Dr. Stacey Bartell wanted to offer vaccines to her patients. But at her small family medicine practice in a Detroit suburb, she could not find a way to make the finances work.
Stocking enough vaccines for her patients would cost thousands of dollars upfront, with no guarantee the sum would be recouped. She employed just one nurse practitioner, and would have to hire additional staff to manage the inventory and stay on top of insurance billing. And the special refrigerators required to store vaccines would cost another $1,000.
She knew how much vaccines mattered to her patients’ health. But it was money her practice, which was already operating on thin margins, couldn’t afford to spend.
“We just haven’t been able to shore it up here,” Dr. Bartell said. Instead she has to send her patients to pharmacies and the county health department for their shots — a concession that “hurts my heart,” she said.
So a few weeks ago, when Robert F. Kennedy Jr., the health and human services secretary, claimed in an interview with Tucker Carlson that vaccine profits created “perverse incentives” for pediatricians to push immunizations, Dr. Bartell was confused.
Doctors widely consider vaccines to be a money pit. Research shows that most pediatricians either break even or lose money on shots. One 2017 study found that nearly a quarter of family medicine providers and 12 percent of pediatricians stopped purchasing vaccines because of prohibitive costs.
To many experts, suggesting otherwise not only ignored that data, but also sent a dangerous message: that patients should doubt their doctor’s motives in recommending vaccines.
“This idea that we vaccinate kids to make money honestly is misleading and dangerous,” said Dr. David Higgins, a pediatrician and preventive medicine expert at the University of Colorado Anschutz Medical Campus.
“We actually overcome obstacles to be able to provide them,” he added.
Mr. Kennedy has long argued that pediatricians benefit financially from vaccines, which he has claimed generate “foot traffic” that boosts business and leads to “huge bonuses” from insurance companies if doctors keep immunization rates high.
In the interview with Mr. Carlson, Mr. Kennedy said research had shown “that 50 percent of revenues to most pediatricians come from vaccines.” (The Department of Health and Human Services did not respond to questions about the source of that statistic, and none of the experts interviewed for this article were familiar with it.)
The economics of vaccines are far more complicated.
In the United States, providers buy about half of vaccines directly from manufacturers. This is often one of the largest financial liabilities a practice takes on, second only to staff salaries, Dr. Higgins said.
A vial may cost anywhere from $10 to several hundred dollars, depending on the vaccine. Small practices, which have less negotiating power with these manufacturers, often pay more.
The practices only recover that money once they administer shots, which allows them to bill the patient’s insurance for the price of the vaccine.
Insurers also pay clinics an “administration fee,” which is supposed to cover the extra costs associated with being a vaccine provider, such as staff and supplies. However, that fee — which is determined through negotiations between insurers and providers — often does not cover routine expenses, let alone unexpected costs. (At her former practice, Dr. Bartell said she once lost dozens of refrigerated vaccine vials after a power outage.)
The other half of vaccines administered in the United States are supplied to doctor’s offices for free through Vaccines for Children, a federal program that covers shots for the country’s poorest children. While clinics don’t pay for vaccines themselves, they still spend money to administer them. And immunizations provided through the program are eligible for an even smaller administration fee.
“I don’t think anyone’s out there making money on vaccines,” Dr. Bartell said.
Experts also said that Mr. Kennedy’s claim about “huge bonuses” was misleading.
About half of pediatricians have “value-based contracts” with insurers, which pay them a flat fee for hitting a number of health care metrics, such as routinely recommending preventive screenings and reviewing medications during appointments. A doctor’s vaccination rate is just one of dozens of measures.
The payments are often modest, accounting for just a small share of what insurers pay to a given clinic, said Dr. James Perrin, who works on the financing of children’s health care services for the American Academy of Pediatrics.
“I’ve worked with a lot of practices that participate in those programs and I’ve never heard of a quote, unquote, huge bonus,” said Dr. Sean O’Leary, a vaccine expert for the A.A.P. Dr. Perrin added that doctors rarely lose any such payment because of low vaccination rates.
Stepping back, Dr. Higgins said, Mr. Kennedy’s statements misrepresent the motivations of pediatricians, many of whom have willingly gone into one of the lowest-paid medical specialties. And even if providers were solely focused on income, Dr. Higgins noted, it wouldn’t make financial sense to encourage vaccination.
“If we were motivated by profit, we’d make more money treating the complications of preventable diseases than by preventing them in the first place,” he said.
Teddy Rosenbluth is a Times reporter covering health news, with a special focus on medical misinformation.
The post Kennedy Claims Doctors Profit Off Vaccines. In Fact, Many Lose Money on Them. appeared first on New York Times.
