The American Academy of Pediatrics (AAP) has created numerous resources to help practices understand their costs to immunize and to lower those costs. This article lists those resources, as well as resources related to vaccine safety and storage and handling.
Pediatricians must be savvy about the business aspects of their practices. The following resources facilitate calculating, understanding, and improving pricing, contracts, and coding.
Know Your Costs
Vaccines: A Survival Guide for Pediatric Practices (www.aap.org/immunization/pediatricians/pdf/Vacc_survival_insert.pdf)
This resource helps practices determine their costs to immunize. Knowing costs is essential for negotiating favorable contracts.
The Business Case for Pricing Vaccines and Immunization Administration (www.aap.org/immunization/pediatricians/pdf/TheBusinessCase.pdf)
The Business Case estimates that 17% to 28% above vaccine product costs is needed to cover overhead costs. Recent studies with multiple pediatric and family practices found overhead costs in the same range. If determination of actual practice costs to vaccinate is prohibitive, then the estimates from this document can be used instead.
Private-Sector Vaccine Price List (www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm)
Costs can be checked against the manufacturer's catalog price listed by the Centers for Disease Control and Prevention (CDC).
Lower Your Costs
Immunization Best Business Practices PediaLink Module (http://tinyurl.com/yzbm9nw)
Preliminary data show wide variability in what it costs practices to immunize. The AAP recognizes that small practices may have trouble negotiating better reimbursement, and this module can help practices find ways to reduce costs, from ordering to administering vaccines.
List of Group Purchasing Organizations (http://practice.aap.org/content.aspx?aid=2381)
Group purchasing organizations combine buying power from multiple units, such as hospitals and smaller pediatric practices, to obtain better pricing for vaccines. The AAP has been collecting information on group purchasing organizations that report working with pediatricians, and Practice Management Online contains information about these organizations.
AAP Immunization Initiatives: Vaccine Financing (www.aap.org/immunization/pediatricians/financing.htm)
The financing section of the Childhood Immunization Support Program Web site features information on coding, Vaccines for Children, studies, and presentations to help practices navigate vaccine financing issues.
AAP Pediatric Coding Newsletter (http://coding.aap.org)
The AAP Pediatric Coding Newsletter can be used for helpful hints on various aspects of coding, including immunizations.
AAP Vaccine Coding Table (http://practice.aap.org/content.aspx?aid=2334)
This table reports proper Current Procedural Terminology and International Classification of Diseases, 9th Revision, Clinical Modification codes for immune globulins, common pediatric vaccines, and immunization administration. The table is updated whenever new codes are introduced, which occurs primarily when a code is assigned to a new vaccine.
Pedialink Contract Negotiations With Payers Module (www.pedialink.org/cmefinder/search-detail.cfm/key/2f65c7bc-b672-46e9-aa8f-155d5c0e7c87/type/course)
This course guides pediatricians through tips for negotiating more-favorable payer contracts, with several examples on immunizations. This module is applicable to small and large practices.
Vaccine Addendum to Payer Contracts (http://practice.aap.org/content.aspx?aid=1306)
This addendum provides sample contract language to address vaccine payments by third-party payers.
Learn From Others
Section on Administration and Practice Management (www.aap.org/Sections/soapm/soapm_home.cfm)
It is the mission of the Section on Administration and Practice Management to impart both basic and cutting-edge administration and practice management innovations that will improve the state of pediatric administration and practice management for its members and members of the AAP. The Section on Administration and Practice Management currently is working to increase residents' awareness of practice management and to enhance the benefits of its affiliate membership for practice managers, pediatric nurses, and nurse practitioners.
Practice Management Online (http://practice.aap.org)
Practice Management Online is the online pediatric practice management resource for pediatricians and their office staff members, to support them in operating a practice that is fiscally sound and efficient and provides quality health care to children and families. Practice Management Online contains a variety of resources, including articles, newsletters, manuals, fact sheets, peer discussions, and sample office forms and documents, in 1 easily accessible Web site.
Setting up a Pediatric Council (www.aap.org/moc/reimburse/pedcouncil/default.htm)
The AAP encourages chapter development of pediatric councils as forums to discuss pediatric issues with payers. Pediatric councils have the potential to facilitate better working relationships between pediatricians and health insurance plans and to improve the quality of care for children. Ideally, changes may lead to more-appropriate coverage for pediatric services, as well as smoothly and efficiently operated pediatric practices and health plan claims adjudication. A pediatric council is not a forum for joint contract negotiation, individual contract discussions, or other fee-related concerns.
Promoting the Value of Pediatrics (www.aap.org/moc/ppa/promotingpeds.htm)
The AAP has developed these materials to assist its members in communicating about one of the greatest values in health care today, namely, preventive pediatric care. These materials focus on primary care provided in a medical home model. These documents may be used to craft letters in response to articles about retail-based clinics or vaccine reimbursement, to prepare for media interviews, to write speeches, to communicate with private payers, and to communicate with parents of patients. Members also are encouraged to convince their local community newspapers to run the prepared articles.
Time spent discussing parental concerns about vaccine safety can cost offices much in the way of overhead. The following resources help address some of parents' most-common concerns.
Vaccine Safety Resources
Vaccinate Your Baby (www.vaccinateyourbaby.org)
This Web site offers parent-friendly information and a video by actress Amanda Peet. Public service announcements are available for free download.
Pictures of Vaccine-Preventable Diseases (www.aap.org/pressroom/aappr-photos.htm)
The AAP has assembled a collection of photographs of vaccine-preventable diseases, to assist journalists reporting stories on infectious diseases and immunization. With proper attribution of the source, photographs may be reprinted to accompany news stories.
The Childhood Immunization Schedule: Why Is It Like That? (www.aap.org/immunization/families/faq/Vaccineschedule.pdf)
This parent handout was written at an eighth-grade reading level and answers questions about why alternative schedules are not recommended.
Questions and Answers About Vaccine Ingredients (www.aap.org/immunization/families/faq/Vaccineingredients.pdf)
This parent handout was written at an eighth-grade reading level and answers questions about why various ingredients are used in vaccines and whether they are harmful.
Vaccine Safety: The Facts (www.aap.org/immunization/families/safety.html)
This form can be modified to include individual office contact information. It describes the basics of the vaccine safety infrastructure in parent-friendly language.
Resources on Parental Refusal to Vaccinate (www.aap.org/immunization/pediatricians/refusaltovaccinate.html)
This AAP Web site offers resources for physicians on common reasons why parents choose not to vaccinate their children, along with tips for coding and documenting those encounters.
Form for Documenting Parental Refusal to Have Their Children Vaccinated (www.aap.org/immunization/pediatricians/pdf/RefusaltoVaccinate.pdf)
This form, from the AAP Section on Infectious Diseases, may be used as a template for documentation of parental refusal to vaccinate but should not be considered a legal document and should not substitute for legal advice from a qualified attorney. This form may be duplicated or changed to suit physicians' and patients' needs.
STORAGE AND HANDLING
Improper storage and handling can lead to wasted vaccines, costing offices hundreds of thousands of dollars and time spent revaccinating children. The following resources help offices stay up to date on storage and handling practices.
Vaccine Storage and Handling Resources
2009 AAP Red Book Online: Vaccine Handling and Storage (http://aapredbook.aappublications.org/cgi/content/full/2009/1/1.5.2)
This excerpt from the 2009 AAP Red Book provides AAP recommendations for safe storage and handling practices.
Lessons Learned From Hurricane Katrina: Ensuring Proper Vaccine Management, Handling, and Administration During a Disaster (www.aap.org/immunization/pediatricians/PracticePres_Preparedness.ppt)
Practices should have plans for vaccine storage or transport in case of power outage or natural disaster. This presentation provides resources for practices that wish to create a new plan or review an existing one.
CDC Vaccine Storage and Handling Toolkit (www2a.cdc.gov/vaccines/ed/shtoolkit)
This toolkit provides general guidelines for correct vaccine storage and handling. Specific recommendations for vaccine storage and handling procedures may vary among state health department immunization programs. This toolkit does not replace state health department policies but is meant to supplement them.
CDC Book on Vaccine Management, Handling, and Storage (www.cdc.gov/vaccines/pubs/vac-mgt-book.htm)
Vaccine Management: Recommendations for Storage and Handling of Selected Biologicals provides shipping requirements; condition on arrival; storage requirements; shelf life; instructions for reconstitution and use; shelf life after reconstitution, thawing, and opening; and any special instructions for all recommended vaccines.
Checklist for Safe Vaccine Handling and Storage (www.immunize.org/catg.d/p3035.pdf)
This checklist lists the 20 most-important things to do to safeguard vaccines.
Don't Be Guilty of These Errors in Vaccine Storage and Handling (www.immunize.org/catg.d/p3036.pdf)
This list includes frequently reported errors in vaccine storage and handling that can be prevented in the practice setting.
Temperature Log for Vaccines (www.immunize.org/catg.d/p3039.pdf)
This log can be used to document daily refrigerator temperatures. Times when temperatures enter the shaded region of the log should be noted, because this indicates unacceptable temperatures, and action to correct the problem should be taken.
- Accepted August 25, 2009.
- Address correspondence to Elizabeth Sobczyk, MPH, MSW, American Academy of Pediatrics, Immunization Initiatives, Division of Pediatric Practice, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail:
Financial Disclosure: The author has indicated she has no financial relationships relevant to this article to disclose.
- Copyright © 2009 by the American Academy of Pediatrics