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Billing processes may hinder school-based vaccination
ATLANTA — School-based vaccination clinics that include insurance billing may require additional billing processes to ensure reimbursement and financial sustainability of the program, according to data presented here at the 44th National Immunization Conference.
Certain evidence supports school-based vaccination programs as a way to boost vaccination rates, but few schools have billed health insurance for administered vaccines, according to Matthew F. Daley, MD, of the Institute for Health Research, Kaiser Permanente Colorado.
Daley and colleagues evaluated a tetanus-diphtheria-acellular pertussis vaccine clinic held in a public middle school in April 2009. The researchers assessed the feasibility of a school-based vaccination program in Denver that was open to all students regardless of health insurance status and was capable of billing insurance companies for vaccines and administration fees.
School personnel obtained parental consent for vaccination, and local public health workers verified insurance information; performed billing; and ran the clinic, according to Daley. Publicly insured and uninsured students were administered vaccines from the Vaccines for Children program, and parents whose claims were denied did not receive bills.
Results showed that 446 of 909 enrolled students had no record of TDaP vaccination. Also, 155 children received consent for TDaP vaccination, with 151 children administered vaccines during one 2.5-hour clinic. Overall, TDaP vaccination increased from 47% to 67%, the researchers reported.
Thirty percent of vaccinated students had private insurance, according to Daley, whereas 5% were insured by the State-Child Health Insurance Plan (S-CHIP). Twenty-five percent were insured by Medicaid, and 40% did not have insurance.
The summary for all costs for vaccination and administration was $3,144, according to Daley. Total reimbursement, however, was $895. Overall reimbursement, including privately insured, S-CHIP–insured, Medicaid and uninsured children was 20%.
“We feel that the implications of this study, as a pilot study, demonstrated some degree of feasibility. However, I’m not sure that this study really demonstrated financial sustainability,” Daley said at the meeting.
Daley acknowledged the need for future research and reported that a 2009-2010 study will involve seven schools and eight comparison schools that will provide more information and address limitations of the current study. — by Melissa Foster
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