Managing Costs

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Managing Costs​​​

​​​Updated April 2018

While there are many costs associated with purchasing and administering vaccines, there are ways for pediatric offices to manage these costs in order to cover overhead.

Purchasing Vaccines
  1. There are multiple ways to order vaccines for your practice. It is vital to understand the pros and cons of each to ensure your practice remains financially viable . Standard programs: Direct purchasing access is offered by all major vaccine manufacturers.
    Pros: Easy access, prompt pay discounts, online order discounts, and promotional sales.
    Cons: Large fluctuations in pricing depending on market competitiveness, lack of discounted pricing due to lower volume being purchased by individual practices.​

  2. Physician buying groups: These offer access to 1 or 2 major vaccine manufacturers. Competing vaccine companies will not be in a physician buying group (PBG) together. (Sanofi and GlaxoSmithKline will not be part of the same group, because they offer similar vaccines).
    Pros: Lower cost than purchasing as an individual, due to group pricing discounts; all the "pros" listed for standard programs; potential rebates (depending on the manufacturer with whom the PBG is contracted).
    Cons: The limited ability to purchase vaccines from manufacturers that are not part of the PBG contract, the potential for being dismissed from the PBG if terms of membership aren't met or honored.

  3. Group purchasing o​​rganizations: These are typically operated by hospital-affiliated purchasing groups.
    Pros: Purchases are not limited to certain vaccine manufacturers or products.
    Cons: Pricing models are not as favorable as in PBGs. ​

Vaccine Administration

There may be ways to manage the costs of vaccine administration.

  • Choosing Staff to Immunize
    Each state has its own rules as to who is qualified to administer immunizations and it is important to be familiar with those regulations. RN's and LPN's, MA's, and, in some offices, the physician or mid-level practiti​oner will administer them. That individual will need to evaluate the appropriate written order, carefully draw up the vaccines with sterile technique, document the administration in the paper or electronic he​alth record, and provide the caretaker with the opportunity to record the vaccine in a personal record or identified on billing stat​ement (visit the vaccine administration​  page for more information).  Most practices have found that validation by a second staff person increases quality and billing accuracy.  ​​​

    All providers must be properly trained and familiar with the potential side effects from each of the vaccines. Most group practices have found that medical assistants are the most cost effective providers to administer vaccines. Registered nurses are best utilized to sup​​ervise other employees, provide medical triage, and to give medical advice. Generally, the employee who is able to perform the work at the lowest price should. For example, do not use a pediatrician when an RN is just as able to do the work.

    Optimum vaccine administration will be achieved when all necessary immunizations are ordered and discussed by the physician, administ​​ered by an efficient medical assistant, and documented and billed at an appropriate vaccine cost and administrative fee.

  • Maximize Opportunities

    Vaccines should be administered according to the joint guidelines developed by the Advisory Committee on Immunization​​ Practices  (ACIP) and AAP. It is important to note that well visits are the usual occasion to provide appropriate immunizations, but that any office encounter provides an opportunity to update a child's protection. Ordinary sick visits should not be a "missed opportunity" for vaccination. Office staff may check for missing immunizations when making appointments or triaging the patient in the office.​

    A general busine​​​ss principle to follow is that the more one can accomplish at a single visit, and the more one can charge, achieves better compliance with pay for performance and achieves fewer visits that ultimately decrease office overhead.

  • Utilizing combination vaccines with appropriate coding

    Using combination vaccines, and coding the appropriate vaccine administration fee for each component of the vaccine, allows practitio​ners to provide combination vaccines without a financial loss compared to vaccinating with individual doses. Visit the coding page for more information.​

Deciding on a Group:

Below are some questions to ask when deciding whether a specific PBG or GPO is right for you:

  • Which manufacturer(s) are included in the program? Under what circumstances can I purchase outside the plan (eg, if one manufacturer has a recall or shortage)? What are the purchasing compliance requirements?
    • On the basis of this contract, how will our usual vaccine routine be affected? Will we need to administer different vaccines (eg, Pediarix vs Pentacel)? How will this affect office education or nurses' time?
    • If we have to change our routine, will the change be worth it? Will another option with similar pricing allow us to continue ordering what we currently use?​
  • Is there a cost to participate? What is the length of the contract commitment? Does this plan provide rebates to its participants?
  • Is pricing tied to volume? Do all participants in the purchasing group have the same terms?
    • How do these discounts compare with our pricing?
    • Does placing large- or small-volume orders allow us to receive the optimal discount?
    • How frequently are we permitted to order? What is the process to order vaccines (online, calling)? Is a code needed to order online? Is there an administrator to call for the purchasing group? Is pricing tied to volume?
    • Do all participants in the purchasing group have the same terms?
    • Will additional manufacturer discounts apply through this program (eg, promotions, prompt pay discounts)?
    • Will we reduce our practice's time and resources, spent on ordering vaccines, so maximum discounts will still be achieved? Will the program eliminate the need to order strategically to achieve best pricing?
  • What customer service resources are in place to answer our questions and provide assistance? How long has the purchasing group been in business? How many physicians does the purchasing group represent? (You can also ask your manufacturer representative, if you have one, for their views of the purchasing group.) 
  • Are there geographic limitations to participation?
  • What value-added services (eg, payment support) does the purchasing group provide?

Physicians have reported working with the following buying groups or group purchasing organizations in the past:

Table 1. Physician Buying Groups and Group Purchasing Organizations

 Resources

 The Latest on Immunizations

​​
Grou​p​ Name Items included in Group Membership/Fee Requirements Contact Information
AAP Affinity Program - Child Health Advantage Vaccines
Clinical supplies
Pharmacueticals
Business services
AAP Member. Membership Coordinator
advantage@childrenshospital.org
913-262-1436
www.childhealthadvantage.com
Atlantic Health Partners

Vaccines
Office Supplies
Medical Supplies
Patient Recall Program
Discounts for Vaccine Refrigerator/ Freezers

None.​ Jeff Winokur
jwinokur@atlantichealthpartners.com
800-741-2044
www.atlantichealth​partners.com
CASA Physicians Alliance Vaccines
Medical and Surgical Supplies
Office Supplies
Rebate Program
No fees. 
Physicians and physician groups in the United States may participate.​

Andi Dixon or Shari Smith info@casaalliance.net 
866-434-9974
www.casaalliance.net

CCPA Purchasing Partners Vaccines, Medical Supplies, Computer Hardware, Commercial Tenant Representation, Document Storage/Scanning/Shredding, Electronic Payment Services, Insurance Brokerage, IT Support, Medical Waste Disposal, Office Equipment/Supplies/Furniture, Payroll Services, Temporary Staffing

None

Nationwide

Administrative Award for Members

Paresh Patel
papatel@ccpapp.org​
312-227-7436​
www.ccpapp.org​
Children's National Health Network (CNHN) Vaccines
Office Supplies
Medical Supplies
No fees. Must be a member of CNHN to access contracts, programs, & services. Donnita Pickett 
dpickett@childrensnational.org
202-476-2727
http://www.childrensnational.org
Children's Practicing Pediatricians, (CPP) Vaccines
Rebates
Office Supplies
Medical Supplies
Vaccine Storage
Vaccine Management
Consultation
No fees Children's Practicing Pediatricians, Inc.
cpp@nationwidechildrens.org
614-722-2145
www.cppdocs.org

Jennifer Koerner, Administrator 
Jennifer.Koerner@nationwidechildrens.org​
Cumberland Pediatric Foundation Vaccines
Medical Supplies
No fees.
May be required to maintain certain benchmarks
Practices must give 30 day notice to opt out of  agreement.
Lora Harnack
lora.a.harnack@vanderbilt.edu
615-936-6053
www.cumberlandpediatric.org
Fair Advantage Consortium Vaccines
Medical Supplies
  Robin Riggs
rriggs@fairadvantage.com
256-265-2464
www.fairadvantageconsortium.com
Integrated Physician Solutions (IPS)

Vaccines
Office Supplies
Medical Supplies
Malpractice Insurance

No fees. Lynne Sherman
lsherman@ips-usa.com
678-832-1824
http://vaccines.ips-usa.com
Kelson Vaccines Unknown. 866-820-4898
http://www.kelsoncorp.com/vaccine.php
Main Street Vaccines

Vaccines
Medical Supplies
Surgical Supplies
Vaccine Refrigerators
Rebates

No fees.

Allen Menkin, MD, MS, FAAP President
drmenkin@mainstreetvacs.com

Kate Beggerow, Administrator
administrator@mainstreetvacs.com
(888) HUB-MAINSTREET
(888)482-6246
http://www.mainstreetvacs.com/

Medical Practice Purchasing Group (MPPG)

Vaccines
Office Supplies
Medical Supplies
20
more Contracts

No fees.​
Loyalty payments for members in good standing.

Brian K. Greenberg, MD, FAAP
818-332-7057

Leslie Fuchs 
leslief@mppg.net
714-469-5296
www.mppg.net

National Physician Care Vaccines 
Medical Supplies 
Office Administrative Services              
CHADIS
Internet and Phone Service
Private practice physicians and clinics. 
No fees for private practice physicians.
Richard Miles
RLMiles@nationalphysiciancare.com
877-598-3286
www.nationalphysiciancare.com
National Discount Vaccine Alliance Vaccines
Office Supplies
Medical Supplies
No fees.
Loyalty Pricing
Any physician or physician group can be members​​
Kathleen Cain, MD, FAAP
kcain@nationaldiscountvacinealliance.com

www.nationaldiscountvaccinealliance.com
Northampton Area Pediatrics Vaccines
Office Supplies
Medical Supplies
AAP membership. Cindy Mayo
cmayo@napeds.com
413-584-8700
www.napeds.com
Pediatric Alliance Vaccines Medical Supplies

No membership fee.Virginia

Dr Richard Grossberg
rgrossberg@pediatric-alliance.com
Richard Lander
rlempg@gmail.com

www.pediatric-alliance.com

PracticeWell  formerly Pediatric Federation
Vaccines
Medical and Surgical Supplies
Office Supplies
MSO Services
PhotoScreening
Credit Card & Health Payment Solutions
Refrigeration & Temperature Monitoring
Medical Waste Disposal
Additional Contracts Available
No Fees   Nationwide

Community Focused

Open to private practices, health
systems, academic practices,
integrated delivery networks, IPAs,
community health systems,
supergroups, and more.
Alan Johnson, M.D. FAAP
President


Joey Chebib
Director, Member Management
415-963-4444 x 84

Peds Pal Vaccines
Office Supplies
Medical Supplies
None. pedspal@cookchildrens.org
877-923-2233
http://www.pedspal.org/contact.html  
Physicians' Alliance of America, Inc.

Vaccines
Vaccines Rebate Program
IUDs
Pharmaceuticals
Malpractice Insurance
Office Supplies
Medical Waste Removal 

No membership fees.

Private practices of all sizes and specialties in the United States are eligible. 
Heather McKelton
info@physall.com
1-866-348-9780
www.physiciansalliance.com
Primary Care Alliance Vaccines
Medical Supplies
Any physician or physician group in the United States may participate. No fees Amy Dahl
adahl@primarycarealliance.com
866-470-0090
www.primarycarealliance.com

River Valley Pediatricians, Inc. (RVPI)

 

Vaccines
Office Supplies
Medical Supplies
Annual fee.
Must be community-based physician in the metropolitan area of Cincinnati, OH.
Ed Freeman
edward@rvpi.com
513-475-6084
www.rvpi.com
Southern California Children's Health Network Vaccines No fees

Robert Kaplan
rrkaplan@ix.netcom.com
Angela Deanda
adeanda@isynermed.com
213-406-2711
​​www.isynermed.com

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