BACKGROUND:
For private providers who administer influenza vaccinations, vaccine purchasing and reimbursement for vaccine is a constant challenge. In 1997, influenza vaccine was plentiful and inexpensive and there were multiple manufacturers of influenza vaccine. In 2003, the average cost for a 10-dose vial of vaccine was $75-$80 and only two manufactures produced influenza vaccine. At the same time that the cost was increasing, reimbursement for vaccine has become increasingly complex.

OBJECTIVE:
To give private providers the opportunity to stabilize and/or reduce their cost of purchasing vaccine and to facilitate the process of filing for reimbursement from third-party insurers.

METHOD:
Beginning in 2001, OSAIC collaborated with all third-party payers in the state to offer a reimbursement training workshop. Each insurer sent a representative to teach participants about proper CPT code use, which forms to use and necessary information, roster billing practices, avoiding pitfalls and a single point of contact. In 2002, OSAIC instituted a physician purchasing cooperative for adult influenza vaccine.

RESULT:
In the pilot year of the purchasing cooperative, five physicians participated and ordered a total of 800 doses of vaccine. In February 2004, the cooperative had 49 providers participating who placed orders for 24,050 doses of vaccine. Providers are also more confident in their ability to file reimbursement paperwork promptly and correctly.

CONCLUSION:
With a purchasing cooperative, providers recognized a financial savings and also had the convenience of having an outside party manage the order. Reimbursement workshops are a win-win opportunity. The providers get payment in a more timely fashion because claims don't get kicked back due to errors. And insurers get paperwork filed correctly the first time around. OSAIC found that facilitating the challenges of vaccine purchase and reimbursement for providers will help to insure that private providers stay in the adult vaccination business.

LEARNING OBJECTIVES:
1. The importance of a purchasing cooperative.
2. Details on forming and managing a purchasing cooperative.
3. The value of promoting compliance of reimbursement.
4. How to plan and execute a reimbursement training workshop.