Tag: bonus

Do Anti-Vaccine Pediatricians Lose Millions Not Vaccinating Kids?

Paul Thomas is upset…

He thinks that Willamette Week, an alternative weekly newspaper in Portland, is trying to discredit him.

How are they using their platform “to try to discredit an ethical top Pediatrician in the community?”

An “ethical top pediatrician” who made up his own immunization schedule???

Paul Thomas was barred from the Vaccines for Children Program.
Paul Thomas was barred from the Vaccines for Children Program.

Willamette Week published a story about how Paul Thomas was kicked out of the Vaccines for Children Program.

“VFC (Vaccines for Children) does not provide any funding (no real dollars) just free vaccines for the underprivileged. What I lost was the ability to provide this free federal program to my patients who qualify for this program. This is simply a major inconvenience to those affected. Financially it is neutral to me.

My clinic had actually stocked the vaccines Rachel mentions – we just didn’t comply in a timely manner, so you got this part right “I didn’t jump through their hoops fast enough.”

Paul Thomas

To make a long story short, he got kicked out of the Vaccines for Children Program because he didn’t follow the rules of the program.

What about the idea that he “just didn’t comply in a timely manner?”

This all started over two and a half years ago???

Although Paul Thomas says in his post that his “clinic had actually stocked the vaccines Rachel mentions,” the order kicking him out of the VFC program says otherwise.

“Dr. Thomas submitted a Declaration signed under penalty of perjury stating his office does not keep stock of HPV vaccines and instead sends patients to pharmacies.”

Default Order Terminating Integrative Pediatrics from VFC

He also did not have any rotavirus vaccine in his office.

Not exercising medical judgement in accordance with accepted medical practice? Where is the Oregon Medical Board???

To get to the point of being terminated and which Paul Thomas characterizes as “I didn’t jump through their hoops fast enough,” actually involved:

  • ignoring an offer for a probationary agreement (August 2018)
  • asking for a contested case hearing (October 2018) which was scheduled for July 12, 2019
  • withdrawing his request for a contested case hearing on July 10, 2019

I’m surprised they gave him that much time!

Did he lose Medicaid funding?

I’m not sure he even takes Medicaid, but he did lose the ability to give his patients vaccines that he didn’t have to pay for.

“One huge misconception, and I see the comments on this, is that pediatricians don’t make money on vaccines or that they are not financially incentivized to vaccinate. There are profits from vaccine mark-ups and huge profits from vaccine administration fees. The average admin fee is about $35 per vaccine. For the 715 patients born into my practice who have refused to give any vaccines (each child would have had 28 vaccines by age 2 and over 60 vaccines in their childhood) amounting to income of $700,000 for the 2 years and $1.5 million over their childhood. Those are real dollars lost for Integrative Pediatrics. The money lost when considering that we serve over 15,000 patients, with most being selective about how they vaccinate would have driven most practices out of business.

There are also built in incentives in many contracts with health plans. Vaccines are a quality measure (if your practice does not reach a bench mark in numbers vaccinated) you loose a % on all services provided to patients under that insurance contract.

Is it any wonder most of my peers discharge patients from their practices who won’t follow the CDC schedule? Often these patients are told to call Dr. Thomas (Integrative Pediatrics).

Let us be clear. It is not a good business decision to allow families not to vaccinate or to permit selective vaccination.”

Paul Thomas

Let us be clear. He certainly doesn’t understand vaccine administration fees…

Some things he gets wrong?

  • pediatricians might charge $35 as an admin fee, but they are lucky if insurance companies pay them 1/3 or 1/2 that or even less. Your average vaccine administration fee is only going to be $35 if you don’t take insurance and can set your own fees!
  • you get a lower vaccine administration fee for the second vaccine component given (you use a different CPT code – 90461) vs the first (90460), and it pays less, so doctors make less when they give multiple vaccines at the same visit. Is that why many vaccine friendly doctors recommend giving one vaccine at a time?

And he misses the whole point behind vaccine administration fees.

It costs pediatricians money to order, stock, monitor, and give vaccines!

“This study shows that the variable costs of vaccine administration exceeded reimbursement from some insurers and healthplans.”

Glazner et al on Cost of Vaccine Administration Among Pediatric Practices

Do they make any money?

Hopefully they do, as health care is a business in the United States, but they certainly aren’t making millions in net profit as Paul Thomas suggests. And if they aren’t very careful, after considering all of the factors that go into giving a vaccine, it is very easy to lose money.

How Do Anti-Vaccine Pediatricians Make Money?

Which brings us back to the business decision of being a pediatrician who scares parents away from vaccinating and protecting their kids.

Is there any money in that?

Paul Thomas doesn't mention that he gets a big cut of the sales for a "free" summit that costs $197 as he promotes his anti-vaccine lecture.
Paul Thomas doesn’t mention that he gets a big cut of the sales for a “free” summit that costs $197 as he promotes his anti-vaccine lecture.

Books, seminars, supplements, essential oils – there are lots of things to sell parents who don’t vaccinate their kids.

Compared to these pediatricians in California, Paul Thomas is a bargain at just $295/year.

Don’t forget the annual membership fees that many of these pediatricians charge for the privilege of skipping or delaying vaccines and at extra risk to get a vaccine-preventable disease.

And the vaccine exemptions that some of them sell…

More on Do Anti-Vaccine Pediatricians Lose Millions Not Vaccinating Kids?

A Crazymother Visits Her Pediatrician to Talk About Vaccines

There is a new Crazymothers video floating around and it is everything that’s wrong with the modern anti-vaccine movement.

What is so shocking about a pediatrician educating a mother about the importance of vaccinating and protecting her child?
What is so shocking about a pediatrician talking to a mother about the importance of vaccinating and protecting her child?

On the fence parents are being told ‘this this and this’ by their pediatricians and then going to someone who has found Internet fame making Crazymothers videos to find out if they are true.

As you might expect, her videos include:

She even defends Andrew Wakefield and doesn’t believe that people died of measles once MMR vaccination rates went down after Wakefield’s study was published.

A Crazymother Visits Her Pediatrician to Talk About Vaccines

Crazymothers?

As someone who is mindful that language can promote stigmas and stereotypes, it is not a term that I chose.

It is the name of a parenting group.

Wait until you hear what this pediatrician has to say when a Crazymother informs her she will no longer be vaccinating!

“Ok, today is just a hepatitis vaccine.”

I have made the decision that I no longer want my kids to be vaccinated.

“At all?”

At all. So, I know that’s not what you want to hear.

“It isn’t. It scares me. It scares me a lot.”

I know. I hear that, but I also have to do what I feel is best.

“Is there a specific concern that you have?”

Oh, there is a lot of things.

“What are they?”

There’s a lot. I’m worried about a lot. I wasn’t planning on having this conversation today. I didn’t know he was getting a shot. I wasn’t prepared. I thought he coming in for a blood test today. There’s a lot of reached out and met a lot of other moms who just have a lot of really sad stories and I just kind of started doing my own research and I just don’t feel like it is best for my kids and … I’m very concerned for his health and him getting vaccinated with all of these problems that he already has isn’t going to benefit him right now so I may change my mind down the road.

That last paragraph says an awful lot about why some parents are choosing to delay or skip their children’s vaccines:

Mostly they are scared. Hopefully this mom does some more research, gets more answers to her questions, and does change her mind soon.

Crazymothers Propaganda

The video, most which I have transcribed, also illustrates why it is important to be prepared when you talk to your pediatrician about vaccines.  After all, you can’t get your questions about vaccines answered if you don’t ask any questions.

“So my job at every visit is to let you know what you are declining and what we’re trying to protect against. It’s also very important if you decide not to immunize to remember that he’s at risk for a lot of other things so if he gets a fever its going to mean something different to mean than a child who is fully immunized as a fever… so if you call us after hours and he has a fever, make sure you tell us, oh by the way, he isn’t immunized…”

How does it mean something different if a child is intentionally not vaccinated?

It is actually very simple.

They are at increased risk for vaccine-preventable diseases.

While a vaccine-preventable disease should be in the back of your mind for any kid if their symptoms fit the disease, since vaccines aren’t 100% effective, they move higher up your list of possibilities if you know the child is unvaccinated and unprotected.

“I also just want to tell you that there’s a very big difference between anecdotal evidence and population based evidence, so just because someone has a sad story doesn’t mean that what happened to them is truly related to the vaccine.”

yeah

“And also keep in mind that in terms of autism, the study that was done in England years ago that supposedly linked autism to the measles, mumps, and rubella vaccine was tainted. It was funded by anti-vaccine lawyers, was retracted by every single person that offered that study and because of that study, children didn’t get the MMR and many died.”

Crazymothers – OMG, I can’t even with this… She said that children didn’t get the MMR and many died. That’s not true. If you look at the cases of measles after 1998 when the Lancet study was published the measles cases actually went down. Nobody died. Nobody has died in America for years and years from the measles. It is completely silly.

Nobody died?

Measles cases went down?

“Between 2001 and 2013 there was a sharp rise in the number of UK measles cases, and three people died.”

Current measles risks in the UK and Europe

As most folks now, before Wakefield was stripped of his medical license, he practiced in the United Kingdom, and not surprisingly, that’s where we saw a big effect on MMR rates. They went down and measles cases went up.

MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn't fully recover until 2012.
MMR vaccination rates had dropped below 80% by 2003, when the first measles outbreaks in the UK began. They didn’t fully recover until 2012.

But even as measles cases and deaths have gone down globally, measles outbreaks and measles deaths have been much worse in the rest of Europe.

Even in the United States, cases have gone way up since we hit a record low of 37 cases in 2004 and there have been deaths, with the last in 2015.

“Again, this was very contentious and you would not get consensus from all members of the group on this, but that is my feeling, that the, the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.”

Andrew Wakefield

It is amazing how many times you hear the phrase “that’s not true” in this video about things that are so easy to confirm as facts.

“Continue to give it some thought because to me vaccines are modern miracles and it scares me to death to have people not getting vaccinated… He’ll probably be okay, but that’s because I’ve vaccinated my kids the other day, so we’re protecting your kid… The more people who stop doing it, forget about it, it’s going to go back to the old days where people are dying all of the time.”

Crazymothers – There’s that herd immunity myth. She says that your kid is going to be okay because I’m doing the right thing. I’m vaccinating my child. And anybody who studies this knows that’s not true! Herd immunity is a myth. Go outside and talk to a 30-year-old, 40-year-old, 50-year-old, who hasn’t been recently vaccinated and you can clearly see, plain as day…

As far as I know, we have indoor plumbing, we have sewage systems, we have clean water, and we have access to whole foods, we have ways to supplement with vitamins and minerals, we have all of these amazing things and that is what actually brings disease rates down.

Proper sanitation, sewage systems, all of the modern things that we take for granted – that is what is actually bringing the disease down, because clearly, in under-developed countries, we still see the diseases rampant, right?

Herd immunity myth?

The idea that herd immunity is a myth because adults aren’t vaccinated is silly.

Adults were either born in the pre-vaccine era and likely have natural immunity or were born in the vaccine era and are vaccinated and immune, as many vaccines provide life-long immunity. That’s why adults get few boosters or catch-up vaccines.

But herd immunity is disease specific, so when we talk about herd immunity for measles, it doesn’t matter if someone has immunity against hepatitis A or Hib. Also, some vaccines, like Hib and Prevnar, have indirect effects, protecting adults even though they aren’t vaccinated, because vaccinated kids are less likely to become infectious.

There is only clearly one modern thing that that anti-vaccine folks take for granted – vaccines.

My uncle got polio around 1950, in Brooklyn, just before the first polio vaccine was developed.

You know what?

They had indoor plumbing, sewage systems, clean water, whole foods, vitamins and minerals, and medicine – he was hospitalized for six months – yet many people still died of polio.

In 1951, during the first season of I Love Lucy, you can see that they had indoor plumbing. Surprised?
In 1951, during the first season of I Love Lucy, you can see that they had indoor plumbing. Surprised?

At that time, during the pre-vaccine era, many people also died of measles, tetanus, pertussis, chicken pox, and many other diseases that are now prevented with vaccines.

In 1954, Lucille Ball and Desi Arnaz asked everyone to “give every dime and dollar” they could spare to fight polio.
In 1954, Lucille Ball and Desi Arnaz asked everyone to “give every dime and dollar” they could spare to fight polio.

And unfortunately, many under-developed countries still don’t have proper sanitation, sewage systems, or good nutrition, but do you know what they also don’t have?

Polio.

We are very close to eradicating polio all over the world. Only two countries, Afghanistan and Pakistan still have cases of wild polio today. And so far this year, there have only been 11 cases. Did every other country in the world suddenly get proper sanitation, sewage systems, and good nutrition? Is that why we are so close to eradicating polio?

Of course not. It’s the polio vaccine.

Vaccines work. Vaccines are safe and necessary. They have few risks and many benefits. You won’t learn any of that from the Crazymothers group and that’s likely why you have made the decision that you no longer want your kids to be vaccinated.

What to Know About Crazymothers Propaganda

Don’t let Crazymothers propaganda scare you away from vaccinating and protecting your kids.

More on Crazymothers Propaganda

The Value and Cost Savings of Getting Vaccinated

We often hear a lot about the benefits of vaccines.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
How much would it cost to close all of the schools in a big city today?

Well, most of us do.

But can getting vaccinated really help save us money?

Cost Savings of Getting Vaccinated

Vaccines are expensive, so it probably doesn’t make a lot of sense to many people that saving money is one of the big benefits of getting vaccinated.

That’s just because vaccines work so well.

“Analyses showed 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.”

Zhou et al on Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

Few of us remember the pre-vaccine era when there were polio and diphtheria hospitals and “pest houses” at the edge of town.

We don’t remember when outbreaks of vaccine-preventable diseases would close schools and these diseases were more deadly, not because they were more severe, but simply because they were more common.

Costs Associated With Getting Sick

If we don’t remember these diseases and outbreaks, we certainly don’t remember how much it cost to control and treat them.

We should though.

Just look at how much it costs to control the recent measles outbreaks that continue to plague us.

“The estimated total number of personnel hours for the 16 outbreaks ranged from 42,635 to 83,133 and the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

Ortega-Sanchez on The economic burden of sixteen measles outbreaks on United States public health departments in 2011

Not including the direct costs for outpatient visits and inpatient care, recent outbreaks have cost anywhere from $3,000 to $50,000 per case to contain. Why the difference? Localized outbreaks, like in a church group or among a single family, will be easier and less expensive to contain, as they will likely involve fewer contacts to track down to see if they were exposed and are already vaccinated.

Again, these costs don’t include the costs of going to your doctor or the ER because your child is sick, getting hospitalized, or lab tests, etc.

It also doesn’t include the costs associated with living under quarantine, which is happening in many of the recent outbreaks.

Getting sick is expensive.

How much is a liver transplant?

How much does it cost to treat someone with cervical cancer?

How much does it take to care for a child with congenital rubella syndrome?

How do anti-vax folks usually counter this important message?

They typically say that taking care of a vaccine-injured child is expensive too. While that can be true, the problem is with their idea of what constitutes a vaccine injury. While vaccines are not 100% safe and they can rarely cause serious or even life-threatening reactions, most of what they describe as vaccine-induced diseases, from autism to SIDS, are not actually associated with vaccines.

The Value of Vaccination

So yes, getting vaccinated is cost effective.

“Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines.”

Luyten et al on The Social Value Of Vaccination Programs: Beyond Cost- Effectiveness

The value of getting vaccinated goes way beyond saving money though.

Most of the ways this has been studied in the past still leaves out a lot of important things, including:

  • increased productivity later in life following vaccination
  • improved cognitive and educational outcomes
  • community-level health gains through herd effects
  • prevention of antibiotic resistance
  • vaccination-related benefits to macroeconomic factors and political stability
  • furthering moral, social, and ethical aims

Why are these important?

“Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries.”

Andre et al on Vaccination greatly reduces disease, disability, death and inequity worldwide

If you are making a decision to get vaccinated vs. trying to hide in the herd, you want to have all of the information about the benefits of vaccines, not just about the risks, or what you might think are risks.

Vaccines Are Expensive

Although getting vaccinated is certainly cost-effective, that doesn’t erase the fact that vaccines are expensive.

If they weren’t so expensive, then we likely still wouldn’t have so many deaths from vaccine-preventable diseases in the developing world, where the problem is access to vaccines, not vaccine-hesitant parents.

“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.”

Coleman on Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Parents should also be aware that vaccines are expensive for the average pediatrician too, who no matter what anti-vax folks may claim about bonuses, aren’t making much or any money on vaccinating kids.

And because vaccines work, pediatricians also don’t make as much money when vaccinated kids don’t get diarrhea and dehydration that is prevented by the rotavirus vaccine, recurrent ear infections that are prevented by Prevnar, or a high fever from measles, etc., all things that would typically trigger one or more office visits.

It should be clear that the only reason that pediatricians “push vaccines” is because they are one of the greatest achievements in public health.

A great achievement at a great value.

What to Know About the Cost Savings of Getting Vaccinated

There is no question that there is great value in getting fully vaccinated on time and that getting immunized is a very cost effective way to keep kids healthy.

More on the Cost Savings of Getting Vaccinated

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: