Cost Considerations for Immunization Recall by Private Providers

Background:
Private providers are encouraged to conduct immunization recall to increase immunization rates. However, costs of immunization recall in the private setting are not well understood.

Objectives:
To describe the costs of immunization recall by private providers.

Methods:
Private practices in metropolitan Detroit, Michigan, were invited to participate in an intervention to increase the use of immunization recall using the Michigan
Care Improvement Registry (MCIR). Participants were provided with hands-on training and ongoing technical support, and were asked to conduct immunization recalls using MCIR over a one year period. Practices recorded labor hours associated with each step of the recall process; recall experiences were documented through interviews with practice managers. Labor costs were estimated based on U.S. Bureau of Labor job classification averages.

Results:
The 17 participating practices conducted a total of 53 recall cycles. Recall tasks utilized 639 labor hours from practice personnel, most commonly office managers (36%) and nursing staff (27%), and to a lesser degree, medical assistants (16%) and physicians (16%). Importantly, practices utilized 270 additional hours from state-funded MCIR staff for training and technical support. Practices typically performed recall tasks during regular work hours, rather than using additional time. Mean cost per recall was highest for the initial recall cycle, with lower costs for subsequent recalls. Overall, recall costs varied widely across practices, influenced by the degree of office automation, staffing mix, practice size, and staff turnover.

Conclusions:
Costs for immunization recall in the private setting are affected by a variety of practice and staff characteristics. The higher costs for initial recall cycles reflect the time and effort required to learn and implement new systems; conducting recalls during regular work hours suggests that opportunity costs may also exist. In addition, the need for outside technical support is considerable, for both initial recall activities and in cases of staff turnover.