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VFC-AFIX Quarterly Conference Call Minutes
July 2009

Summary

VFC Updates

• Fraud & Abuse
• VFC Management Survey
  • How does CDC use the information
  • Accurate reporting
  • Definitions for VFC follow-up and VFC contact

AFIX Updates

• American Board of Pediatrics Maintenance of Certification requirement and development of a modified AFIX process/track
  

Other VFC/AFIX Updates

• IPOM Chapter 4 -- 4.1a.
• CoCASA Training Website: http://www.cdc.gov/vaccines/programs/cocasa/training.htm 
• CoCASA Team Lead Update
• Vaccine University - May or June 2010 in Atlanta

VMBIP Updates

• PPOC Users’ Guide
• VTrckS Rollout Strategy

Minutes

VFC Updates (Nancy Fenlon and Kevin Malone)

• Introductions: Kevin Malone is our legal counsel for the VFC program who is from the Office of General Counsel at CDC. He joined the call to discuss the topic of Fraud & Abuse in the context of the VFC Program.
• Fraud & Abuse
  Kevin Malone discussed the importance for programs to have processes in place to help prevent and address situations involving fraud and abuse. The VFC program has grown and evolved over the last 15 years. A mature VFC program creates high expectations for accountability by VFC providers and active oversight by state VFC programs. CDC encourages grantees to review and update their fraud and abuse policies as their experience gives them new insights into issues related to oversight of the VFC program. Fraud and abuse oversight runs the gamut from avoiding and addressing mistakes based on ignorance or inadvertence to intentional fraud and abuse. Education of providers prior to VFC enrollment and throughout their tenure as a VFC provider, proper accountability and record keeping by VFC providers, and diligent fraud and abuse oversight by VFC programs go hand in hand in assuring the integrity of the VFC program.
• VFC Management Survey
  Nancy Fenlon walked through a slide presentation to discuss the VFC Management Survey, its purpose, efforts to improve data quality reported to CDC, and definitions for VFC follow-up and VFC contact. The decision to create and share this presentation during July’s quarterly call was made based on the feedback received during the VFC trainings held in Atlanta in the spring, and also based on the discussion that followed the previous review of "Purpose of Contact" Definitions during the April Quarterly Conference Call.

Highlights from the presentation:

• VFC Management Survey was created in 2002 to assist CDC in gathering information from grantees on both VFC & AFIX activities
• From 2002-2006, the data analysis primarily focused on AFIX activities. In 2006, analysis of the VFC data showed the data was difficult to interpret because many surveys had missing or inaccurate data. These issues would limit CDC’s ability to use VFC related data in a meaningful way. To improve this, the first goal was to have grantees submit the survey in a timely manner and have the data that was reported be accurate. Next, our goal is to be able to use all the data submitted to support both the annual VFC/AFIX report and funding requests to OMB regarding VFC & AFIX activities. Thanks to the grantees efforts, we are making progress toward these two goals. For the 2008 VFC Management Survey, CDC had the best submission of on-time VFC Management Surveys ever. The completion has improved and the number of questions left blank decreased. But as with any program, there is still room for improvement.
• The difference between planned VFC follow-up vs. reported VFC follow-up and definition for VFC Contacts were discussed.
  • Question #32a & #32b of CDC’s Site Visit Questionnaire documents Corrective Action plans for providers who answer a high priority question incorrectly in Section I of CDC’s VFC Site Visit Questionnaire. Once the Corrective Action plan is developed in Question #32, how that plan will be followed-up is documented in Question #33 of the VFC Site Visit Questionnaire.
  • To illustrate the example, the difference between the number of planned follow-ups compared with the number of reported follow-ups for three example grantees in 2008 was discussed.
• We all can understand and appreciate the amount of time and effort site visits involve. Furthermore, to improve provider compliance with VFC requirements requires follow-up which involves additional time and effort from staff. CDC would like to be able to illustrate follow-up activities as a key component of the VFC program, as it reflects a significant amount of time & effort made by the grantees. However, at this time, the data we are receiving appears to show a discrepancy between planned follow-up compared to follow-up that is documented as being completed. Follow-up may be occurring, but perhaps not documented and reported correctly via the Management Survey.
• There are several slides that show the evolution of VFC follow-up and VFC contact definitions. In 2006, when VFC follow-up was initially established, it was a catch-all for any type of contact with a VFC provider between site visits. In 2007, delineation was made between VFC follow-up and VFC contact. This was done to be able to have more precision in identifying what caused the communication/interaction with the provider. If the interaction is related to a site visit issue, it was defined as a VFC Follow-up. If it was related to something identified outside of site visit, the communication/interaction was defined as a VFC contact. These definitions remained unchanged for two years (2007 & 2008).

  In 2009, VFC follow-up has been expanded to three levels of VFC follow-up. This was done to accommodate long term follow-up related to complex non-compliance issues. The three levels are:

• VFC follow-up for issues that need follow-up but are not significant to enroll into Secondary or Tertiary Education follow-up
• VFC Secondary Education Follow-up: A contact with a provider who was identified with VFC compliance issues and enrolled in Secondary Education program, and this follow-up is part of the Secondary Education program.
• Tertiary Education Follow-up: A contact with a provider who was identified with VFC compliance issues and enrolled in Tertiary Education program and this follow-up is part of the Tertiary Education program.
• The definition for VFC contact remains the same since it was created in 2007. The three levels of follow-up started in 2009 and will be reported in VFC Management Survey due March 1, 2010.
• Changes to the definition of "follow-up letter" for 2010:
  • Beginning 2010, the planned follow-up option of “follow-up letter” will be changed to “Routine Follow-up letter” and will be excluded from the count of “planned” follow-up. This change will be reflected in the Site Visit Questionnaire and in CoCASA.
    
  • If a letter is written specifically for an individual provider (no template is used) - document this as “other” in Question #34.
    
  • Also please note that the numbering for the 2010 questionnaire will change slightly so question #33 in 2009 will become tentatively question #34 in 2010.
    
  • When the letter (non-routine and specific) is sent, document an appropriate level of VFC follow-up: VFC follow up VFC Secondary Education Follow-up or VFC Tertiary Education Follow-up. If using CoCASA, you can document this on the Visit Information sub-tab.
    
  • For routine letters, no documentation needs to occur when that letter is sent out. If using CoCASA, you would have already indicated “Routine Follow-up letter” under question #34.
• VFC Contact

• This slide provides some parameters for what to include when documenting VFC contacts and what not to include. If a single issue takes multiple interactions over a period of time that should be reported as a single VFC contact. When CDC reports this information to OMB, we provide examples of situations that represent VFC contact and VFC follow-up.
  
• Even by setting some moderately tight parameters on what to count as a VFC contact – CDC feels that what has been reported in previous years represents an undercount of the effort that grantees expend on the VFC program. If it is not documented – we must assume that it is not done.

• If you use CoCASA to administer Section One of the VFC Site Visit Questionnaire, all follow-up and contacts made can be documented in CoCASA. If you do not use CoCASA, you must have a method to document the 3 different levels of follow-up (VFC follow-up, VFC Secondary Education follow-up, VFC Tertiary Education follow-up) and VFC contacts. The goal is to report follow-ups & contacts accurately.
  

AFIX Updates (Nathan Crawford)

• Nathan discussed a requirement the American Board of Pediatrics (ABP) will begin in 2010 that will require pediatricians seeking board certification to participate in an approved quality improvement (QI) activity to maintain certification. Additional information on this requirement can be found at the American Board of Pediatrics website: http://www.abp.org .
• Efforts are being made to explore the creation of an alternative AFIX track that would become an ABP approved quality improvement activity, so that pediatricians interested in meeting their maintenance of certification requirement would have the option of using an ABP approved AFIX option to meet that requirement. The development of the alternative/enhanced AFIX option is still in a preliminary stage. The process will be developed and piloted in two locations: California and Colorado.
• To clarify, the current AFIX process that grantees are implementing now would remain. A new, optional AFIX track would be developed. A component of the new track/option would likely involve having the grantee educate and guide the provider on the enhanced AFIX process and then eventually having the provider/practice be engaged in performing their own routine assessments and feedback.

Additional VFC-AFIX Updates (Mary Huynh)

• Updates to the IPOM will be posted to the CDC website in the next couple of weeks, which will include a change to Chapter 4 – 4.1a. Please refer to the updated version of Chapter 4 when working on your 2010 grant. Under “4.1a.” we’ve removed the requirement to submit written AFIX policies and procedures – so we will not be asking for that submission next year in 2010. You will still be required to submit the AFIX Standards Self Assessment Worksheet with the grant.
• Recordings and transcripts from the April and May CoCASA webinars are available on the CoCASA training website located at: http://www.cdc.gov/vaccines/programs/cocasa/training.htm.
• Troy Waddington, who has been our CoCASA team lead, is currently on a temporary detail assignment. Pamela Jones will be filling-in as a back-up. If you have any CoCASA related questions that you may have contacted Troy directly in the past about, please send your questions to the CoCASA help desk: nipcocasa@cdc.gov or 1-800-803-5212.
• Vaccine University will be in May or June of 2010 in Atlanta. Please include travel expenses for this meeting in your 2010 grant.
  

VMBIP Updates (Jeanne Santoli & Brad Prescott)

• PPOC Users’ Guide
  Jeanne Santoli provided a summary of the changes recently made to the PPOC User’s Guide. (Note: an all-grantee message was sent on July 9th highlighting significant changes. A revision to this email and updated PPOC Users Guide was sent July 10th. Please refer to the July 10th email for the updated copy of the guide and message.)
  
  Noted in the July 9^th email:
  
  Following are four important changes and updates since the last version of the PPOC Users' Guide was published in March 2009. Additional details about these updates are available in the bolded section(s) listed at the end of each bullet.

• The preferred method of contacting McKesson Specialty Customer Care to hold or cancel an order is by phone. If you want to follow up with an email for documentation purposes, note in your email that you have already spoken to someone at McKesson Specialty Customer Care. (A. Customer Service; B. How to Ensure Provider Orders Are Received in a Timely Manner; N. Provider Order Cancellation)
• Questions about vaccine viability during shipment (e.g., if the temperature monitor is out-of- range or not activated) must be received by McKesson Specialty Customer Care within two hours of provider receipt of a vaccine shipment. To facilitate this requirement, providers are encouraged to contact McKesson Specialty Customer Care directly via a dedicated phone line 877-TEMP123 (877-836-7123). Updated text on the temperature monitoring cards provides this phone number and instructs providers to call with vaccine viability concerns as soon as they receive the product. McKesson Specialty Customer Care ensures you are made aware of these calls, and you have a role (in conjunction with CDC) in requesting manufacturer advice about vaccine viability as part of this new liability procedure. (A. Customer Service; C. Shipments)
• Implementation of a new shipping box eliminates the need for empty box returns for all grantees (even those who will not be receiving vaccines in the new shipping box). The new box is being phased in over a two-month period (which began on June 22, 2009) with approximately 20 percent of all orders added every two weeks. Please note that the new box is NOT being utilized at this time for locations in Alaska, Hawaii, Puerto Rico, the Pacific Islands, and the U.S. Virgin Islands. These new shipping boxes do not contain pre-printed return address labels. When non-viable vaccines need to be returned to McKesson Specialty Distribution, you (not the provider) must contact McKesson Specialty Customer Service to schedule a pick-up. (G. Wasted or Expired Vaccines; I. No More Empty Box Return)
• New procedures are in place to address overshipments, misshipments, and overorders to minimize vaccine wastage. (C. Shipments)

Correction noted in the July 10th email:

• Below is a correction regarding wasted/expired vaccine returns, which is described on page 16 of the updated PPOC Users' Guide. The guidance should read as follows:
  • 2. With the June 22, 2009, implementation of the new shipping box, providers no longer return empty boxes to McKesson Specialty Distribution, and these new shipping boxes do not have pre-printed return address labels. When nonviable product needs to be returned to McKesson Specialty Distribution, you must [need to] contact McKesson Specialty Customer Care at 1-877-822-7746 to request a return label. McKesson will then send the return label to the provider via the U.S. Postal Service. Upon receipt of the return label, the provider must contact you, and then you must contact McKesson Specialty Customer Care to coordinate the pick-up service. UPS will be dispatched within 1 to 2 days following your contact with McKesson. Providers may NOT contact McKesson Specialty Customer Care to coordinate pick up of wasted/expired vaccine. However, if the provider has a regularly scheduled UPS pick up at their facility, it is not necessary for you to contact McKesson to schedule the pick up; the provider may hand the labeled box of wasted/expired vaccine to the UPS driver if this is acceptable to you.
• This correction appears in the PPOC Users' Guide, version 2.0.1.
• VTrckS Rollout Strategy
  Brad Prescott provided an overview of the VTracks Rollout Strategy. CDC is in the process of summarizing the rollout strategy and developing a Frequently Asked Questions document to provide further information. The summary will be communicated to grantees via the VMBIP newsletter or by email.

Next Call

The next VFC-AFIX quarterly call will be on October 14th, 2:00 to 3:30 pm EST.

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