(Borganic.org) An open letter to President Obama:I'm a pediatrician and writing to let you know, because not many people do seem to know, that small,private, primary care doctors' offices around the country, including mine — where the majority of people receive their immunizations — are being reimbursed chronically under cost for purchase and operating expenses when we administer vaccines.
If we refuse to immunize at a loss, we put our patients at risk for disease and risk losing our insurance contracts (and therefore our ability to provide continuity of care) because not immunizing is bad medicine.
The success of the national immunization program depends on the consistency with which immunizations are provided around the country, and it is in peril of becoming “moth-eaten” and therefore ineffective in optimally preventing disease because practitioners increasingly have to choose between purchasing immunizations and having our offices survive.
Insurance companies reimburse primary care physicians either at cost or barely above the cost of administration for each vaccine we give, with no allowance for contribution to the overhead necessary to keep an office running. Essentially, we are expected to carry the weight of the immunization program on our backs.
Primary care physicians — family practice doctors and pediatricians — are increasingly being forced to run their offices at a loss to keep immunizing their patients. Many are being forced out of practice.
Physicians' offices, like any small business, must rely on dwindling and increasingly difficult-to-come-by lines of credit for capital to purchase expensive vaccines. Practically, small primary care offices are becoming nonprofit brokers between the large insurance companies (who reimburse however they want and can change their rate of reimbursement without warning at any time) and the drug companies (many of whom have a monopoly on each specific vaccine — take a look at Wyeth and the vaccine Prevnar for meningitis or Merck and the vaccine for measles).
The sine qua non of operating at a loss if you are trying to keep your patients immunized is particularly true for small primary care offices, where the majority of American children receive their vaccines.
I don't have much hope that a missive such as this will ever reach the ears of anyone who has the power to decide policy. But, since your campaign was about hope — here's hoping. Please help me keep immunizing my patients.
Lindsay Irvin, M.D., is a San Antonio pediatrician.
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