School-located influenza vaccination with third-party billing: outcomes, cost, and reimbursement.
OBJECTIVE
To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers.


METHODS
SLIV clinics were conducted in 19 elementary schools in the Denver Public School district (September 2010 to February 2011). School personnel obtained parental consent, and a community vaccinator conducted clinics and performed billing. Vaccines For Children vaccine was available for eligible students. Parents were not billed for any fees. Data were collected regarding implementation costs and vaccine cost was calculated using published private sector prices. Reimbursement amounts were compared to costs.


RESULTS
Overall, 30% of students (2784 of 9295) received ≥1 influenza vaccine; 39% (1079 of 2784) needed 2 doses and 80% received both. Excluding vaccine costs, implementation costs were $24.69 per vaccination. The percentage of vaccine costs reimbursed was 62% overall (82% from State Child Health Insurance Program (SCHIP), 50% from private insurance). The percentage of implementation costs reimbursed was 19% overall (23% from private, 27% from Medicaid, 29% from SCHIP and 0% among uninsured). Overall, 25% of total costs (implementation plus vaccine) were reimbursed.


CONCLUSIONS
A SLIV program resulted in vaccination of nearly one third of elementary students. Reimbursement rates were limited by 1) school restrictions on charging parents fees, 2) low payments for vaccine administration from public payers and 3) high rates of denials from private insurers. Some of these problems might be reduced by provisions in the Affordable Care Act.
Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Colorado Health Outcomes Program, University of Colorado, Aurora, Colo. Electronic address: Allison.Kempe@childrenscolorado.org.
Allison
A
Kempe
Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Pediatrics, University of Colorado, Aurora, Colo; Institute for Health Research, Kaiser Permanente, Denver, Colo.
Matthew F
MF
Daley
Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo.
Jennifer
J
Pyrzanowski
National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Ga.
Tara
T
Vogt
Department of Health System, Management and Policy, University of Colorado, Aurora, Colo.
Hai
H
Fang
Health Services Research, Denver Health, Denver, Colo.
Deborah J
DJ
Rinehart
Physician Billing, Denver Health, Denver, Colo.
Nicole
N
Morgan
Denver Public Health, Denver Health, Denver, Colo.
Mette
M
Riis
Denver Public Health, Denver Health, Denver, Colo.
Sarah
S
Rodgers
Institute for Health Research, Kaiser Permanente, Denver, Colo; Public Health Prevention Services, Centers for Disease Control and Prevention, Atlanta, Ga; Denver Public Health, Denver Health, Denver, Colo.
Emily
E
McCormick
Community Health Services, Denver Health, Denver, Colo.
Anne
A
Hammer
Colorado Health Outcomes Program, University of Colorado, Aurora, Colo.
Elizabeth J
EJ
Campagna
Colorado Health Outcomes Program, University of Colorado, Aurora, Colo.
Deidre
D
Kile
Children's Outcomes Research Program, The Children's Hospital, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo.
Miriam
M
Dickinson
Department of Pediatrics, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo; Community Health Services, Denver Health, Denver, Colo.
Simon J
SJ
Hambidge
Department of Family Medicine, University of Colorado, Aurora, Colo; Denver Public Health, Denver Health, Denver, Colo.
Judith C
JC
Shlay
D002648:Child; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D017048:Health Care Costs; D006801:Humans; D017589:Immunization Programs / Q000191:economics* / Q000458:organization & administration; D007252:Influenza Vaccines / Q000191:economics / Q000627:therapeutic use*; D007251:Influenza, Human / Q000517:prevention & control*; D007349:Insurance, Health, Reimbursement; D008297:Male; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000458:organization & administration; D012572:School Health Services / Q000191:economics* / Q000458:organization & administration; D012574:Schools
D007252:Influenza Vaccines
cost of care; influenza immunization; reimbursement; school-based health care; school-located immunization