Vaccination and Billing Outcomes From a Multi-Site School-Located Vaccination Program for Adolescents

Background: Few school-located vaccination programs have billed health insurance for vaccines given, which may hinder sustainability.

Objectives: To assess vaccination and billing outcomes of a school-located vaccination program, open to all adolescent students regardless of insurance status, and designed to bill health insurance for vaccine and administration fees.

Methods: From January through May 2010, 21 vaccination clinic days were held for 6th through 8th grade students at 7 Denver public schools. School personnel obtained parental consent, and public and community health personnel verified insurance, conducted clinics, and performed billing. Parents did not receive bills for any uncovered costs.

Results: Of 3057 enrolled students, 359 (12%) received one or more vaccines at a school-located vaccination clinic. Comparing January to May 2010, overall vaccination rates in study schools significantly increased for ≥1 tetanus-diphtheria-acellular pertussis (75.3% to 82.3%, p<0.01), for ≥1 meningococcal (60.6% to 69.1%, p<0.01), and among female students for ≥1 human papillomavirus (46.3% to 55.3%, p<0.01) vaccines. Forty-four percent of vaccinated students were uninsured, 27% privately insured, 21% Medicaid-insured, and 8% insured by the State Child Health Insurance Plan (SCHIP). Overall program costs to the public health entity and school district for conducting clinics and administering vaccines were estimated at $25.25 per vaccine given. For vaccine costs, payment of any amount >$0 was received for 49% of private and 62% of SCHIP claims; for administration fees, payment >$0 was received for 42% of private, 86% of SCHIP, and 94% of Medicaid claims. Overall, 58% of total vaccine costs and 10% of non-vaccine program costs were covered with reimbursement from third-party payers.

Conclusions: A school-located program vaccinated students with private, public, and no insurance. Although billing procedures were implemented, reimbursement was substantially less than vaccine and non-vaccine costs. Increasing reimbursement while reducing program costs may be needed to ensure sustainability.