BALTIMORE — One in five pediatricians surveyed said that inadequate reimbursement prevents them from using combination vaccines in their practices.
The finding, from a nationwide survey of 630 pediatricians, was presented by Dr. Courtney Gidengil at the annual meeting of the Pediatric Academic Societies.
New combination vaccines reduce the number of injections required to complete the childhood immunization series, and may increase immunization coverage. However, pediatricians typically receive lower reimbursement for administering combination vaccines because fees are tied to the number of injections given, said Dr. Gidengil of Harvard Medical School, Boston.
Surveys containing 15 questions about the use of combination vaccines, benefits of combination vaccines, and vaccine reimbursement were mailed to a random sample of 1,045 pediatricians from the American Medical Association master file.
The 70% who responded did not differ from the nonresponders on any measured practice parameter: Just over half were from small practices (1–5 clinicians), a third worked in medium-sized practices (6–20 practitioners), and only 11% worked with 19 or more other clinicians. Almost half of the practices were single specialty, a third were solo or two-physician practices, and 23% were multispecialty or other types of practices. In 52%, more than 20% of patients had public health insurance.
Most of the practices (86%) participated in the Vaccines for Children (VFC) program. The vaccine financing policies of the states where the responding pediatricians practiced were 47% VFC-eligible children only, 4% with universal coverage, and 49% with coverage between those two extremes (VFC eligibles and some additional underinsured groups of children).
A majority of respondents (70%) reported currently using Pediarix, while smaller proportions used other combination vaccines including Pentacel, Comvax, TriHIBit, and Kinrix, although many said they were planning to use the two newer combinations Pentacel and Kinrix.
Less than half of the respondents agreed or strongly agreed that the practice was adequately reimbursed for the cost of vaccines in general (42%), for administration of vaccines in general (40%), or for the cost of combination vaccines (40%) or the administration of combination vaccines (39%). Inadequate reimbursement for the cost of vaccines and for the administration fees were cited by 23% and 20% of the pediatricians, respectively, as preventing them from using combination vaccines (defined as use of Pediarix or Pentacel).
Pediatricians from practices that participated in the VFC program were significantly more likely to use combination vaccines (81% vs. 61%) than were those who said they were adequately reimbursed for vaccine cost and administration (90% vs. 76%). Respondents from single-specialty, solo, or two-physician practices were somewhat more likely to use combination vaccines than were those from multispecialty or other types of practices, Dr. Gidengil said.
In a multivariate analysis, significant negative predictors of combination vaccine use were working in smaller practices, working in practices with a high proportion of privately insured patients, practicing in states with less-inclusive vaccine financing policies (ranging from VFC only to universal coverage, with intermediate levels in between), and responding “no” to being adequately reimbursed for vaccine cost and administration.
This study was funded by grants from the Centers for Disease Control and Prevention, and the Agency for Healthcare Research and Quality (for Dr. Gidengil's time). She stated that she had no financial disclosures regarding this study.