Lately, people opposed to vaccines have been very upset about a recent finding that Blue Cross Blue Shield of Michigan has a Performance Recognition program for provider incentives, including paying $400 to providers for every fully vaccinated two year old in their practice. This screen shot comes from page 16 of the document:
As you can see, the target is 63% of patients, so people opposed to vaccines think this means that if a provider can vaccinate at least 63% of two year olds in his or her practice, they will receive $400 per patient. As many pediatricians have between a few hundred to 1000 patients, people opposed to vaccines postulate that providers could be earning as much as $80,000 extra a year for vaccinating.
There are many problems with this claim. First of all, most people opposed to vaccines (POTVs) are not recognizing or posting that this program is only for BCBS of Michigan providers and only if they join the incentive program, called the Physician Group Incentive Program. Secondly, POTVs are not clarifying this only works for patients insured by BCBS, with providers enrolled in the program. Thirdly, they are also not clarifying that the program is comprehensive and involves many different healthcare outcomes, not just vaccines. There are incentives for helping patients achieve healthy weight, healthy diabetes control, hypertension control, and more. Finally, POTVs are not sharing that these programs SAVE the insurance company money.
Blue Cross Blue Shield of Michigan is a non-profit company. Saving $155 million a year is considerable and enables them to make healthcare more affordable for all enrollees. They have done a seemingly tremendous job creating partnership programs with providers that save money and keep people healthy. Pediatricians earn a good living, but compared to most specialties, they earn considerably less. The average pediatrician earns $175,400 a year while cardiologists earn $525,00 a year and orthopedic surgeons earn almost that much. Clearly, pediatricians could earn far more money with other medical specialties. Furthermore, BCBS of Michigan doesn’t come anywhere near paying out the $80,000 per provider POTVs estimate because this benefit only applies to a few children.
Think about this: How many fully vaccinated, two year old children are there in a pediatrician practice? Pediatricians see patients from age newborn to 21. Even if they are getting $400 per fully vaccinated two year old, pediatricians usually have a case load of 1000 patients each so that would be about 45 two year olds per practice. They are not going to all be fully vaccinated. The threshold is 63% and not all providers will meet it. Assuming they do meet it, 63% is 28 two year olds so that could mean $11,000 a year, but only if they meet the threshold. After taxes, that would be an extra $7000 a year, perhaps? And, remember, the insurance company IS SAVING MONEY by offering this and other incentives. In fact, if you browse the brochure, they pay out more for vaccines than anything else. That tells me that vaccination saves them MORE money than the other health indicators.
So what if insurers pay out providers a benefit when they vaccinate? This is about saving money, in the long run. Insurance companies save money when children are healthy. They lose money when children are chronically ill or hospitalized. This incentive is PROOF that vaccines work and save insurance companies money.
Always think for yourself.