|
Vaccinate for the Health of Your Patients…and Your Practice
(Source: Dr. Todd Wolynn, medical director, Atlantic Health Partners)
The adolescent: gawky, Internet savvy, likely suffering with acne and at risk for vaccine- preventable disease. The family physician: clinically astute, over-worked, adapting to the practice of electronic health records (EHR) and adept at providing immunizations.
A match made in heaven? Well, if you can improve patient care with vaccinations AND the financial performance of your practice then, hello pearly gates!
As you are aware, there has been a significant increase of recommended adolescent vaccines. Physicians can do the right thing in regard to their patients’ health and public health in a fiscally and operationally responsible manner. Adolescents represent a significant new challenge (and opportunity) to us as but they are less likely to comply with regular follow-up and repeated vaccine series compared to infants (who do not protest and evade as effectively). Additionally, new vaccines and new schedules put a significant strain on our already overstretched office staff and resources, primarily in the form of time and money.
Unless we and our staff truly understand why a particular vaccine is important, we are less likely to be effective in preventing the targeted disease. Let us focus on Pertussis and Meningitis protection.
Why Vaccinate Adolescents and Adults for Pertussis?
For decades we purposefully immunized children 2 months-5 years against Pertussis and purposefully used non-Pertussis containing “tetanus boosters” to immunize adolescents and adults. What has changed? Multiple studies dispelled commonly held myths:
- Pertussis is not that common
- Adolescents and adults have lifelong immunity to Pertussis if they received Pertussis immunizations in childhood
- Even if an adolescent or adult gets Pertussis they only develop mild symptoms
- It is not worth the resources to immunize adolescents
Over the past two decades, there has been a large and rapidly increasing number of reported cased of Pertussis cases, particularly in the past couple of years. An estimate from J.D.Cherry (Pediatrics, 2005;115:1422-1427) indicates 800,000 to 3.3 million cases of adolescent and adult Pertussis each year in the United States.
Adolescent and adult Pertussis is NOT benign. A study in Quebec De Serres G, Shadmani R, Duval B, et al. Morbidity of pertussis in adolescents and adults. J Infect Dis. 2000;182:174-179 evaluated 664 adolescents and adults with confirmed Pertussis and found that the cough lasted at least three weeks in nearly 100 percent of patients, and in half the cough persisted for nine weeks or more. Paroxysmal cough occurred in three-fourths of these adolescents and adults, whoop in about two-thirds, and post-tussive emesis also in about two-thirds. Teens typically missed a week of school and adults missed seven days of work, and most suffered extensive disruption to their normal sleep pattern. Additionally, in the Quebec study, 16 percent of adolescents and 28 percent of adults had some type of complication. One of the more serious complications was pneumonia (particularly in somewhat older patients). For patients younger than 50, about 2 percent were hospitalized for a mean stay of three days. For those 50 and older, about 6 percent were hospitalized with a mean stay of 17 days.
The high risk of death and morbidity for infants with Pertussis is a driving factor in the push to immunize adolescents and adults. Infants who suffer through a Pertussis infection face significant rates of hospitalization, pneumonia, seizures, encephalopathy and even death. The piece that ties this all together is the realization of just exactly who is giving the babies Pertussis in the first place. Bisgard KM, Pascual FB, Ehresmann KR, et al. Infant pertussis: Who was the source? Pediatr Infect Dis J. 2004;23:985-989 showed that the clear majority of transmission is from adolescents at 20 percent and adults at 56 percent of the time. So, adults are primarily the ones who give Pertussis to vulnerable infants.
Interestingly, mothers are often sited as a common source for exposure to the infant. This is part of the reason that some maternity hospitals have chosen to offer and provide Adacel (sanofi pasture’s Tdap) prior to mom’s discharge appointment. While there are two Tdap vaccines on the market, only Adacel has the broad range of 11-64 year olds making this an excellent choice for family physicians, as well as pediatricians, internists and OB/GYNs.
Vaccinating Against Meningitis
A more obvious life-threatening, vaccine-preventable disease is caused by Neisseria Meningitidis. As a result of the successful implementations of Hib and Pneumococcus (PCV7) vaccines, the most prevalent cause of bacterial Meningitis is now Neisseria Meningitidis. This bacterium causes devastating disease which can be initially difficult to diagnose and progresses so rapidly that prevention is paramount to avoiding its complications. Beyond death, severe neurologic sequale and gangrene with amputations is a very real risk. We are all aware that this is yet one more vaccine that has been crammed into the early adolescent schedule but this one is a “no brainer.” Sanofi pasture’s Menactra is effective and well tolerated in protecting children and is approved from age 11 – 55.
So, remember at the beginning of this article I mentioned doing the right thing? Hopefully, the preceding helped address the clinical pieces; but, just as important to your practice is the ability to provide these vaccines and realize an appropriate margin. Adolescents are difficult to track down, but due to mandatory vaccine(s) for these older children you have a chance to incorporate them into a regular process.
Review charts and vaccine records for immunization compliance at all visits. Call families with adolescents behind on their immunizations. Use the opportunity to consider Hepatitis A vaccine and human papillomavirus (HPV) for girls. In this fashion, you will also be able to provide recommended well-visits to your adolescent patients – thereby improving patient care and your practice’s financial performance.
However, to achieve acceptable financial results you must not make the mistake of ordering vaccines at inflated prices. Paying list price for these vaccines or obtaining them via a supplier/distributor (great for medical supplies but typically expensive for vaccines) is almost never a good idea; furthermore, the vast majority of hospital group contracts (GPO) typically provide no or minimal vaccine discounts. The best prices for the Adacel and Menactra vaccines can be obtained through a physician buying group. Whether you affiliate with Atlantic Health Partners (AHP) and OAFP or another program, these contracts are seamless in that you continue to order directly from the manufacturer and have the support of your local sanofi pasteur representative (with respect to Adacel and Menactra).
While we are not always completely satisfied with managed care vaccine reimbursement, you can certainly improve your margins by lowering your vaccine costs. In general, practices participating in a purchasing program such as AHP can expect Adacel and Menactra margins of 20-30 percent and 10–20 percent respectively, along with the additional payment for administration. Needless to say, by realizing an appropriate vaccine margin you can more confidently provide these products and help stop preventable disease.
If you would like more information about AHP, please contact Jeff Winokur or call 800.741.2044. If you would like to discuss or review clinical aspects of these vaccines, please contact Todd Wolynn.
|
