Quality America

Where's the Flu Vaccine?

Even with record flu vaccine production, 115 million doses, doctor's offices currently turn away some who patients request a flu-shot. At many locations, clinicians postpone vaccinations or serve only high-risk patients. The problem? Sporadic vaccine shortages induced by shipment delays.

Some physician's offices are shipped less than 10% of scheduled delivery amounts, with no promises on when, or if, the remaining order will arrive. Office staffs scramble, spending hours rescheduling hundreds of children signed up for flu shots. Yet immunizations at in-store clinic chains seem to be proceeding without difficulty. Facilities that can't meet patient demand question the fairness of the distribution.

The CDC's director, Julie Gerberding, acknowledged the issue but denied the allegation certain customers were given preferential treatment. Manufacturers and distributors are committed to at least partially filling all orders early on. "But we all know that this is easier said than done," Gerberding said. "We still have providers who do not have vaccine when a large shopping chain does."

The CDC has limited ability to direct distribution, and warns many orders will not be fully filled until late November. Gerberding also calls for "significant effort" to continue immunizations into January. Since flu cases usually peak in February, even doses administered late still provide protection.
Source: The Washington Post, 10/17/2006.

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Posted by Karen @ Quality America on October 18, 2006 | Comments (2)


In reading the OSHA Watch blog you state that he Hep B vaccine can only be billed to the employees insurance if it is through the company worked for. What about flu vaccine? Can you bill the insurance if the employee has a different insurance and not the employers?

Posted by: Deborah Manning, LPN at November 1, 2006 04:03 PM

The cost issue isn't as clear cut with the flu vaccination as it is with the Hep B vaccine. OSHA clearly states the Hepatitis vaccination is at no cost to the employee, but OSHA doesn't say this about the flu vaccine. OSHA has the authority to enforce recommendations made by other agencies, and this is where OSHA positions on flu vaccination cost comes from.

The US Public Health Service (CDC) has published its 2006-07 Recommendations for Influenza Vaccination of Health-Care Workers Prevention and Control of Influenza. They say: "All health-care workers should be vaccinated against influenza annually. Facilities that employ health-care workers are strongly encouraged to provide vaccine to workers by using approaches that maximize vaccination levels... Physicians, nurses, and other workers in both hospital and outpatient-care settings, including medical emergency-response workers (e.g., paramedics and emergency medical technicians), should be vaccinated, as should employees of nursing home and chronic-care facilities who have contact with patients or residents."

You will notice the CDC doesn't specifically mention who should pay! The employer paying for the vaccine could be considered a "approach that maximizes vaccination levels." But, there are other "approaches" as well, so the area isn't black and white, its kind of gray. A non-governmental but nationally influential group, the Association for Professionals in Infection Control and Epidemiology (APIC) has put out a position statement as well.

APIC position statement on flu says: "Remove all costs associated with vaccination. As a patient safety measure, institutions should provide employees with influenza vaccination just as it does other infection control interventions, such as personal protective equipment and hand hygiene products (e.g., soap or alcohol hand rubs, etc.)"

So, according to APIC the employer should clearly pay. But since they aren't a government agency would OSHA enforce their guidelines? Maybe, maybe not. It is really your call based upon how much risk you want to exposure your practice to in this situation. Since the area is gray, if the employee was fine with you billing their non-employee provided insurance it might be okay.

However, my recommendation would be for the employer to pay for the vaccine. This avoids any potential issues down the road. Consider if the employee said they were alright with it, but then their insurance rate went up and they thought it was related to your billing the shot to their insurance. They then called OSHA and complained "My employer made me get a flu shot and they put it on my insurance and now my insurance is so much I can't afford to pay for it!" I am sure that would get OSHA's attention in a way you don't want!

Hope this helps!

Posted by: Sarah Alholm at November 1, 2006 04:04 PM

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  • About Dr. Dunn

Dr. Sheila Dunn is president and CEO of Quality America, Inc., a health care consulting firm located in Asheville, NC. She holds a doctoral degree in medical
laboratory education, and is a widely
respected lecturer and author of more than 200 articles on practice management and regulatory compliance issues for the primary care medical market.
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