Monday, July 25, 2016

Pediatricians Paid to Vaccinate: Another Myth Easily Debunked

"Vaccines are big money-makers for pediatricians".

I see this myth all the time in the anti-vaccine world - a world with a very limited arsenal of anti-vax weapons.  Do we make a lot of money off vaccines?  Not only can I, as a pediatrician in private practice (only 2 providers) who buys shipments of vaccines monthly to the tune of $15,000 - $20,000 every month, attest to the fact that we don't always get paid back in full for the vaccines we buy and give, but multiple studies have also concluded that what we experience in my practice is reflective of most pediatric practices.

Vaccinations Can Be Money-Losers For Doctors
"After looking at what insurers paid more than 1,400 doctors for eight different vaccines, athena health concluded that almost half the time the payments weren't large enough to cover estimated costs."

Net financial gain or loss from vaccination in pediatric medical practices
"CONCLUSIONS:  We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money."
Cost of Vaccine Administration Among Pediatric Practices
"CONCLUSION: This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and health plans."

I guess when you still try to cling to the claim that pediatricians are well paid to vaccinate and it keeps getting disproven, you have to find SOMETHING that validates your claims.  So the most recent myth being circulated around the anti-vax world is an AV spin on a single kernel of truth.

The 2016 Blue Cross Blue Shield Incentive Program Booklet is a real document.  Just as real is page 15 which clearly shows that if 63% of a practice's children under the age of 2 meet all of their combination 10 criteria, or are "fully vaccinated", the payout is $400 per patient.

An example of the claims about this program was posted to the Wellness and Equality website in an article entitled:  "How Much Money Do Pediatricians Really Make From Vaccines?"

It didn't take long for someone to come up with a meme to twist this information further to the benefit of anti-vaxers.

As one of the anti-vaccine devotees who posted this very picture stated:  "Basic, very basic research can do wonders to combat indoctrination."

Let's examine the problems with this twisted claim that conveniently leaves out some key points:

(1)  This "bonus" money doesn't just come out of thin air and certainly isn't out of the generosity of the insurers. The "pool" of money that this "bonus" comes from is collected from the providers!  In other words, BC/BS keeps a certain percentage of what they owe the doctor in payment and put it into an incentive pool.  Pediatricians earn back their OWN money for meeting goals and are penalized for not meeting goals.

Guidelines for the physician group incentive program (PGIP)

"How we fund the PGIP reward pool

The PGIP Allocation is used to fund the PGIP reward pool.
It is a percentage of the applicable fee schedule on most professional paid claims.
All BCBSM participating providers agree by contract to make an allocation from their reimbursement into the PGIP reward pool."

(2)  The calculations are inflated as pediatricians are not likely to only have Blue Cross Blue Shield patients.  Any pediatric practice would prefer to have a bigger payer mix than just a single insurer.

(3)  It's deceiving that the picture provided doesn't clearly show that this is Blue Cross Blue Shield Commercial Insurance of MICHIGAN and would only apply to those pediatricians who are in network with BCBS Commercial in that state.  Generalizing this incentive scheme to ALL pediatricians is also deceiving.

(4)  Any money awarded from the PGIP reward pool does not go directly to the doctor.  The incentive reward is given to the participating organization and it's the organization that decides what to do with the money.

So what happens when this very information is posted to dispel these myths?  Censorship, of course.  I tried 3 times to provide this information as a reply on the Wellness and Equality website.  I replied briefly to someone else's comment and when the reply I received in return was blatantly inaccurate and I tried to reply again, my comment was not posted.

Not surprisingly, the same happened to my comment on the Cutler Integrative Medicine Facebook page.  

Not only was my comment deleted, but I was banned from posting.  Hmmmm......I guess he assumed I was also going to leave a 1 star review since he seems to be very concerned about his rating.  Oh wait, maybe it's because he couldn't counter the truth and wasn't willing to actually admit that he was wrong.

So, again, anti-vaxers demonstrate how inconvenient the truth is.  Sadly, combating indoctrination  with "basic research" doesn't actually work.


Anonymous said...

If the info I have read here is accurate, than someone upline from physicians is manipulating the system by taking physicians money and only giving back if the physicians follow there rules, which by my standards is still wrong and a way to force their agenda on the physicians and further down to the patient.

krishna said...
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