and whether it would be an ear or sinus infection starting when she was teething. And once they were all in no more infections. This was at about 9 mos to about 1yr of age.

She was getting her molars in.

And has anyone even thought about all the allergies? What is causing those. It's bad enough they use aborted fetus embryos and chicken embryos to create different vaccines, but I have also been told they used other things as well that have really increased, asthma, peanut allergies or tree nut allergies, egg allergies, gluten issues etc..

[katelove]

GP practices in Australia get immunisation incentive payments from Medicare. It's a pretty token amount though - $14/patient/year - and only for children under 7 years old who are fully vaccinated. The information document from Medicare says that it is linked to practices and not individual GPs because it is to help with costs associated with providing a vaccination program (reminder notices, cold chain maintenance etc). I doubt it is enough to make it worth GPs pushing vaccination just to get the money.

Also, a lot of people get their children's vaccination and well baby visits done by Child Health nurses at Community Health Centres because they don't have to pay for a GP visit that way. I've never personally known a GP to discourage this for any reason, even though it means they couldn't claim the incentive payment for that child.

[jartiff72]

Doctors do recieve financial incentives although I feel many Drs push for immunisation as they strongly believe in its benefits. But my concern is the information/ or lack of, that parents/carers recieve about immunisation. I feel that it may not always be unbiased so parents may be pressured into making a snap decision, not make an informed decision.

[nukuspot]

I personally don't vax but I do take my DD to all her well baby checks.  It's not just vax they are checking for, there are all sorts of developmental things they look for, and I honestly like getting to know our doctor and forming a relationship with her, and for DD to do the same as well.  Now if they were pressuring me to vax at each WBV I probably wouldn't feel the same.  But I made my position clear by scheduling a consultation even before the birth, and so they must have written it in her chart.  I've never been asked once about vax.  We've done physicals, eye exams, etc.  I think WBV/WCVs are useful for both vaxxing and non vaxxing parents alike.

And for the record, I don't personally think most doctors offer vaxxes for the kickbacks.  I think they (like many people) truly believe they are beneficial to their patients.

[Taximom5]

Originally Posted by nukuspot 

And for the record, I don't personally think most doctors offer vaxxes for the kickbacks.  I think they (like many people) truly believe they are beneficial to their patients.

I agree with you.  But I think that the kickbacks--along with the very strong "education" on the "necessity" of vaccines--play a role in how strongly a doctor might push for those vaccines.

[Rrrrrachel]

HMOs provide bonuses for vaccinating because it saves them a lot of money for kids to get vaccinated vs. catching the various diseases.  

[Serenity Now]

My BFF is a Pediatrician, and the clinic loses money on every vaccine. Medicare payouts for vaccines are very small compared to the actual costs, as are other insurance company payouts. I was told they lose on average $50 per vaccine, and that includes what they get reimbursed for the office visit. They only do it because they believe in it so much. Most of their money is made on regular sick visits, and not on WBV.

Also, I was told that new regulations keep drug companies from giving out anything anymore, even pens and paper. They will pay for a lunch if you attend their talk, but they can't give anything out. There are very strict rules about what drug companies are allowed to give doctors. There really are no kickbacks.

WildKingdom, it is interesting that you say that about your car. I've never known a general practitioner to drive anything but a beater, lol. They don't make much money at all. Cosmetic surgery is where all the money in medicine is, that and being a CEO for an insurance company.
 

[Rrrrrachel]

dammit.  The world just lost it's biggest source of free pens!

[JamieCatheryn]

Around here it seems like the CDC and medical community are really going after offices that take patients who aren't fully vaxxing, every pediatrician has started refusing these families only a couple of family practices within 100 miles accept them. I don't know what they can do to them but doctors here who were previously fully supportive of non or selective vaccination have switched sides and it looks like fear of something, not any sort of greed for rewards.

[purslaine]

nm - link was right at the top!

Edited by purslaine - 6/5/12 at 10:35am

[Rrrrrachel]

I'm interested in how widespread that practice really is, but I can't get a good fix on it.  I (unsurprisingly) read a variety of pro-science writer and blogs and they all pretty much universally say that doctors should NOT refuse to treat families that don't vaccinate.  Even Dr. Offit has said this.  I would be very surprised if there was pressure coming from the CDC or similar source to encourage doctors to deny treatment.