Holding Providers Accountable: Philadelphia Vaccine Reimbursement

Background: In February 2007, the Philadelphia VFC Program introduced a new vaccine wastage policy to VFC Providers.  The policy holds providers accountable for any vaccine expiration or wastage due to provider negligence by requiring the provider to reimburse the program for the vaccine cost. 

Objectives: To determine the impact of the Philadelphia VFC Vaccine wastage policy on overall program wastage and compliance of providers with VFC policies.

Methods: Records were reviewed to determine the number of doses and VFC cost of the vaccine that was reimbursed between October 2007 and September 2010.  Record reviews included determining the number of doses for reimbursement, VFC cost at the time of the wastage, number of days the provider was suspended, and reason for the wastage.  Reimbursement and total VFC wastage for each fiscal year were compared.

Results: From October 2007 through September 2010, 85 (37%) VFC providers were suspended from the VFC Program due to negligent vaccine wastage or expiration.  These 85 providers included a total of 121 cases of suspension (some providers were suspended multiple times).  Reimbursement occurred in 86 cases (71%) of negligent wastage.  Over the three-year period, the amount of vaccine that was wasted due to provider negligence decreased.  The total cost of vaccine submitted for excise tax by the VFC Program remained consistent meaning that vaccine still continued to be wasted.  

Conclusions: Providers over the three years of policy implementation have increased their compliance with VFC policies as indicated by the decrease in reimbursement costs. However, the overall cost of VFC Program wastage has not decreased with the implementation of the reimbursement policy.  Provider education efforts have increased provider knowledge and awareness of vaccine wastage policies and increased compliance with VFC Policies.  Implementation of additional VFC policies and education addressing prevention of vaccine wastage and appropriate vaccine ordering patterns may continue to be necessary.