Margie C. Andreae

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.

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 non-governmental 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 carryover to other combined vaccines. Although proposed by certain political groups, no policy changes regarding combination vaccines were made in any study country.

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.

Vaccine safety policy analysis in three European countries: the case of thimerosal

Increased societal concern regarding the safety of vaccines has had an impact on the risk tolerance of public health officials, parents, and medical professionals. Risks that were either unknown or accepted for years have come under new scrutiny and may result in new and changed perspectives. This has been due partly to the fact that effective immunization programs have markedly diminished the incidence of vaccine-preventable diseases in industrialized countries. As a result, there is a lower awareness of the risks associated with the diseases themselves and a greater prominence of the potential risks of adverse effects associated with the vaccines. Risk perceptions and the actions taken in response to real or perceived risks regarding vaccines can and do vary significantly among nations. Due to the heightened awareness and concern over vaccine safety issues, immunization policymakers must carefully balance newly identified potential risks from vaccines with the actual risk of vaccine-preventable diseases. Concern regarding public reactions to new and often unverified safety issues may place pressure on policymakers and/or health care providers to act quickly in response to new

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

Basis for immunization recommendations among countries of the World Health Organization European region

23 less from commercial payers and

The process of public policy formulation: the case of thimerosal in vaccines.

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.

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

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 decisionmaking 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.