Universal State Vaccine Administration

I am guilty of blog neglect.  The busier I am, the more I have for the blog, but the less time I have to do it.  Here’s an interesting one that I’ve saved for a few weeks – an analysis of the immunization administration fees paid in Universal vs. non-Universal states.

The analysis was based on the question of whether or not states that cover vaccines for all patients tend to pay well for the admins.  Some folks on SOAPM posited that without the possibility of even a small profit on vaccine products, physicians in Universal states might really suffer financial hardship.  I thought about the Universal states for a second and said to myself, “Wait.  I bet they get paid better.”  and I think they do.
In fact, I think that many of them are paid well enough that they might fare
better with their overall vaccine “profit” than non-universal states.

I had Igor @ PCC look into it for me.  This isn’t entirely scientific, and I
certainly welcome comments/questions/complaints, but if you want to see
something shocking:

Universal States: VT, MA, NH, NC, WA, NM

 CPT Code Avg PaymentUniversal State Average PaymentNon-Universal State
 90460  $26.38 $20.35
 90461  $12.95 $10.26
 90471  $17.31 $17.18

[we forgot the 90472, but it’s nearly identical for both sets of states]
Fascinating, indeed.  Again, non-scientifically, it would appear that our
universally-stated clients get a ~30% boost on their admins *when they use the
new codes* yet are effectively the same with the older codes.
The now-expired 90465/90466 codes showed a similar boost for non-Universal states.
So, here’s the question.  Let’s say we’ve got a 15m well visit at hand.  A
U-state could easily generate $30-80 more in admins.  Can every Non-U practice
say that their real margin on their products is that high?  No, they can’t.
In fact, for too many, it’s negative.

FTC nerds: this data is from a huge data sample across many practices in many states who
can’t possibly compete against or conspire with each other.  And it’s >3m old so we could look at
paid claims.

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