AskDrSears - The Vaccine Book: Do Doctors Have a Financial Incentive to Get Their Patients Fully Vaccinated?

Do Doctors Have a Financial Incentive to Get Their Patients Fully Vaccinated?

Friday, May 29, 2009

I get a lot of emails from people who wonder if doctors have any sort of financial incentive to get their patients vaccinated. Do we get any sort of bonus from the insurance companies that pay us? I’ve always thought that the answer to this question was no. I recently found out otherwise.

Now, if you count the fact that part of the income for a doctor’s office comes from providing vaccines themselves, and the checkups that go along with the vaccines, you could argue that that’s a financial incentive. Yes, doctors’ offices do make a little money on vaccines. But I don’t really count that as an actual incentive to try to talk any patients into getting vaccines or as a reason to kick a patient out of a practice if they don’t vaccinate. I don’t think any doctor would kick someone out just because the doctor isn’t going to be able to make as much money on an individual patient who doesn’t get vaccines.

But I recently talked with two physicians in different states that told me the HMO plans that they contract with do chart reviews and patient surveys at the end of each year. If their office scores high enough on these reviews, the HMO plan gives them a several thousand dollar bonus. This bonus varies depending on the number of patients the doctor sees. One of the requirements for a patient’s chart to pass the test is that they are fully vaccinated.

Now, I can somewhat understand the logic behind this. The insurance wants to make sure all their clients are fully vaccinated so they don’t catch any particularly severe disease that might result in an expensive hospitalization or disability that would cost the insurance company a lot of money. Oh, and they probably also care about their clients overall health and wellbeing too. So, why not give their doctors a bonus for meeting this goal?

Here’s why. This policy gives any doctor who contracts with such HMO plans an incentive to NOT want any unvaccinating families in their practice. Maybe a few such families wouldn’t make them fail the chart reviews, but if they have too many, there goes their year-end bonus. One colleague here in southern California told me that he happily gives up this bonus because he wants to serve these families. Good for him! But I bet that many doctor across the U.S. refuse care to these families solely because they don’t want to lose this bonus. They make so little from the HMO plan as it is that losing this bonus could make them actually lose money caring for these families. In fact, this bonus isn’t actually a bonus at all. It is actually money that should be paid to the practice anyway month by month, but it is held back until the year-end surveys are done. I don’t know of any PPO plans that do this, fortunately.

I’ve always wondered by so many doctors are so adamantly hardcore about demanding all their patients fully vaccinate, and why they kick patients out of their office who refuse. I’d always just assumed it was because the doctors felt that the vaccine protection was so important that they don’t want any children to be at risk, so they draw a line in the sand for the good of the child (in their minds). BUT some doctors, especially those large groups who rely heavily on large HMO contracts, may actually be doing this because of money. Do they have the right to do so? Of course. But is it right? I don’t know. The American Academy of Pediatrics Committee on Bioethics makes it very clear that the official AAP policy is that doctors NOT kick patients out of their office over this issue. But when money talks, some people don’t listen.

So, knowing this information doesn’t really help parents one way or another. But I thought you’d find it interesting to know why you might be having a hard time finding a vaccine-friendly doctor. If you’ve never checked out my vaccine-friendly doctors list, click here to find one near you (he’ll be the one driving the Honda instead of the Lexus).

38 Comments:

At May 31, 2009 8:13 AM , Science Mom said...

Dr. Bob, Do you have any resources about the scheme for HMOs to provide incentives? I am particularly curious as to what constitutes 'fully vaccinated' that would allow a patient to stay with a physician.
At May 31, 2009 2:56 PM , Dr. Bob said...

No I don't. I don't have any HMO contracts myself. But I believe that for a patient to qualify as meeting the criteria, he has to be FULLY vaccinated. It can be done on ANY schedule, but they all have to be up to date for the child's age.
At May 31, 2009 8:06 PM , Anonymous said...

We got kicked out of our ped's office for not vaccinating. I pretty much figured it had to do with money. Doesn't everything..
At May 31, 2009 10:25 PM , Anonymous said...

Dr Bob, Do you drive a Honda or a Lexus? :)
At May 31, 2009 11:47 PM , Catherina said...

Dr Sears - how many "thousands" of dollars are we talking about exactly? Enough for a new Lexus, or enough for a repair on the Honda? A friend of mine, who is a pedatrician in the US, actually makes a deficit on vaccinations, but gladly does so, because she wants children protected. You could interpret the end of year bonus as an incentive for providers to keep vaccinating although they are not netting much money from it, if any.

A written copy of such an incentive plan would be nice to see so we can form an informed decision.
At June 1, 2009 5:28 AM , AngelaW said...

Hmmm.....this might explain why our 1st pediatrician that we went to got such an attitude when I even QUESTIONED vaccines. I don't care what anyone says, in the end...it always comes down to money.
At June 1, 2009 2:44 PM , Dr. Bob said...

Catherina - one that I spoke with (the one that gives up the bonus) said 3 thousand. Another told me 5000. It was all based on percentages of patients. These were small offices. So, in a large 10-doctor office we would likely be talking tens of thousands.
I don't have any contracts to show you - these probably vary GREATLY by company - and most may not even have this in their contract.

I just raised the issue because I found out about it.
At June 1, 2009 3:47 PM , Dr. Bob said...

Catherina -
I also wanted to comment on how much money doctors make or don't make from vaccines. here's the deal:
We buy vaccines from the manufacturers. We administer them and bill insurance. Insurance pays us about 10 to 20 dollars MORE than what we paid for the vaccine, PLUS about a 10 dollar injection fee. So, the most a doctor makes on a shot above cost is about 30 bucks.

Here's where we can LOSE money though - some insurances pay us less - may 5 dollars more than we pay. So, less profit.

BUT when you factor in all the time spent ordering, preparing, and giving the shots (paying the nurse, etc), we probably don't end up making any profit on vaccines at all.

Do we actually LOSE money? No - here is why. We make money by doing the checkups themselves. If there weren't any vaccines to give, parents would probably come in for about half the checkups. We wouldn't make as much money then. So, although we don't make money from the vaccines, we do make more money BECAUSE of the vaccine schedule. That's how I see it anyway.

For your friend to say she LOSES money by vaccinating her patients . . . I'm not sure that's accurate. It definately may be true from SOME insurance plans that pay less, but this might be made up by other plans or people who pay cash prices.

Anyway, this is my perspective.
At June 1, 2009 7:59 PM , Science Mom said...

I don't think it is quite that simple: http://www.nytimes.com/2007/03/24/business/24vaccine.html?_r=3&oref=slogin
At June 1, 2009 8:01 PM , Alexis said...

The bonuses are not a new concept. The NHS pays GPs bonuses for meeting various targets. One of those targets is vaccination levels. There's been accusations of GPs striking patients off their lists for not vaccinating, though they aren't supposed to do that. I daresay that in London it doesn't happen much because levels on some jabs are so low--and if you're dropped by your GP and can't find a new one, the PCT will find one for you, so you'll end up back on someone's list anyhow.

That said, I don't think this is the main factor by a long shot. I think the targets mainly affect doctors who are close to the margin for getting the bonus, which is a small group.
At June 2, 2009 9:52 AM , Dr. Bob said...

Honda . . . Civic . . . 1998 - very nice green color
At June 2, 2009 9:56 AM , Dr. Bob said...

Science Mom - good article. This is DEFINATELY a problem with each new vaccine that comes out. New ones are way more expensive, and it can often take insurance companies up to a year to begin paying for new shots. So, many doctors won't give new shots until the insurance has started to pay. Many can lose money if they do give new shots.

However, once a shot is established and has been in use for a couple years, virtually all payment and reimbursement snags are worked out and a doctor would no longer actually LOSE money on a vaccine.
At June 4, 2009 8:34 AM , jessica moore said...

Thanks so much for keeping us informed, Dr. Sears. You really go above and beyond! : )
At June 7, 2009 10:48 PM , slm said...

I can't believe the guilt,pressure, and even some rudeness that some mothers, myself included, have endured for wanting to just DELAY a vaccine because of a bonus!?!
Sigh...
At June 8, 2009 12:52 PM , Sensory Solutions, Inc. said...

Thank you Dr. Sears for a sane, measured, rational look at vaccination. I was wondering what you thought of Generation Rescue's appearance on "The Doctors."

I think everyone has a right to informed consent, and to make the decision they feel is right for their child. No one should be guilted or forced into a medical decision without all the facts.
At June 9, 2009 8:35 AM , So Cal Kate said...

I love Dr. Bob's advice and all the Sears books! Thanks for verifying what I have suspected for a long time--there is a financial incentive for doctors! The amount is immaterial. The vaccine industry is there not only to protect people but for profit. My kids have had very few vaccines for this reason. People who get the flu shot containing mercury for their kids are either uninformed or crazy. I hope that people wake up and realize that every year there is a new vaccine typically for a fairly benign condition/disease and they are being manufactured for profit! If people would take the time to read the ingredients, the potential adverse side effects or to look at the VAERS website they would question but we have become a nation of sheep . . .
At June 9, 2009 9:04 PM , Dr. Bob said...

Sensory Solutions - I didn't see the episode, so I can't comment.

So Cal Kate - thanks! I will remind you though that not all doctors have this incentive. I don't think PPO's do this, and I doubt that ALL HMOs do it.
At June 10, 2009 8:44 AM , Joey Sorenson said...

Dr. Sears,

As a practicing pediatrician for the last 10 years who has found profit margins getting slimmer each year as insurance reimbursements drop and overhead rises, I find it disappointing that you are now reinforcing parent's beliefs that we get a "kick-back" from insurance companies for vaccinating children. As you stated in a previous answer, we do get paid for giving vaccines, but the cost of ordering, storing and administering vaccines almost always equals the reimbursement we receive. I know of no physician groups receiving incentives for vaccinating their patients. This practice is probably very limited and I think your article is disingenous at best - "I’ve always thought that the answer to this question was no. I recently found out otherwise." This statement opens your article and is clearly suggestive that all physician get a "kick-back". By the way, I drive a 1999 Camry (with many dents/dings, because all the pediatricians I know went into medicine to help their patients - not become rich off of them...)
At June 10, 2009 10:31 AM , Anonymous said...

According to the Johns Hopkins Vaccine Safety info at http://www.vaccinesafety.edu/thi-table.htm there are mercury-free flu shots available.
At June 10, 2009 2:38 PM , Anonymous said...

We are currently HMO patients in California. When we asked to modify the vaccine schedule for our newborn, our pediatrician told us that we couldn't use Dr. Sear's schedule because according to the HMO, he has to be fully vaccinated by age 2. However, he has been willing to space out the vaccines within those 2 years with shot-only visits. He said that the HMO would "penalize" him for having patients who weren't fully vaccinated. It didn't occur to us to ask what this penalty would be. After reading your post, it is all starting to make sense. He said that this is why they call it "managed care", and that if we were on a PPO we'd have more flexibility and choices.
At June 15, 2009 9:44 AM , Permission to Mother said...

I've never been offered bonus money to comply with a full vaccine schedule.

Logic would tell me that it is MORE cost efficient for managed care if their patients choose not to vacinate. Less supplies, less staff, less storage, less inventory, less of everything.
At June 15, 2009 6:37 PM , Anonymous said...

Thanks Dr. Sears for your honesty. What about the pharmacuetical reps? What kind of "kick back" do they give for using vaccines? Are pediatricians wined and dined at fancy restuarants to listen to them talk about how great their vaccines are?
At June 16, 2009 7:50 AM , Joey Sorenson said...

Anonymous,

We get no kick back from Vaccine reps...no longer even any free pens....
At June 19, 2009 11:37 PM , Anisia said...

I live in the uK and there is absolutely no way I would give the combined MMR to my son/. My daughter had the individual jabs but now the more I read the less convinced I am there are absolutely No connection between the jab and mmr...at best I think immunisation should be done individually and spaced out.
At June 19, 2009 11:38 PM , Anisia said...

I meant the connection between the jab and autism..sorry
At June 23, 2009 5:09 PM , Sharon Wallace said...

The wording was indeed disingenuous. No evidence was presented that any physician implemented a vaccine schedule in order to maximize personal profit. The article was full of "I believe" and "May be" and "could it be?" I also see that despite no evidence that it's true, poster after poster reads your words (Dr. Sears) to mean that greed is a motive for adhering to the recommended vaccine schedule.

Based on my own practice and what I know of my colleagues' practices, I believe that procedures, including immunizations, are NOT done for profit, and that, in fact, the article doesn't actually support the idea that they ARE done for profit. People are reading what they want to believe into it.

Sharon Wallace
Family Physician/Home birth provider
At June 23, 2009 7:26 PM , Tiffany G said...

Short Version: When we moved to Dallas, TX; we decided not to give our son the HEP B vaccination. Dr. Crow at Richardson, TX wanted to know why and what our source was for making our decision. I explained my reason and he said ok. I went ahead and did vaccinate our son w/ other shots.

2nd visit: Saw the other Ped Doctor and stated she was going to vaccinate our son with the Hep B; I explained that I've opted to not give him Hep B. She then went ahead to explain how this was a pro-vaccination office and that she would ask me to leave if I contin. to decline vaccinations. I left and found a Pediatrician w/ some common sense. I only declined Hep B!
At June 23, 2009 9:22 PM , Shannon said...

You are the only doctor I trust these days Dr. Sears. Thank you for keeping my faith in others alive!!
At June 24, 2009 6:14 AM , Anonymous said...

In Massachusetts if you work for the state and have an HMO, the state and the HMO together rate different providers and then your copays reflects what group the provider is placed in. For example, I had a certain insurance and had to pay $20 per visit instead of $10 per visit for providers in another group. I was surprised because I go to a community health center that serves mostly low income clients (and thought my copay should be the lowest). Then I learned that one of the criteria given for the ratings was timleliness of check-ups and vaccinations. I didn't mind paying the extra $10 per visit, but there was a financial disincentive for me, the patient.
At June 24, 2009 9:00 AM , Anonymous said...

Its all a bunch of bolony. Yes children need to be protected, but you shouldnt be pushed into getting them. I made sure my son had all....but I prolonged it. If it said 12 months, I waited until he was 18 months and so forth. Worked
At June 27, 2009 11:12 AM , Sue said...

We initally had friction from our Pditrician about vaccine safety...I asked her if she held her child's hand when crossing the street or put on her seatbelt in the car? Our doctor replied "yes" to both, then I explained that when you already have one child with Autism, it makes you look at the world differently and as a responsible parent, you must question everything including vaccines! Its just as important was wearing your seatbelt! Good luck to all the parents on their journey!
At June 27, 2009 11:26 AM , Sue said...

Dr. Bob, What do you think about immunization checks prior to giving vaccines? My "mom theory" is that my son had a "weak" immune system (a cold coming on, which is almost weekly in preschool) or for any other random reason; then he got the all the vaccines at the "well baby" visit which insulted his immune system and ignited the Autism? I know I might sound crazy, but it was frightening to watch your child age/developmentally appropriate turn into a non-verbal, shy person who seemed lost in his mind. We had several challenges such as: at 18 months old it took two adults to give our son a bath, it seemed like the water hurt him or "expressive and receptive speech delay"....why are Peditricians not more pro-active in screening for Autism when these sort of events occur? I know "its all the hype" now...but the only proven therapy is Early Intervention and its not textbook for each child. The other issue is dealing with your local school districts to get help and the services that the kids require to be successful; any thoughts or ideas on how to make that process easier, its extremly stressful and challenging on families! I do have a fulltime job and being an active "case manager" for your child is one job that failure is not an option! Its challenging to wear so many hats, and keep yor non-autistic child happy too! Thanks for your time! Luv, Sue (Nor Cal Mom)
At June 27, 2009 8:19 PM , Anonymous said...

Did you vaccine your kids?
At July 3, 2009 5:52 PM , Anonymous said...

I'd rather find the vaccine-friendly doctor driving a Ford or GM. Any recommendations????
At July 19, 2009 10:24 PM , Earthy Mama said...

Irregardless of whether doctors get paid to vaccinate or not, children should not be kicked out of pediatric groups for not vaccinating according to the AAP "recommended schedule" as my children were. I was happy to find a new doctor, one who is willing to let his patients, and parents have a say in their care. He actually appreciated parents who are well-informed and make decisions accordingly, rather than just doing what is told to them. We love our new doctor, but when our other ped flat out said, "we can't see you any more." I was shocked to say the least. Especially since she was telling me that my newborn would be getting a "new" combo vax which included 11 vaccines in one!! Are you kidding me?! If he reacts, how will I know what he is reacting to?

Ridiculous.
At July 20, 2009 4:35 AM , Anonymous said...

I agree with you Earthy Mama... I cannot understand why parents and doctors just don't question what we are doing to our children. It is outragoues. I will NOT vaccinate my son at least until he is 2 years old and even then, I do not think I am going to. Who do we trust?
At July 22, 2009 2:09 PM , Holly said...

My doctors office was so eager to vaccinate my kids that they gave my oldest a shot he already had even after I only approved one of the shots they wanted to give him.....needless to say their new doctor is great and he even gives me options of which shots I want and which ones he says they can get later.
At July 26, 2009 9:51 PM , Mom2Es said...

I've been told that Kaiser is one of the companies that does have a bonus structure that is at least partially tied to immunization compliance, although I have not been able to verify that directly.