By Dr. Sue Kressly
Vaccines save lives.
I was going to stop there. For pediatricians, that’s a given. What’s not a given is how to effectively manage vaccines for the benefit of your patients, your community and your practice.
First, if improving immunization rates and vaccine management are not one of your Continuous Quality Improvement (CQI) project in your office, I urge you to start today. The immunization schedule and available products continues to grow and get more complex. Vaccine financing can add to practice profitability and success, or be a significant loss to the bottom line if not managed well. High immunization rates in your practice translates to a protected community and a high performing practice which is often rewarded in pay-for-performance (P4P) programs. This core of pediatric care delivery deserves your continued attention.
Where to start? All good CQI projects start with a team. Why a team? Because immunizations affect everyone in your office. Does your triage staff look at vaccine status when speaking to families? Do they notice that a patient hasn’t had their MMR when they are triaging a child with a fever and a rash who just travelled abroad? Do they have clear direction on how to triage this patient in a way that doesn’t put newborns in your waiting room at risk? What does your check-in staff say when a mother asks, “will Sally be getting any shots today?” When your providers decided to change from HPV4 to HPV9, how does your staff know to make appropriate changes in the billing system and update your fee schedule? Who notices when insurance company x is not paying you as much as it is costing you for a particular vaccine? What do you do about it? You “think” that your practice has a unified voice about vaccinations, but do you know if your immunization rates are different among all your providers?
This may seem overwhelming at first, but that’s the beauty of a PDSA cycle. First, your team should first make a list of potential questions you would like to answer, and identify any processes you would like to improve. From there, the group can elect to get some baseline information to prioritize your focus or tackle a single high-impact project. Do you know what your immunization rates are for the Every Child by Two metric? What about your adolescents? As you begin the planning phase of the project, you need to ask yourselves, “what is it that we are trying to accomplish?” It’s important to get relevant feedback from different stakeholders so that you have a complete view of the task at hand.
Many of the CQI projects people are familiar with are part of P4P programs. The same mindset can be used to improve practice operations and vaccine management. Would your practice benefit from a project directed at improving your vaccine profits, reducing wasted vaccine product, examination of the impact of combination vaccines, or development of a policy regarding vaccine hesitant families? The “C” in CQI is for continuous…make improving immunizations and your practice vaccine management an integral part of your DNA.