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July 7, 2008
By Jim McLean
KHI News Service
TOPEKA, July 7 Dr. Dennis Cooley is not part of the problem.
The Topeka pediatrician is among the relatively few private-practice doctors in Kansas who provide a full-range of immunization services.
"Vaccines are one of the greatest things in medicine," Cooley said between patient visits. "Some people don"t realize that because we"ve been so successful. I don"t think they remember what it was like to see someone with a bad case of the measles or chicken pox."
Few physicians would argue with Cooley about the importance of immunizations. Even so, many in Kansas choose not to provide them.
Kansas ranks among the bottom seven states in the country for the number of private physicians who provide immunizations. In 49 of the state"s 105 counties no private physicians offer vaccinations, according to a recent study done for the Immunize Kansas Kids project, a multi-million dollar effort to improve the state"s immunization rate.
The project is being funded by the Kansas Health Foundation and managed by the Kansas Department of Health and Environment and the Kansas Health Institute.
The same study found that of the private providers who offer immunizations, only 51 percent use the free vaccine available under the federal Vaccines for Children VFC program. Nationally, the VFC participation rate is 81 percent. Also, less than 60 percent of private physicians who provide immunizations treat low- and moderate-income children enrolled in the Medicaid and State Children"s Health Insurance Program.
"Some physicians feel like it"s just not worth the hassle," Cooley said.
For one thing, Cooley said, there is the up-front cost.
"Pediatricians like me may have anywhere from $50,000 to $100,000 in inventory sitting in refrigerators in their offices," he said, referring to the cost of the vaccines required to protect his young patients from 11 childhood diseases.
Then, Cooley said, there are the additional costs of refrigerators to store the vaccine and special thermometers to trigger alarms if something like a power failure causes the temperature inside to inch too high. Many immunization providers also purchase generators for back-up power.
Another problem, Cooley said, is that insurance company reimbursement rates vary widely. Sometimes, they don"t cover the cost of administering vaccines.
Richard Morrissey, interim director of health at the Kansas Department of Health and Environment, said a "liability crisis" in the 1980s and early 1990s caused some private physicians to stop offering immunizations. He said many who stopped never resumed even though a federal program was established to help protect them from immunization-related lawsuits.
Citing the same cost and reimbursement factors as Cooley, Morrissey said the way the immunization system is set up "isn"t a good business model" for physicians.
The IKK steering committee, which includes representatives from 32 provider, public health and health care organizations, is recommending strategies to increase the number of private physicians giving immunizations. They range from the establishment of a vaccine purchasing program to lower physicians" up-front costs, to an educational campaign that will employ physicians to convince other physicians to participate in the VFC program. Accelerated implementation of the state"s immunization registry a digital tool for keeping track of immunization records also would help physicians manage their vaccine inventories.
Parents also are key to improving the Kansas immunization rate which ranks 35th among the 50 states. Parents surveyed for the IKK project said it is inconvenient when they can"t get their children immunized at their doctor"s office and must instead go to a local public health department. That inconvenience, they said, sometimes causes them to get behind schedule in having their children immunized.
Tracy Barngrover of Topeka said being able to have her children immunized during regularly-scheduled visits to Dr. Cooley"s office has helped her stay on schedule.
"Dr. Cooley"s office is good about reminding you," she said. "If you pay attention at all to what they"re telling you, it"s no problem."
-Jim McLean is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached a firstname.lastname@example.org or at 785-233-5443, ext. 110.