That $3 Million Vaccine Bonus for Pediatricians

The BCBS Michigan PGIP vaccine incentive.
BCBS Michigan offers a Physician Group Incentive Program to improve care to their members.

Have you heard about the bonuses that some pediatricians get for making sure their patients are fully vaccinated?

Depending on who you want to believe, this bonus, kickback, or so-called bribe, could be as high as:

  • $40,000
  • $80,000
  • $600,000
  • $3,000,000

Why the differences?

These anti-vaccine folks are simply reading an insurance company’s provider incentive program and trying to make it fit their narrative that pediatricians push vaccines on kids for profit.

While Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program does use Healthcare Effectiveness Data and Information Set (HEDIS) criteria on completed vaccinations to give members a $400 payout, it isn’t what some people think.

The money used to make the payout or incentive reward comes from “a percentage of the applicable fee schedule on most professional paid claims.” So it is, in effect, money that the pediatrician has earned and should have already been paid. And if they don’t meet HEDIS performance measurements, they don’t get that money.

“All network physicians agree by contract to allocate funds from their fee schedule reimbursement to the PGIP Reward Pool. The current amount of the allocation is 5 percent. This 5 percent allocation goes into a pool to be paid out to physician organizations that meet performance metrics established by Blue Cross Blue Shield of Michigan.”

2016 Physician Group Incentive Program Clinical Quality Initiative: FAQ

Now, if you are creating a pool of money that is going to distributed to all or most of the doctors in the group and it comes from just 5% of reimbursements, how can they be getting bonuses of $40,000 or $80,000 or more?

Also keep in mind that in 2006, the pool of money totaled just $4,000,000 to be divided among all of the physicians in the program. Again, you are not going to get very large bonuses from those kinds of numbers.

Although the reward pool is much larger now, it is for dozens of PGIP initiatives and is divided up among over 19,000 doctors in almost 50 physician groups.

Most importantly though, does the simple fact that they do get bonus mean that they are pushing or forcing vaccines on kids just to make their childhood immunization target and get their bonus? If you consider that only 63% of their patients need to be fully vaccinated, which is much lower than vaccine coverage levels in the United States overall and in Michigan, it isn’t very hard to get the “bonus.”

A pediatrician who intentionally doesn’t vaccinate their patients might suffer under this type of program, but most of them don’t seem to take insurance anyway. Their patients usually have to pay cash for the “benefit” of seeing a vaccine-friendly doctor.

In the end, folks try to use these PGIP payments to mislead parents into thinking that something fishy is going on.

This means that a 5-doctor pediatric practice, if they reach 100% compliance on vaccinations, will receive a bonus of just over $3,000,000 (that’s not a typo, my math is right, that’s $3 million bucks!!)*.

JB Handley

Is his math really right?

Think about it. How often do kids have a two year birthday, which triggers the incentive?  Handley mentions that his calculation isn’t annualized, to cover that, but still, no pediatrician is getting a $3 million vaccine bonus.

Or a $40,000 bonus for that matter. You just have to look at the salaries for pediatricians in Michigan to understand why these claims are ridiculous.

The $400 childhood immunization payout.
Pediatricians aren’t making multi-million dollar bonuses to get kids vaccinated on time.

The most obvious error all of these folks make is that is almost unheard of for a doctor to only accept one single type of insurance plan. What percentage of patients does the Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program make up among all of the insurance plans these doctors take?

If it was even 5 or 10%, which would be high, then there would be at most a handful of patients turning two each year to trigger the bonus. The yearly payments, which cover more than just vaccines, are no where close to being as big as anti-vaccine folks make them out to be.

Examples of payouts in the BCN 2017 Medical Services Agreement.
Examples of a yearly payout in the Blue Care Network 2017 Medical Services Agreement.

Again, this is a voluntary program the doctors join and in which the payout or incentive reward comes from “a percentage of the applicable fee schedule on most professional paid claims.”

And remember, this isn’t really extra money they get anyway. They are not bribes or kickbacks. It is money they likely would have gotten if they had not joined the incentive program.

What about the idea that Blue Cross Blue Shield has removed the incentive program pamphlet detailing the $400 payout? No conspiracy. The 2016 program expired. It was replaced with a new one.

Benefits of Pay for Performance Programs

So why do they join? Research from the programs shows that they help provide higher quality care at a lower cost.

That makes sense.

Consider how much it costs to contain a measles outbreak, for example, it is easy to understand why and insurance company would rather encourage doctors to get kids immunized rather than pay a lot more to take care of sick kids with vaccine-preventable diseases in doctor’s offices, ERs, and hospitals.

A recent study in Pediatrics, “Economic evaluation of the routine childhood immunization program in the United States, 2009,” actually used similar HEDIS immunization data as the Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program and found that “routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42,000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.”

So why aren’t they used even more often?

They can be expensive to implement, especially if a doctor doesn’t already have electronic medical records. And some experts believe that improvements aren’t necessarily from changing doctors behavior, but rather from better documentation of things that they were already doing.

What To Know About Vaccine Bonuses for Pediatricians

Pediatricians are not getting big bonuses, bribes, or kickbacks to vaccinate kids.

For More Information on Vaccine Bonuses:

 

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