The shingles vaccine: Not practice friendly

This internist has serious concerns about the vaccine for shingles:

Like it or not, my practice is a business with real expenses. At best, the cost of the vaccine will be covered but I will have to bear the initial outlay of $180 per dose. I still will also have invested significant staff time in storing, monitoring, and administering the vaccine, and doing the special paperwork.
At worst, I will be stiffed for the entire amount and have to fight the patient who believes she should not have to pay for the vaccine.
Primary care doctors are already being gouged for the dubious privilege of giving flu and pneumococcal vaccines at terrible rates of reimbursement.
Excuse me if I err on the side of not going bankrupt. I am not giving the zoster vaccine.

Comments

Anonymous
Why don’t you do what any other business owner does: buy the vaccine, mark it up by 100 to 200%, collect payment before administering the vaccine, be happy. The majority of patients who have witnessed or had shingles would gladly tell you that the vaccine is worth the expenditure. The mistake you are making is getting insurance involved. Let them reimburse the patient, not you. Until physicians stop being the monkey-in-the-middle with regard to insurance, all they can expect is a green banana for their efforts.
Anonymous
Definitely go the ABN route with this and collect the money up front. You should mark it up to cover all the potential costs: purchase, storage, refrigerator, compliance documentation, and wastage. 200% markup might be appropriate. Make the patient pay up front and in full if they want it. Have the patient file the claims themselves. You aren’t running the local county public health clinic and you and your staff aren’t getting a government paycheck. Run your practice like the business it needs to be.
I do therapeutic as well as cosmetic treatment with Botox. That medicine costs me $500 a bottle which once reconstituted has a four-hour shelf life if used on-label per the manufacturer’s instructions. Often there is wastage. The allowed wastage by most insurers is so little as to make the use of that medicine a significant financial loss if I buy the Botox ahead of time. For uses where patients expect their insurance or Medicare to cover, I give them a prescription to go buy the Botox from a local pharmacy. That keeps me from having to chase after the patient or for having for pay for the Botox myself. You can do the same with vaccines. That will keep you from having to front the cost. You can also have the pharmacy deliver the vaccine to your office on the patient’s behalf.
Anonymous
Ah, you internists. Welcome to the daily world of the pediatrician. You fret (most legitimately) about the zoster vaccine; whereas we have been dealing with the DTaP, Hib, polio, varicella, MMR, (and now MMR-V combo), Td, TdaP, HepB, HepA, Rotavirus, Prevnar, flu, and HPV all this time. Anonymous 1 and 2, most insurance contracts explicitly billing the patient for a covered service; furthermore, billing them for more than the insurance reimbursement and not refunding the difference is known as “balance billing” which is even more prohibited. You can probably bill and recover the cash for now while the insurers are still deciding what to do with this new vaccines–that gives you probably about six months–after that, you’re in their domain.
Now, if the insurers decide not to cover the shot at all, then I agree it’s entirely up to you what to do. I have no plans to carry the Gardasil (HPV) vaccine for my patients because it’s not reimbursed at enough for me to risk the storage and tying up capital in a fragile nonrefundable product.
The American Academy of Pediatrics has an excellent paper on the business case for vaccine pricing, or something to that effect. http://www.aap.org. Check it out.
Anonymous
The only sustainable future will be for physicians to set their prices and balance bill (with advance disclosure to the patient of course). Insurance MUST revert to being a contract between company and patient. Doctors may “accept” insurance, but will not be economically viable without the ability to balance bill. When enough physicians wake-up and realize that a contract cannot be unilaterally imposed without the ability to balance bill, change will occur. This is already the only way an increasing number of patients can obtain the care they desire (you can call it “concierge medicine” if you like, I call it the future of private medical practice.
Julie
I am not a doctor, nor am I in the medical field. I have never had shingles myself, but have know a few people who have suffered from this debilitating and painful disease. All I can say after reading this post is that if I were going to a doctor for shingles treatment, I would not want to visit a doctor with a policy such as yours.
http://www.patmosemergiclinic.com Robert Berry
As a physician who takes no insurance, this is the way I deal with this issue. I do not stock the shingles vaccine. If a patient is considering getting it, I discuss the pros and cons and the indications. I then write a prescription for it and the patient pays me directly for the consultation. The patient then takes the prescription to a local pharmacy that keeps the vaccine in stock and they administer it.
What’s so difficult about that? Americans neither need nor can afford insurance for everyday medical care. If we are not willing to pay directly for primary care out of our own pockets then we will be paying insurance or federal bureaucrats to ration this kind care for us – and it will then be more expensive that if we had paid for it directly.

The shingles vaccine: Not practice friendly

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