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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Financial impact to providers using pediatric combination vaccines.
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Financial impact to providers using pediatric combination vaccines.

机译：对使用小儿联合疫苗的提供者的财务影响。

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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 Dollars 23 less from commercial payers and Dollars 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.
机译：目的：了解使用组合疫苗（Pediarix [GlaxoSmithKline Biologicals，普鲁士国王，宾夕法尼亚州]）与同等成分疫苗对1岁或以下儿童的经济影响。方法：使用向私人执业诊所医师提供的订阅汇款计费服务，我们分析了提供商在2007年6月至2009年7月之间向保险付款人提交的费用和付款信息。我们分析了提供商和付款人的特征，付款人意见和比率疫苗产品按照免疫管理（IA）编码进行计算，并为研究的两个部门计算了向提供者支付的总费用和费用。结果：我们数据集中的大多数提供者为儿科医生（74％），大多数付款者为商业（75％），主要是管理治疗。在大多数索赔中，疫苗产品数量与IA数量的比例为1：1。付款人对20％的索赔不作任何调整，而对超出合同安排或收费表的费用对76％的索赔进行了调整。与使用等分量疫苗相比，提供者从使用Pediarix时获得的商业付款人减少了23美元，从Medicaid减少了13美元。特定年龄的现行程序术语IA代码90465和90466的平均商业付款要比非特定年龄的代码90471和90472的平均商业付款要大，而医疗补助则相反。结论：为儿童接种疫苗的提供者在选择提供联合疫苗时将减少付款。应监控新的IA法规，以纠正使用组合疫苗的财务障碍。

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