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Health Objectives for the Nation Implementation of the Medicare Influenza Vaccination Benefit -- United States, 1993

Influenza is a major cause of debilitating illness and premature death in the United States, particularly among persons aged greater than or equal to 65 years and those with chronic conditions such as lung or heart disease, diabetes, and cancer. Medicare reimbursement for excess hospitalizations during influenza epidemics ranges from $750 million to $1 billion (1). In May 1993, influenza vaccination became a covered Medicare benefit after its potential cost-effectiveness was established by the Medicare Influenza Vaccine Demonstration (2). During the fall of 1993, the Health Care Financing Administration (HCFA) initiated an information campaign to promote use of the influenza vaccination benefit, implemented simplified billing procedures, and improved electronic billing capabilities. However, reports during the 1993- 94 influenza season suggested problems experienced by state and local health departments in implementing the new benefit. To characterize public influenza vaccination programs and problems with implementing this benefit, in the spring of 1994, CDC collected information from all 63 state and local health departments receiving federal immunization grants. This report summarizes the reports from these programs.

During April-May 1994, immunization grant programs were mailed a questionnaire asking whether they implemented influenza vaccination programs and about use of the Medicare influenza vaccine benefit. Of the 63 health departments, 45 (71%) responded; of these, 27 (60%) reported conducting influenza vaccination programs during 1993-1994 and answered questions about influenza vaccination and Medicare. All 27 reported at least one of the following problems with initial implementation of the Medicare influenza vaccine benefit: 1) perceived complex billing procedures, problems with claim forms (completion and complexity), or uncertainty about how to determine eligibility (18 {67%} of 27); 2) lack of timely, accurate, and/or complete publicity and information about the benefit (17 {63%}); and 3) concerns about reimbursement for vaccine administration (e.g., varying rates within the same state and use of state funds to buy a federally reimbursed vaccine) (14 {52%}).

Respondents reported the need for two categories of improvement: 1) improved billing, claim forms, and/or eligibility procedures (24 {89%} of 27); and 2) timely and accurate publicity and information dissemination (14 {52%}). Reported by: Selected immunization program managers and project directors. Consumer Information Team, Health Care Financing Administration. Epidemiology and Surveillance Div, National Immunization Program, CDC.

Editorial Note

Editorial Note: One of the national health objectives for the year 2000 is to achieve 60% influenza vaccination coverage in noninstitutionalized persons at high risk for complications of influenza, including those aged greater than or equal to 65 years (3). During 1991, only 41% of persons aged greater than or equal to 65 years reported having received influenza vaccine during the previous year (4). Implementation of the Medicare influenza vaccination benefit is expected to improve coverage in this population by reducing the financial barrier to vaccination. Preliminary data from HCFA indicate that, during September-December 1993, claims for influenza vaccine were filed for 9.8 million Medicare beneficiaries aged greater than or equal to 65 years (HCFA, unpublished data, 1994); however, this number represents only 34.6% of all Medicare beneficiaries who do not routinely receive their services from health maintenance organizations (HMOs) (data are not available on vaccination levels in Medicare beneficiaries served by HMOs). An estimated 10%-20% of Medicare beneficiaries may have received influenza vaccinations that were not billed to Medicare (HFCA and CDC, unpublished data, 1994). Vaccines were provided at public health clinics, health fairs, private medical settings, and other sites that did not bill Medicare, including hospitals not submitting separate bills for influenza vaccinations. Private providers delivered approximately 80% of all influenza vaccinations administered to persons aged greater than 65 years.

During the first year of Medicare influenza vaccine coverage, some providers reported not receiving timely information about the new benefit. To improve influenza vaccination of Medicare beneficiaries and use of other covered prevention services, in May 1994, HCFA initiated the Consumer Information Strategy (CIS) (5). Through CIS, HCFA will develop and provide information on choice and use of health-care services to physicians, other health-care providers, consumer-based and professional societies, peer-review organizations, contractors, state health departments, other federal agencies, and to Medicare and Medicaid beneficiaries (5). The strategy initially focuses on major campaigns to increase beneficiary use of influenza vaccine and other preventive services.

In 1992, collaborative activities of the Medicare Influenza Vaccine Demonstration increased overall influenza vaccination rates to 59% among Medicare beneficiaries aged greater than or equal to 65 years (2). Similar activities may be necessary to improve the vaccination rates for other vaccines intended for adults. Achieving the national health objectives for adult vaccination will require multifaceted strategies to reduce cost and accessibility constraints, increase collaboration between public and private sectors to improve awareness and service delivery, and evaluate vaccination programs.

References

  1. McBean AM, Babish JD, Warren JL. The impact and cost of influenza in the elderly. Arch Intern Med 1993;153:2105-11.

  2. CDC. Final results: Medicare Influenza Vaccine Demonstration -- selected states, 1988-1992. MMWR 1993;42:601-4.

  3. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991:122-3; DHHS publication no. (PHS)91-50213.

  4. Heath KA, Strikas RA, Stevenson J, Williams WW. Influenza and pneumococcal vaccination among older adults: results of the 1991 National Health Interview Survey {Abstract}. In: Program and abstracts of the CDC Epidemic Intelligence Service 43rd annual conference. Atlanta: US Department of Health and Human Services, Public Health Service, CDC, 1994:33.

  5. Vladeck BC. From the Health Care Financing Administration: the consumer information strategy. JAMA 1994;272:196.




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