Government’s Decision may result in increased costs to the health care system
Government hopes to save $496,233 by eliminating physician-delivered flu shots under MCP. These savings will be used to pay for the expansion of the HPV vaccination program to include males at a cost of $360,000. Eastern Health will need $227,000 to accommodate patients who will no longer be vaccinated by doctors. These two items alone will result in an increased expenditure of $90,767 before factoring in: 1) costs for the other regional health authorities; 2) the replacement MCP billings of physicians for patients they will see when they are no longer providing flu shot-only appointments; and, 3) the costs associated with extra emergency room visits and hospitalizations that will likely occur if flu shot coverage is reduced. It costs Eastern Health $9 per influenza immunization. If this cost is consistent across other RHAs, it could cost between $355,000 and $400,000 to accommodate the 39,500 to 44,500 patients that will be displaced from physicians this year in addition to the $360,000 needed for the HPV vaccination program.
“...we would have to incur the cost of hiring and orientating a seasonal influenza team to do this additional work across Eastern Health. It may involve some travel costs as well..."
Email from Manager of Public Health – Peninsulas, Eastern Health to Vice President, Clinical Services, Eastern Health, February 20, 2017
“Eastern Health can do it in mass immunization clinics but it would need resources. We currently immunize about 17,000 in our current clinics but it costs us $250K which is unfunded so a deficit for us.”
Email from Vice President, Clinical Services, Eastern Health to Medical Consultant, DHCS, February 21, 2017
“Other than moving the service to the correct provider there is no financial gain and a lot of physician unrest that would be caused by this.”
Email reply from Medical Consultant, DHCS to Vice President, Clinical Services, Eastern Health, February 21, 2017
“We should address the potential concerns around the proposed delisting of the fee code for physicians for influenza immunizations…We expect uptake to RHA for that and we are quite over budget in the city for that already.”
Email from Vice President, Clinical Services, Eastern Health to Assistant Deputy Minister (Policy, Planning and Performance Monitoring), DHCS, March 30, 2017
“Our public health shortage is in the city. Last year we spent $175K over budget on influenza vaccination team in the city – this was above our usual vaccination numbers and excluded rural delivery.”
Email from Vice President, Clinical Services, Eastern Health to Assistant Deputy Minister (Policy, Planning and Performance Monitoring), DHCS, March 31, 2017
“Dividing the cost of the influenza campaign in 2016/17…by the number of doses given by PHNs gives us a cost of approximately $9.00 per dose…We are assuming that 75% of individuals who were vaccinated by physicians will come to public health clinics for their immunizations. That would mean a further 25,000 individuals to immunize. Added to the nearly 18,000 individuals PHNs immunized this year, that number would be approximately 43,500…The cost of immunizing 43,500 individuals at a cost of $9.00 per immunization is $391,500. Therefore, the differential between EH actual costs to date and physician administration replacement costs would be $227,000. This does not take into account our goal of increasing the uptake of influenza vaccine but merely represents the status quo … We would need to run clinics 6 days per week to keep up with the demand. This would mean hiring additional staff to enable this to be completed along with other public health work."
Eastern Health Influenza Immunization Briefing Note, April 3, 2017
“Our (Eastern Health’s) actual costs for influenza now are $165 (already in a deficit position). Uptake of physician administered vaccine group estimated at a further $227K. Uptake of HPV for boys will be 47K. Total new money required for HPV and influenza (new uptake only) is $274K”
Email from Vice President, Clinical Services, Eastern Health to Assistant Deputy Minister (Policy, Planning and Performance Monitoring), DHCS and President and CEO, Eastern Health, April 3, 2017
"There is therefore some risk involved with the plan to eliminate the influenza fee code and use the savings to introduce HPV for boys. We are estimating the cost of the vaccine alone at $360,000. While we should be safe to estimate that we will save that much money, we have little certainty around whether we have the flexibility to add on the additional public health resources that we have heard will be needed in Eastern and Western.”
Email from Assistant Deputy Minister (Policy, Planning and Performance Monitoring), DHCS to Chief Medical Officer of Health, DHCS, April 5, 2017