Vaccine Practice Payment Schedules Create Perverse Incentives for Unnecessary Medical Procedures – at What Cost to Patients?

Authors

  • James Lyons-Weiler The Institute for Pure and Applied Knowledge, Pittsburgh, PA
  • Paul Thomas Integrative Pediatrics, Portland, OR USA

Keywords:

California SB277, CDC vaccination schedule, Common Federal Policy 745, insurance payment schedules, pediatric practice survival, perverse incentives, pharmaceutical lobbyists, protection of human subjects, quantity versus quality in health care, voluntary informed consent, vaccine profits

Abstract

No published assessment of revenue variation associated with variance in pediatric vaccine uptake exists. Using data from patients in a pediatric practice that provides full-service with informed consent, we provide a detailed analysis of the financial realities of respecting informed consent and allowing parents to exercise their legal right to refuse some or all pediatric vaccines. The data from a 30-day period of billing were tracked and analyzed via superbills, noting vaccines that were ordered and those that were refused. Considering that other practice income covered all operating expenses; these numbers reflect actual profits (from vaccines given) and losses (from vaccines refused). Patients in the practice exhibited increased refusal of some or all vaccines over a period of approximately ten years.  These real-world data show losses would exceed one million US dollars for a practice that bills out just over 3 million (gross revenue). With pediatric administrative overhead running 60–80%, it becomes clear that the financial incentives to vaccinate are now a matter of survival for pediatric practices.

Author Biographies

James Lyons-Weiler, The Institute for Pure and Applied Knowledge, Pittsburgh, PA

The Institute for Pure and Applied Knowledge, Pittsburgh, PA USA

Paul Thomas, Integrative Pediatrics, Portland, OR USA

Integrative Pediatrics, Portland, OR USA

cover for issue 2 of volume 1 of IJVTPR

Published

2021-03-31