Influenza vaccinations of Washington state Medicare beneficiaries seen by physiatrists in the outpatient setting in 1994.
OBJECTIVE
To compare influenza vaccination billing rates for patients seen by physiatrists with those of four other specialties: neurology, rheumatology, family practice, and internal medicine.


METHODS
Retrospective cohort analysis using Medicare billing data.


METHODS
234,164 Medicare outpatients seen in Washington state between September 1 and December 31, 1994.


RESULTS
Based on Medicare's billing data, only 6 of 99 physiatrists ordered vaccinations, and they immunized only 159 (6%) of the patients seen. An additional 1,109 (42%) patients seen by physiatrists were vaccinated by other physicians. Physiatric patients were less likely to have been vaccinated than those seen by internists, family practitioners, or rheumatologists (p < .002), but equally likely as those seen by neurologists (p = .07). A significantly smaller percentage of physiatrists ordered vaccinations than all other specialties (p < .04). Utilizing pre-existing survey data, the misclassification rate (those immunized but not billed) was estimated at 22% of our original cohort. Thus, approximately 800 patients, one third of those seeing physiatrists, may not have been immunized. We estimated the increase in hospitalization costs to be $117 per nonvaccinated patient (total >$90,000).


CONCLUSIONS
Missed opportunities for vaccination by physiatrists appear to be more frequent than in other specialties and have potentially large health and economic costs.
Chan
L
L
Division of Clinical Standards and Quality, Health Care Financing Administration, Region 10, Seattle, WA 98121, USA.
Houck
P M
PM
Rosenblatt
R A
RA
Hart
G
G
Baldwin
L M
LM
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D007252:Influenza Vaccines; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D007388:Internal Medicine / Q000706:statistics & numerical data; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data; D010810:Physical and Rehabilitation Medicine / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012219:Rheumatology / Q000706:statistics & numerical data; D014481:United States; D014611:Vaccination / Q000706:statistics & numerical data*; D014861:Washington
D007252:Influenza Vaccines