In this episode, Dr. Phil Boucher and Dr. Marina Capella discuss one of the most pressing concerns for pediatricians considering DPC: managing vaccines. They explore the challenges and solutions surrounding vaccine procurement and administration in a DPC model and offer practical advice on how to navigate this critical aspect of pediatric care without feeling overwhelmed. Whether you’re a seasoned DPC practitioner or just contemplating the switch, this episode is packed with valuable insights to help you ensure your practice can effectively handle vaccinations.
Link To Podcast: Vaccine Management in Pediatric DPC
Welcome to DPC Pediatrician. We are Dr. Phil Boucher and Dr. Marina Capella, two DPC pediatricians who are on a mission to share our love of direct primary care with you. Hey everyone. Okay, today we are going to be talking about vaccines, which is a huge issue and question when it comes to pediatric DPC.
0:22
I think outside of just the general idea of starting a business from scratch oneself, that vaccines are probably the main hangup where people realize, vaccines are super expensive and I don’t have a good way to get vaccines. And I’m just going to keep doing what I’m doing and, you know,
0:41
remain an employed physician and continue to burn out. Like that’s as big of a deal as vaccines is in the pediatric realm. In the family practice realm, I feel like it’s not as big of a thing because you can always say, we don’t have vaccines here,
0:53
but CVS down the road has your flu shot and your pneumonia vaccine, whatever they say to do adults. But in pediatrics, like it’s, it’s very bread and butter. And so It’s worth discussing what people do. So I’ll share first mine and then you can share yours and then we can kind of talk
1:09
about the other ways that people do things. I was lucky because I got in with VaxCare and VaxCare was already established in Nebraska. I actually, I didn’t plan it this way, but it worked out that VaxCare came to Nebraska and got set up and launched in Nebraska six months to 12 months before I launched my practice.
1:29
And so that was already in the back of my mind when I first thought of it. It was like, okay, this is going to make life easier. Now, VaxCare is in most states. There’s a few states that VaxCare is not in, but they continue to expand, I know.
1:40
But they have requirements on the number of vaccines that you give in order to get into the system because it does cost them to get your clinic set up and give you all the tools and things along those lines. And so… For some practices, if you’ve been a pediatrician for a while in a community,
1:56
you can usually get them to look at your past vaccine record, like administrations, and they can get a good sense of how many vaccines you give. And then that will often get your foot in the door. This is somebody that gives enough vaccines to make it worth our while.
2:11
Jumping ahead to how does it work in our day to day practice with vaccines is we just give all the regular vaccines that everybody gives. We have them all in our fridge and freezer. We scan them out. They give you like a little device that looks like a big phone.
2:26
It is probably some sort of Android phone that you just QR code scan them. and then administer them. And then VaxCare takes care of, one, paying for the vaccines for your fridge so you don’t have to pay for them. Two, billing the patient’s insurance for the vaccines so that you don’t have to do that. And then three,
2:46
keeping track of your supplies so that when you run low on rotavirus, you don’t have to remember to get more. They just know based on scanning the QR code and all those sorts of things that you gave eight of 10 available rotaviruses, they need to ship you more rotavirus and then they do that. And so basically,
3:02
getting that set up is pretty sweet and makes a world of difference for getting things set up. Because vaccines, I mean, our fridge probably has $100,000 worth of vaccines in it easily because vaccines are so expensive. And you don’t realize that when you’re an employed physician and somebody else is paying the bills for your HPV vaccines.
3:20
And you’re like, yeah, just give them a vaccine. Yeah, just give them a vaccine. Yeah, just give them a vaccine. Well, those are some pricey vaccines that are sitting in those fridges.
3:27
Oh, absolutely. Yeah, I did not realize how much vaccines cost until I went into practice for myself. I got sticker shock about some of those prices. I echo your sentiment that vaccines is such a sticky issue for pediatric DPC practices because a major part of what we do is prevention and that includes vaccines.
3:49
And so a lot of people just cannot envision being a pediatrician and not having vaccines. So I live in a state that does not have VaxCare. So I reached out to them early on to see if it was even an option. And they said, sorry, we’re not in Utah.
4:04
We don’t have any plans to be in Utah anytime soon. Good luck. So I had to figure out a different way. And it was frustrating in the beginning because what I ended up having to do when I had a really small number of patients was send them to the public health department or say,
4:22
you can go back to your other pediatrician. But they did not like doing that because they had to do the whole physical all over again. There was no option to just schedule a nurse visit. Most practices refused because then they can’t bill for an encounter. And so they just hated doing that.
4:37
So a lot of them would rather just go to the public health department. For older kids, like adolescents, you can send them to the pharmacy and they can get things like their flu shot, their COVID shot, their Tdap. Sometimes the meningitis and HPV vaccines are available at certain pharmacies as well.
4:54
But when it comes to younger kids, that’s when it really gets challenging. No pharmacies will give children basically under the age of eight or nine or 10, somewhere in that range. And they don’t even stock the infant vaccines. I know that some practices, and I tried doing this too in the beginning,
5:12
they have found out how to establish a cooperative relationship with a local small pharmacy where the pharmacy will purchase the vaccines and And then you will send a prescription to the pharmacy for that vaccine. They will dispense it.
5:27
You pick it up or the family picks it up, brings it right to your clinic, and then you administer it. So that’s a solution that some people have found works for them. Others have a cooperative relationship with another insurance-based practice in their area. And they say, hey, can I purchase vaccines from you?
5:48
Usually there’s a fee associated with that. And so they do that. or they send them directly to that practice just for vaccine administration. For me, after about a year and a half or two years in practice, I think about a year and a half, we were finally able to have enough volume, have enough income,
6:03
have enough cashflow that I was able to purchase private stock vaccines. And I had to increase my costs in order to absorb the cost of those vaccines because they’re expensive. And I also especially increased the price of memberships for newborns and The first year of life, because that’s when I first did the math,
6:23
I calculated that that first year of life, cumulative vaccines cost about $2,000 and the prices have only gone up.
6:31
So I was thinking $3,000 or more. Yeah. Yeah. So that’s a lot. And I guess then financially you pass those along to the patients to some degree or how does that work?
6:45
Yeah, I do. But I just kind of, estimated. I mean, it was hard to get like exact numbers of how many people would get vaccinated and which ones they would get. So I just across the board increased my prices, including those newborn prices in order to be able to absorb those costs. Now,
7:03
I happen to have an integrative pediatric practice that attract more vaccine hesitant families than I like. And I mean, as much as I encourage them, and a lot of them do agree to just slower schedules, Right. That does decrease the cost for me because it’s not every single family that is receiving vaccines.
7:23
So I did take that into consideration. So I didn’t have to like go sky high on my prices, but I did have to increase my prices for sure.
7:32
So I think in general, from what I’ve heard from the Facebook groups and talking with others about vaccines, I mean, there’s the gamut of different options when it comes to vaccines. And the bottom line that I think we both want to get across is that vaccines don’t have to be the thing that keeps you
7:51
from starting your pediatric DPC, or the thing that you have to have completely squared away final verdict before you decide to jump off the fence and do it because there’s a lot of different options out there. There’s not offering vaccines and sending them to the health department or the wherever.
8:09
There’s setting things up with a local pharmacy, which they still exist and regular sized towns, like there’s local pharmacies that will do that because then it’s getting the patient in the door. They’ll buy other things. They’ll have a preferred relationship when it comes to filling their other prescriptions. They can bill insurance and send those to the insurance.
8:28
It’s financially, it makes sense for them to do that. So it’s often like establishing those relationships. And then it’s a nice relationship because they’re going to be the ones that help you out when Walgreens and CVS won’t even pick up the phone. And so you’re going to send…
8:41
prescriptions there and it’s going to be a win-win for those those families we do that like one specific pharmacy as a tangent we use to get lat gel so lidocaine adrenaline tetracaine gel so that you know we can apply it to when kids need
8:56
stitches and so cvs or walgreens isn’t going to pick up the phone to help you with that but a compounded pharmacy We’ll make that for you and deliver it to you. Easy peasy. And so those are really nice relationships to develop. And then so the pharmacy working with another local practice that can either sell
9:13
you their vaccines or arrange some sort of relationship where you’re able to work with them because there’s others in the community that like you and like what you’re doing enough to say we’ll play along and we’ll help out to getting VaxCare access so that you can kind of have it streamlined and everything. So there are
9:32
a lot of different ways to do it.
9:33
Yeah. I will also add that since I’ve had to just absorb the cost of vaccines, I’ve explored ways to try to bill insurance just for vaccines. And I recently started using an online program called ClaimMD because I tried submitting claims that I had just filled out via PDF and it was really tricky
9:54
figuring out the right codes and they got rejected because I never had to submit a claim before, right? Other people did that in my past practice. So ClaimMD made it a little bit easier to submit the claim correctly. And out of like five I’ve submitted the last two months that I just started,
10:13
I did get one back that gave me $50 for a Tdap. So there were others that were rejected. And it really depends on the insurance because some insurances have out of network benefits and those are more likely to cover the cost of vaccines.
10:27
If they have no out of network benefits, they are most likely going to say, it’s just not covered. You’re not in our network. We’re not going to pay you anything. So it’s a little, I mean, at least I’m just going to try to see what I can get. ClaimMD is only $25 a month.
10:43
And I think it’s 30 cents for each claim you submit. So it’s like, even if I could just recoup a few hundred dollars a month.
10:50
Yeah, that’d be amazing. That’s a great one. I have heard about that. Nitin was telling me about that at the Pediatric DPC Conference, and I put it on my to-do list. And this is a good reminder to circle back on that clean and be idea.
11:02
So I think the bottom line is that there’s a way to do the vaccines. It doesn’t have to be the thing that keeps you from opening your practice or moving in that direction, is I don’t have this tied up in a nice bow.
11:14
The other good thing to know is when you start a pediatric DPC, it grows over time. And vaccines are never an emergency. If you get started and you’re starting to bring in patients and all those sorts of things, then you can go and buy those vaccines.
11:31
Like you don’t have to have a fully stocked fridge because you know that they’re going to come in. And if they come in and they want to do their vaccines, you can say, well, we don’t have any hep A today,
11:39
but I’ll order some and I’ll text you in two weeks or we’ll get it at their next visit. Like those are easy things to do. And you’re providing so much that the patients don’t mind buying coming back at their next visit or swinging by to get their hep A or whatever it
11:52
might be out of the regular schedule. I think that’s another thing because in a huge mega practice, everything has to be running super efficiently. And we have to have this fridges stocked and people getting their vaccines on time and getting all their vaccines at once and all those sorts of things.
12:05
But when the bandwidth, when you have so much more bandwidth it’s not as hard to say, we’re out of hepatitis A today. We’ll get it at your next visit. I’ll make note of that. Or I’m going to order it because I see they’re coming in in a couple of weeks and
12:20
get that in so that you have that. And like, those are all possible things when you’re not seeing 30 patients a day and have a practice of 10,000, whatever it is, patients amongst the doctors.
12:32
Absolutely. Let me just add one more thing. I think VFC is also an option for children programs. And there’s so much paperwork and monitoring involved though. You don’t really want to consider that early on when you’re really tiny and it’s going to be dependent on your population.
12:47
I happen to have a fair number of families who might be middle income, but are uninsured because they’re business owners or for some other reason, as well as some lower income families in my practice. And so I think two years out, I finally took the leap,
13:04
but it was when I already had a medical assistant that could help me to do all the data, like the temperature tracking on the fridge and freezer and submitting those reports and filling out all those paperwork and training because That was not something I looked forward to doing. So it was nice to have someone.
13:20
We’re similar. Yes, that’s the thing too that I’m glad that you mentioned that too, because we have VFC because we have a lot of patients that have Medicaid as well, or they qualify for VFC for the reasons that you described. And it’s huge to have that available for them, but it is a lot of work.
13:37
And so that is not something that you need to have buttoned up before you start because they can certainly get their vaccines elsewhere, or you can do the things that we described. throughout this episode as well to get them their vaccines. And then when you have enough momentum,
13:52
then is the time to add that in and just make it more full circle that you can take care of everybody and you don’t have to check. I mean, we still do ask what their insurance is because we have to submit, you know, through VaxCare or through VFC, depending on who’s who,
14:05
but we have a full stock of vaccines for both sets.
14:09
Absolutely. So you have lots of options and I mean, if you live in a state with VaxCare, you’re lucky, take advantage of it. I know, Phil, you’re working on establishing a little bit more of a relationship with VaxCare to see if they’re willing to be more supportive of smaller DPCs that are starting out.
14:26
Do you have hope that there’s going to be traction there?
14:29
I have so much hope and I have actual traction that we’re making like slowly and surely to getting there and getting the right key players on board with this is an important thing to, to support. And it is a financially viable option so that it doesn’t feel like charity work for Vaxcare to take them on, but we’re,
14:49
we’re making progress. So yes, I think that we’re making traction and that there’s hope to be had.
14:56
Wonderful. Well, I’ll keep crossing my fingers. I would say my bottom line is don’t let vaccines and the vaccine challenges keep you from pursuing DPC if you really feel like that’s otherwise a wonderful option for you. There is a way to figure it out.
15:14
Yep. It’s very figureoutable. All right. Until next time. Take care, everyone.
