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October 2007 NVAC Meeting Minutes - page 35 / 40





35 / 40

October 2007 NVAC Meeting Minutes

locations to receive vaccines would make it more difficult to record who has been immunized and to then attach those data to an immunization registry. Dr. Almquist also explained that not long ago, about 50 percent of childhood immunizations were done in the public sector and that a minimum—15 percent or so—are now done in the public sector while the majority of childhood immunizations are given in the private sector. He explained that that has made a difference in terms of coverage levels.

Dr. Adele E. Young pointed out the difference between adult immunization as an entire topic and flu vaccination in terms of venue, delivery, and uptake. She explained that we have to be careful not to confuse the problems that are inherent with the yearly delivery of the flu vaccine with the problems with adult immunizations. Dr. Lance Rodewald agreed with Dr. Young’s clarification between the flu vaccine and other adult immunizations. He explained that there is a huge difference between a vaccine series and a vaccine that is needed every year.

Dr. Lovell then commented on the complexity of the flu vaccine in terms of the administration fees and managing the vaccine and vaccine reimbursement. He explained that if the flu vaccine is going to be administered in the private sector, an easier process needs to be created.

Dr. Gina T. Mootrey then discussed one project that CDC will probably be doing that was previously done in the 1990s for the pediatric population. They initiated community action plans to see how grantees could increase childhood immunization coverage. Currently, CDC is thinking of a way to have a competitive process for similar plans for adult immunizations for the grantees. Only some of the grantees would come up with model plans for the other grantees. These plans would not be implemented but would set the stage for the grantees to think about what needs to be done to increase adult immunization coverage in their jurisdictions.

Dr. Walter A. Orenstein mentioned the fact that in the United Kingdom, physicians were given bonuses if certain vaccination coverage levels were achieved. The result was that vaccination coverage levels increased. He wondered if the United States was planning on doing something similar or if that might even be feasible. Dr. Wayne Rawlins responded by explaining that there are a variety of pay-for-performance plans available for a variety of evidence-based activities. Most insurers would value ways to encourage physicians to do the right thing using incentives available, such as cash. However, the incentives need to balance out, which may bring the need for negative incentives as well. Dr. Rawlins did mention not wanting to reward people for doing the wrong thing. In response to Dr. Orenstein’s comments, Dr. Gary L. Urquhart explained that there are health plans that pay up to $250 per patient for a completed pediatric series. The only catch to the plan is that the vaccines have to be represented in the registry. He explained that perhaps this plan would work with adults as well. Dr. Almquist agreed that much like pediatric doctors offices, vaccination records are going to go electronic for adults as well.

Dr. Lovell returned the focus of the discussion to the private sector and stated that the challenges they face are different from those faced by the workplace and public health facilities. He also explained that the billing aspect in the private sector is too complex.

Dr. Jeffrey A. Kelman clarified that no Medicare part D plans provide the influenza or pneumococcal vaccine and that this has always been a part B benefit. He also mentioned that the Centers for Medicare & Medicaid Services (CMS) recently completed a piloting project with CDC that showed that flu vaccine uptake can be monitored to a very high degree and that it can be linked to databases in real time.

Dr. Almquist reminded the group that when vaccination recommendations become complex, uptake does not happen. He emphasized that the more standard the recommendations, the more the uptake. If the recommendations become too complex, it gives physicians an excuse not to vaccinate. Dr. Young responded by emphasizing that while it is important for recommendations to not be too complex, it is

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