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 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.
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:
- CDC – Vaccination Coverage Among Children Aged 19–35 Months — United States, 2015
- Study – Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009
- About the Physician Group Incentive Program
- The Problem With ‘Pay for Performance’ in Medicine
- Physician quality pay not paying off
- Study – The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates
- Study – Medicaid Pay for Performance Programs and Childhood Immunization Status
- Study – Does a pay-for-performance program for primary care physicians alleviate health inequity in childhood vaccination rates?
- Study – Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial
- State Pay-For-Performance Program Summaries
- Analysis of Pay-For-Performance (P4P) Program for Utilization of Preventive Care Services among Medicaid Population in United States
- Incentive Payments Lead to Healthier Patients, Say Michigan FPs
- Blue Cross incentives save $50M in health care costs
- Getting Rewards for Your Results: Pay-for-Performance Programs
- A Bonus for Health, Payable to the Doctor
- Pediatricians Paid to Vaccinate: Another Myth Easily Debunked
- Doctors are “pushing vaccines”? Gee, you say that as though that were a bad thing!
- Do doctors get paid to vaccinate?
- Vaccinations Can Be Money-Losers For Doctors
- Pediatrician Busts Common Vaccine Myth In Powerful Post
Great post.
You’re kidding with this, right?! It’s absolutely true. My brother-in-law is an administrator for corporate…it’s LITERALLY right there in the booklet, (gee, wonder why they took it down?), and your subsequent explanation was gibberish.
What booklet, Carole? The Blue Cross Blue Shield of Michigan 2016 booklet? Did you read what was written above about how it is not a bonus? Have you seen anything like this in any other state? With any other insurer?
Carol it’s better to do the research yourself and later compare your findings rather than just believing your brother in law. You may find some valuable information.
Very vague post. In Maryland right now, Merck is being sued for these very types of “incentives”. So how much money do you make for peddling this bullshit? My son is vaccine injured and our previous pediatrician didn’t listen to me about his reactions, didn’t report it, and ultimately broke her Hippocrates oath to do no harm when she clearly could see there was harm. You’re directly harming thousands of children by a vaccine schedule that is untested for safety and unproven in overall health outcomes.
Do you have a link to the Merck lawsuits in Maryland?
Look it up on google … I would expect since hour so informed at you ha e access to the same information… especially lawsuits… that everyone else does. Btw… how about you start researching the impact of having to live with Vaccine reactions. Oh that’s right… as a mainstream pediatrician you don’t give a darn about my vaccine injured children. You don’t give a darn about how much they have suffered and don’t give a darn about violating my first amendment rights for my children.
I find this article insulting. Your statement “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.””
“Incentive”: ‘a payment or concession to stimulate greater output or investment. A thing that motivates or encourages one to do something.’ A pediatrician out of college with 100’s of thousands of dollars in debt who has been conditioned into thinking inoculations are a must WILL adhere to the program, only a fool would not do so if they are going to vaccinate the child anyway. So in other words, your article is about the dumbest thing I’ve read, and you have the audacity to attack those ‘anti-vaccine folks’. You’re a complete ass, how about calling them CONCERNED PARENTS you Nazi bastard.
Good try to manipulate the fact that an ‘incentive’ isn’t an ‘incentive’ BTW, my wife is in the drug industry which DOES make tons of money on ‘incentives’. Every week the drug reps visit doctors with complete lunches for the office workers, and if they get the Dr’s signature it could be worth up to $1,000 bonus for the drug rep. Keep of the FAKE NEWS, I wonder who the hell paid you for this BS article. BTW, I notice you didn’t post the entire PDF file from Blue Cross and what you did post its so convenient that you reduced its size so it can’t be read.
Spot on Bailey. Honestly in this age of information, at a time where old structures are being exposed, people still want to cling to these corporations like they have their best interest in mind. Let them keep living in their little bubble of ignorance. Most articles like this who claim to “debunk,” aren’t actually debunking anything. They’re just feeding to their mindless audience who eat up this garbage and can’t take the time to open a new tab and do some research.
You can always fact check the information with reputable sources and see that that the author right, despite her initial introduction being insensitive. 🙂 it seems that you have not done enough research either.
The most important issue is the lack of testing and the insane desire for injecting toxic metals into babies and humans in general. This is genocide by injection…
Doctors play Russian roulette with vaccinations every day. Also with many drugs that are not adequately tested. Why would anyone in their right mind think it is safe to inject an infant with multiple doses of vaccines at once and do it again within a short period of time at the next visit? Infants are not able to detox well like adults to begin with. It makes absolutely no sense. It certainly is not beneficial to the infant to slam them with all these chemicals at once even if they are minute particles of mercury, formaldehyde, and aluminum. We know that there are babies that die or are disabled from vaccinations and older children as well.
Genetics are playing a role. Why are vaccination companies/doctors not telling parents about the genetic risks involved. There should be genetic tests done before vaccinations are begun or certain drugs are given. But the herd mentality continues and the screams of mourning mothers are ignored. We as women continued to be berated by male doctors and treated like we are hysterical females when our children are dying and becoming disabled. That is why the adverse affects are not reported. Sorry your child is dead or disabled but it is for the good of everyone else. Right? Not one child’s death is acceptable. It is barbaric to think like this.
I wonder if the guy writing this article got a bonus for his propaganda. Anti Vaxers? No such thing. Those of us that are not bought and paid for are all about REAL health care and protecting our children as our top priority.
Ah! Thanks for this explanation, it helps debunk the repeated claims that I keep reading.
So the manual promises $40,000… but it’s not at all a “bonus” for vaccinating children.
They just give you a $40,000 (or $80,000, etc) reimbursement, that you wouldn’t have otherwise had, if you vaccinate the children. But it’s not a bonus, and it’s not like you’re really getting real money. It’s just money that you didn’t have before, and now you do.
So if you drop below the 63% vaccination rate, the doctors don’t really “lose” a bonus or anything like that. They just don’t receive the money that they otherwise would have received.
Man these antivaxxers are crazy to think this would “incentivize” anyone to vaccinate a child who should have been screened out, etc. Of course, the manual calls it an incentive, but technically it’s not really an incentive, since it’s not really a bonus.
The fault is really with the BCBS manual, should have used clearer language.
Exactly, Wes!
Brillant comment!
I think a lot of this shill’s argument boils down to the claim that a negative incentive does not count as an incentive. We are giving your money we earmarked for you, if you do not jump through our vaccination hoops to mangle the babies, you will not get the money.
Either way you look at it … incentive.