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

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.