Vaccine administration error rates at a large academic medical center and its affiliated clinics - Familiarity matters.

OBJECTIVE: The purpose of this study was to track and describe the absolute number of vaccine administration errors and corresponding error rates over time and by patient age and vaccine type. METHODS: Total vaccines administered to patients aged 0 through 19 years 364 days from 1/1/2006 through 12/31/2017 at a large academic health system in the Midwest United States with primary, specialty and school-based clinics, and a pediatric hospital were obtained from an electronic medical record. Vaccine administration errors over the same time period for the same patient criteria were analyzed from the health system's incident reporting system and further compared to the frequency of all incidents reported. Vaccine administration error rates were calculated. Data were analyzed by patient age, vaccine type and year administered. RESULTS: Of the 1,431,206 vaccine doses given, 552 vaccine administration errors were identified (0.04%). The highest error rates occurred in children aged 2, 3, and 19 years. Vaccine types with the highest error rate were Td, rabies and pneumococcal polysaccharide vaccines. Overall vaccine doses given and errors reported increased over the study period. However, the increase was disproportionate, resulting in an increase in the error rate initially followed by a stabilization at the end of the study period. CONCLUSIONS: Vaccine administration errors are uncommon. The error rate appears to be stabilizing. Errors are more likely at ages when vaccines are not commonly given, with vaccines that have age-specific dosing and with vaccines that are given less often. This suggests more safety checks are needed for vaccines that are rarely used or given off-schedule, and manufacturers should avoid vaccines with age-specific dosing.

Application of the resource-based relative value scale system to pediatrics.

The majority of public and private payers in the United States currently use the Medicare Resource-Based Relative Value Scale as the basis for physician payment. Many large group and academic practices have adopted this objective system of physician work to benchmark physician productivity, including using it, wholly or in part, to determine compensation. The Resource-Based Relative Value Scale survey instrument, used to value physician services, was designed primarily for procedural services, leading to current concerns that American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) surveys may undervalue nonprocedural evaluation and management services. The American Academy of Pediatrics is represented on the RUC, the committee charged with maintaining accurate physician work values across specialties and age groups. The Academy, working closely with other primary care and subspecialty societies, actively pursues a balanced RUC membership and a survey instrument that will ensure appropriate work relative value unit assignments, thereby allowing pediatricians to receive appropriate payment for their services relative to other services.

Financial impact to providers using pediatric combination vaccines.

OBJECTIVE: To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger. METHODS: Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study. RESULTS: Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1:1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received $23 less from commercial payers and $13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for age-specific Current Procedural Terminology IA codes 90465 and 90466 than for non-age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid. CONCLUSIONS: Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines.

Basis for immunization recommendations among countries of the worldHealth Organization European region.

Despite World Health Organization (WHO) goals to reduce the incidence of several vaccine preventable diseases across the European region, the adoption of new vaccines has been slower than expected. To identify factors that influence the decision to recommend new vaccines, especially hepatitis B and Haemophilus influenzae, type b (Hib) vaccines, we studied the factors used in immunization decision-making across this region. A structured questionnaire was sent to the Immunization Program Manager of each country with the option to return the completed survey by e-mail, fax or complete a web-based survey. Frequency distributions were explored for all survey items. Bivariate analysis was conducted to assess differences between countries by economic status. Of the 47 (89%) countries responding, the majority reported vaccine safety (91%), epidemiology of disease (85%), and the severity of disease prevented (74%) as very important factors when making immunization recommendations. Half of the countries reported the cost of disease burden and cost-effectiveness data were very important financial information when implementing vaccine recommendations. While no significant difference was seen by economic status in countries recommending hepatitis B vaccine (p = 0.1129), high economic status countries were significantly more likely to report Hib vaccine is part of the country's recommended schedule (p = 0.0011). Understanding the importance of the factors considered by countries when making national immunization recommendation decisions can aid public health experts in providing countries with information needed to support these decisions.

Inadequate training in billing and coding as perceived by recent pediatric graduates.

INTRODUCTION: The literature supports a high rate of error in physician coding for professional services, suggesting that residency training in this area is inadequate to meet the needs in clinical practice. METHOD: From the American Board of Pediatrics database of recent graduates, 1200 generalists and 1100 subspecialists were selected to receive a structured questionnaire. Participants rated the adequacy of their training in billing and coding using 3 choices. RESULTS: The response rate was 76% among the generalists and 77% among the subspecialists. Eighty-one percent of generalists (N = 549) and 78% (N = 423) of subspecialists indicated that they could have used additional training in billing and coding. This finding was common throughout all practice settings. CONCLUSIONS: Pediatric residency training programs are not meeting the needs of generalist or subspecialist physicians in training of billing and coding. Residency programs must enhance this training component to prepare physicians to maintain a financially viable practice.

National immunization advisory committees of the World Health Organization's European Region.

This study sought to understand the prevalence, structure and decision-making process of national immunization advisory committees (IACs) among the 53 member countries of the World Health Organization (WHO)'s European region. Of the 47 countries responding to the electronically administered questionnaire, 37 (72%) have an IAC. The majority of committees have a legislative basis while just over half have formal terms of reference. Fewer than half have experts in health economics. The vast majority of countries do not allow the public to attend committee meetings nor distribute publicly the minutes of their meetings. Countries should partner with financial experts early in the process of immunization policy decision-making and should examine their policies regarding conflicts of interest and public access to meetings, as financial strategy and public trust are essential to the successful implementation of new vaccines.

Physician compensation programs in academic medical centers.

Many academic health centers are creating incentive-based physician compensation programs, leading to skepticism regarding the impact on the academic mission. We sought to systematically review the impact of these programs. Most academic compensation programs demonstrate a positive impact on clinical and scholarly productivity, quality of education, and faculty satisfaction.

Hitting the mark ... sometimes. Improve the accuracy of CPT code distribution.

Researchers examined the current procedural terminology (CPT) evaluation and management (E&M) code distribution before and after applying corrections for the inaccuracy of code assignment to actual CPT E&M claims. They found that code distribution differed dramatically after the practice's claims were corrected for coding errors identified by coding analysts. Physicians' poor understanding of coding guidelines and regulatory pressure to code correctly may account for the discrepancies. Regardless of the reasons, poor coding opens an organization to compliance audits and loss of legitimately earned revenue.

Safety concerns regarding combination vaccines. Perspective of select European countries.

This study explored health officials' perception of parental concern regarding the safety of combination vaccines and its impact on policy decisions in different European countries. Interviews were conducted with governmental and nongovernmental health officials in the United Kingdom, France, Ireland and Sweden over a four-month period. Parental concern regarding the safety of combination vaccines was perceived to be prevalent in the United Kingdom, Ireland and Sweden while no such concern was evident in France. The concern was limited to the combined measles, mumps and rubella vaccine and its alleged causal association with autism and did not carry over to other combined vaccines. Although proposed by certain political groups, no policy changes regarding combination vaccines were made in any study country.

Safety concerns regarding combination vaccines: the experience in Japan.

This study explored the safety concerns associated with combination vaccines in Japan. The impact of Japan's decision in 1975 to withdraw the combined diptheria, tetanus, and pertussis (DTP) vaccine, and then in 1993, the combined measles, mumps, and rubella (MMR) vaccine and provide only the single antigen vaccines was analyzed. Interviews with both governmental and non-governmental agency officials in Japan demonstrated that withdrawal of the DTP and MMR vaccines had significant impact on the rates of immunization and disease despite the availability of monovalent vaccines.

Using a productivity-based physician compensation program at an academic health center: a case study.

PURPOSE: With increased budget constraints, academic health centers (AHCs) have turned their focus on physician compensation. While many AHCs are concerned that compensation programs driven primarily by revenue generation will have a negative impact on their academic mission, little information is available to support this. The authors examined the effects on teaching and clinical productivity of an innovative compensation program for pediatrics primary care faculty at an AHC and related those effects to national standards for productivity. METHOD: A baseline productivity and compensation assessment was conducted for a group of 35 academic general pediatricians. The data were compared with Medical Group Management Association (MGMA) figures for general pediatricians. A productivity-based faculty compensation program using the work component of the relative-value unit (RVU) as the measure of productivity was designed and implemented. Productivity and compensation were measured after the first year of the program and compared with the baseline assessment. The numbers of hours precepting students and residents and the students' evaluations of their clinical experiences before and after implementation of the program were compared. RESULTS: The baseline assessment showed that over half of the faculty had productivity that fell below the MGMA 25th percentile, while the majority had compensation that exceeded this percentile. After implementation of the compensation program, 89% of the faculty increased their clinical productivity. The times faculty spent precepting and students' evaluations before and after program implementation were unchanged. CONCLUSIONS: Successful productivity-based physician compensation programs can be developed for AHCs.