Immunization Recall: Realizing the Financial Benefit to the Pediatrician

Background:
Patient reminder and recall systems can increase immunization coverage levels by 5-20% in primary care settings. Implementation of reminder recall systems targeting immunizations has also resulted in increased utilization of preventative services, which can generate additional revenue for the provider. Despite these findings, recall systems have yet to be widely adopted by pediatricians.

Objectives:
1. To identify and immunize children ages 19-35 months who are in need of routinely recommended immunizations;
2. To examine the revenue generated from the increased office visits prompted by the recall initiative.

Methods:
Immunization-delayed patients were identified from the Houston-Harris County Immunization Registry (HHCIR). Registry and paper immunization records for these patients were compared. Patients who were still immunization-delayed after record comparison were randomized into 2 groups: standard and enhanced recall. Patients receiving enhanced recall were contacted over a 6-week period. Patients receiving standard recall were observed during the study period and contacted at its conclusion.
The baseline rate at which immunization-delayed patients returned for immunizations without prompting was determined using patients who received standard recall. The additional amount billed and reimbursed per recalled child was calculated.

Results:
4,471 patients were initially identified as immunization-delayed; 1,455 (33%) were up-to-date after record defragmentation. 2,196 active patients were randomized: 1,096 and 1,100 received standard and enhanced recall, respectively.
17% (n=182) and 25% (n=280) (p<0.0001) of patients who received standard and enhanced recall, respectively, scheduled appointments during the study period. An average of $162.41 was billed for each visit, with insurance companies reimbursing $122.02. After adjusting for recall expenses and vaccine costs, an additional $59.83 was billed and $19.44 reimbursed for each patient who received enhanced recall.

Conclusions:
In a time when many physicians believe administering vaccines to be prohibitively expensive, this study suggests that recalling immunization-delayed patients could offset these costs by generating additional revenue.