AAP Releases “Policies to Preserve the Vaccine Delivery System for Children”

In response to declining vaccination rates due to the COVID-19 pandemic and to a forthcoming COVID-19 vaccine, the AAP released policies leaders say need to be enacted to preserve the vaccine delivery system. In addition to maintaining routine immunizations in order to prevent an outbreak of a vaccine preventable disease, a strong vaccine delivery system is critical to administering influenza vaccine for the critical 2020-21 flu season and to delivering the COVID-19 vaccine when it becomes available.

These policies include:

  • Prospective Medicaid Vaccine Payments
  • Increasing Regional Maximum VFC Vaccine Administration Fees
  • Appropriately Valued Vaccine Codes
  • Allow Borrowing Between Public and Private Vaccine Stock
  • Prioritize Delivery of Seasonal Flu Vaccine to VFC Providers
  • Reduced Regulatory Burden and Collaboration with Providers on Quality Initiatives

The AAP’s new policies can be found here. They have also released a one pager “Strengthening Immunization Delivery for Children: Preparing for a COVID-19 Vaccine.” Additional resources include:

AAP Launches social media campaign to encourage parents to #CallYourPediatrician

The American Academy of Pediatrics (AAP) launched a campaign on May 20 urging parents to call their pediatricians to schedule check-ups and vaccines in light of falling immunization rates. The #CallYourPediatrician campaign aims to help parents understand the importance of vaccinating and urges parents to keep pediatric check-ups and routinely vaccinate their children.

The AAP is sharing the graphics, videos, and messages on its social media platforms using the hashtag #CallYourPediatrician. Campaign materials can be downloaded in many formats and for various social media platforms, and include light hearted and humorous images. One campaign shows children jumping on the bed or making a mess with the message, “Dear parents: We’ll take them off your hands for 20 minutes. Love, Your pediatrician.”

All messages and images can be found on the AAP’s website.

Increase Outreach to Families to Maintain Childhood Immunizations

The data is clear: childhood immunization rates have plummeted due to the COVID-19 pandemic and associated stay-at-home orders. With the uncertainty of the pandemic’s timing, health care providers must take action to maintain vaccinations among patient populations that are wary of leaving their homes. The CDC’s Morbidity and Mortality Weekly Report (MMWR) released May 8, states the urgency of the situation:

Reminding parents of the vital need to protect their children against serious vaccine-preventable diseases, even as the COVID-19 pandemic continues, is critical. As social distancing requirements are relaxed, children who are not protected by vaccines will be more vulnerable to diseases such as measles. In response, continued coordinated efforts between health care providers and public health officials at the local, state, and federal levels will be necessary to achieve rapid catch-up vaccination.

Last week, we examined the current vaccination data. The situation is dire, however there is some good news. Examining the VSD doses administered shows an uptick in vaccine administration to children aged ≤24 months beginning in late March. This increase might reflect the success of strategies to promote childhood vaccinations in the context of the pandemic.

Below are strategies that have shown early success. These include practice management resources, talking points, and social media images to share.

Practice Management and Resources for Providers

By now, providers are well aware of the guidelines for continuing to see patients for well visits. The CDC recommends

  • Scheduling sick visits and well-child care visits during different times of the day
  • Reducing crowding in waiting rooms, by asking patients to remain outside (e.g., stay in their vehicles, if applicable) until they are called into the facility for their appointment, or setting up triage booths to screen patients safely
  • Collaborating with healthcare providers in the community to identify separate locations for providing well visits for children.

The CDC’s page on caring for children during the COVID-19 pandemic includes up to date information on maintaining childhood immunizations. The IAC has an “Ask the Experts” page titled “COVID-19 and Routine Vaccination.”

Talking Points

Vaccinate Your Family has put together two helpful guides for providers. The first, “Call, Don’t Cancel: Talking to People about Vaccinations during the COVID-19 Pandemic,” contains talking points for providers to use in communications to families. These include sections on new practice policies, setting reminders to follow-up on missed immunizations, links to help uninsured children, and information on why vaccines are still critical during this time.

The second resource from Vaccinate Your Family is designed for vaccine advocates. “Raising Vaccination Rates During a Pandemic” has steps and resources for advocates to use that may encourage people to reach out to their providers and receive routine vaccinations. These include:

  • Share talking points with your governor’s office and your state’s Secretary of Health.
  • Work with local medical professional societies to help spread the word.
  • Submit opinion pieces and letters to the editor to your local papers.
  • Consider how your community receives information.

Social Media/Images to Share

An excellent strategy to encourage vaccination during the pandemic is by communicating with families via social media or email. Many of the talking points in the “Call, Don’t Cancel” resource can be posted in a social media message or including in email or website content. The CDC has created a social media image with an important message for providers to share.

The CDC also recommends directing families to

In addition, the CDC has created sample text to share via social media with links to their easy to read schedule:

 The Ohio AAP created a handout that can be shared digitally or in print.

Hopefully by using these resources, immunization rates will rise in all age groups and we can prevent outbreaks of vaccine preventable diseases.

Childhood Immunization Rates Plummet After Stay-at-Home Orders

For weeks, public health experts have warned about the effects of stay-at-home orders on routine childhood vaccines. New data confirms those fears. In the CDC’s Morbidity and Mortality Weekly Report (MMWR) released May 8, data shows vaccine orders and administration have plummeted. The CDC analyzed data from two sources: the first is Vaccines for Children Program (VFC) provider order data from CDC’s Vaccine Tracking System. VFC is a national program that provides federally purchased vaccines to approximately 50% of U.S. children. Researchers analyzed VFC orders of noninfluenza vaccines between January 7, 2019–April 21, 2019 (period 1) and January 6, 2020–April 19, 2020 (period 2).

The other data source is Vaccine Safety Datalink (VSD) vaccine administration data. VSD is a collaborative project between CDC’s Immunization Safety Office and eight U.S. health care organizations serving publicly and privately insured patients. VSD data was analyzed for measles-containing vaccine doses administered between January 6, 2020 and April 19, 2020 for two age groups: children aged ≤24 months and those aged >24 months through 18 years.

The chart below displays the plummet in vaccine orders and administrations after a national emergency was declared on March 13.

VFC purchases dropped sharply in the weeks after the March 13 declaration, while vaccine administration dropped immediately. Vaccinations among children 24 months and younger have not seen as large of a decrease as those given to older children.

Other data sources show similar results. On April 23, The New York Times reported on data gathered by PCC, a pediatric electronic health records company.

(PCC) gathered vaccine information from 1,000 independent pediatricians nationwide. Using the week of February 16 as a pre-coronavirus baseline, PCC found that during the week of April 5,  the administration of measles, mumps and rubella shots dropped by 50 percent; diphtheria and whooping cough shots by 42 percent; and HPV vaccines by 73 percent.

This is especially worrying as many children in the United States were not receiving the recommended vaccinations on time prior to the pandemic. In a March 2020 study published in the journal Pediatrics, researchers found that only 58% of children were up-to-date with all Advisory Committee on Immunization Practices (ACIP) recommended immunizations by 19 to 35 months. A further decline in vaccination rates could put many children at risk for life-threatening diseases such as measles and whooping cough.

So far, attempts to increase vaccination rates during the pandemic have centered on children 24 months and younger. However, as the stay-at-home orders stretch on, experts are looking at older children’s immunization rates. 4- and 5-year-olds received booster shots for measles, mumps, and rubella, and 11-year-olds for tetanus and whooping cough. A prolonged delay of these boosters will cause immunity to these diseases to wane.

What can be done to prevent a second health crisis caused by these plummeting vaccination rates? Next week, we will post detailed recommendations, resources, and best practices gathered from public health organizations to assist health care providers in increasing vaccination rates.

Additional COVID-19 Vendor Updates

Pfizer has announced an update to their payment terms for vaccine invoices dated January 1, 2020 or later. This update applies to Pfizer vaccines purchased through primevaccines.pfizer.com or through Pfizer Customer Service by physicians, clinics, and group practices.  Invoice payment due dates will be automatically extended to August 31, 2020 or will receive 75-day payment terms, whichever is later. The 2% prompt-pay discount will continue to apply to payments made within these terms.  No action is required on your part. No new invoices will be issued; therefore, we recommend you simply make note of the updated payment due date on your current invoice.

These temporary payment terms will apply to any new vaccine orders placed either online at primevaccines.pfizer.com or via Pfizer Customer Service at 1-800-666-7248 through August 31, 2020.  Starting September 1, 2020, payment terms of 2% 75 days, net 76 days will resume.

To help keep track of the frequent vaccine manufacturer updates, CPP has created a grid to summarize the most current payment terms. Since updates are happening regularly, bookmark this page to keep up on the latest details! https://www.cppdocs.org/covid-19-practice-management-resources.php

More Resources: Maintaining Immunizations During COVID-19

Children’s Hospital of Philadelphia (CHOP) has published an excellent guide to maintaining childhood vaccinations during the Coronavirus Pandemic. The piece warns that current factors related to the pandemic are creating a situation in which many children may be missed routine vaccines. This could result in a large population of unimmunized or under-immunized children and an increase in outbreaks of vaccine-preventable diseases (VPD).

The article continues by reporting data from the CDC on the circulation of VPDs between January and March 2020. In addition, it lays out solutions to continuing well child visits and routine vaccines. It ends with resources, some of which we listed in last weeks blog post Immunization Guidelines During COVID-19.

Be sure to check out this timely resource to assist your practice in maintaining routine immunizations.  

Vaccine Vendor Updates Due to COVID-19

Due to challenges related to managing the Coronavirus outbreak, our vaccine vendor partners have made the following updates to their ordering and payment policies:

NEW: Sanofi Pasteur – Effective April 13, 2020 Sanofi Pasteur will:

  • Extend current payment terms for an additional 30 days on invoices due in April and May 2020
  • Extend the 2% prompt pay discount on invoices due in April and May
  • Extension is retroactive to April 1, meaning any invoice due in the month of April will receive the additional 30 days

The 30-day extension applies to all purchases through Sanofi Pasteur or VaxServe via your Sanofi Pasteur sales representative, VaccineShoppe.com , 1-800-VACCINE (1-800-822-2463) or VaxServe.com and/or 1-800-752-9338.

Please note that since Merck has also extended their payment terms and prompt pay discount by an additional 30 days, invoices for Merck vaccines purchased through VaccineShoppe or VaxServe will also carry these same terms.

Pfizer – Effective March 26, 2020, all open invoices dated January 1, 2020 or later for Pfizer vaccines for physicians, clinics, and group practices will automatically have an additional 30 days payment terms added to them. No action is required on your part. No new invoices will be issued so we recommend you simply make note of the additional 30 days on your current invoice. Additionally, all NEW orders for these customers placed between March 26 and May 31, 2020 will have extended payment terms of 105 days with the 2% prompt pay discount. Please click here for more information.

Merck – Effective April 6, 2020, all open invoices for Merck vaccines purchased by Physician Clinic and Physician Practice customers through MerckVaccines.com, MerckOrders.com, or Merck Vaccine Customer Center beginning January 7, 2020 through April 6, 2020 will have 30 days added to their existing payment terms. No action is required on your part. A new invoice will not be issued; therefore, we recommend you simply make note of the additional 30 days to pay on your current invoice.

Additionally, all NEW orders placed by Physician Clinic and Physician Practice customers on MerckVaccines.com, MerckOrders.com, or through Merck Vaccine Customer Center April 6, 2020 through May 6, 2020 will have an additional 30-day payment term extension, for a total of 120 days to pay.

Please note that these extended payment terms apply to Merck vaccines purchased directly from Merck. For Merck vaccines purchased through a Merck Prime Vendor Distributor, please check with your distributor for current payment terms.

Immunization Guidelines During COVID-19

The CDC has released updated guidelines for preventative health services for children and adults during the COVID-19 pandemic. These include guidance on providing immunizations to patients.

Children

The AAFP and AAP have joined the CDC in offering guidance on maintaining childhood immunizations in the current pandemic. In order to continue to immunize pediatric patients, practices should follow guidance from the AAP on modifying clinic schedules and physical space. Recommendations include:

  • Limit well visits to early morning and use the remainder of the day for sick visits
  • Dedicate specific rooms for sick visits and well visits. If a practice has multiple sites, use one location for well visits only.

If a practice is unable to provide wells child visits for all patients in their practice, priority should be given to newborn care and vaccination of infants and young children through 24 months of age.

Adults

The American College of Physicians released a statement on non-urgent in-person medical care on March 23. This statement recommends the cancellation of elective and non-urgent procedures, and for physicians to move patient care to telehealth services when possible. The CDC recommends that adult immunizations be postponed except in two scenarios:

  • An in-person visit must be scheduled for some other reason and delivering preventative services during that visit will not increase risk.
  • An individual patient and their clinician assess that the benefit of the vaccine outweighs the risk of exposure to COVID-19.

Additional Resources

CDC:

Administering vaccines when a child is sick

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings

AAFP:

COVID-19: Guidance for Family Physicians on Preventive and Non-urgent Care

AAP:

Email address for member questions concerning COVID-19: COVID-19@aap.org

Vaccine Vendor Updates Due to COVID-19

Due to challenges related to managing the Coronavirus outbreak, our vaccine vendor partners have made the following updates to their ordering and payment policies:

Pfizer

Effective March 26, 2020, all open invoices dated January 1, 2020 or later for Pfizer vaccines for physicians, clinics, and group practices will automatically have an additional 30 days payment terms added to them. No action is required on your part. No new invoices will be issued so we recommend you simply make note of the additional 30 days on your current invoice. Additionally, all NEW orders for these customers placed between March 26 and May 31, 2020 will have extended payment terms of 105 days with the 2% prompt pay discount. Please click here for more information.

Sanofi Pasteur

Many customers have credits accumulated on VaccineShoppe.com and can use these credits to pay current invoices. If a particular practice or group is in a huge bind and would like special consideration for paying invoices, they are invited to call customer service at 1-800-VACCINE.

Merck

Effective April 6, 2020, all open invoices for Merck vaccines purchased by Physician Clinic and Physician Practice customers through MerckVaccines.com, MerckOrders.com or Merck Vaccine Customer Center beginning January 7, 2020 through April 6, 2020 will have 30 days added to their existing payment terms. No action is required on your part. A new invoice will not be issued; therefore, we recommend you simply make note of the additional 30 days to pay on your current invoice.

Additionally, all NEW orders placed by Physician Clinic and Physician Practice customers on Merckvaccines.com, MerckOrders.com, or through Merck Vaccine Customer Center April 6, 2020 through May 6, 2020 will have an additional 30-day payment term extension, for a total of 120 days to pay.

Please note that these extended payment terms apply to Merck vaccines purchased directly from Merck. For Merck vaccines purchased through a Merck Prime Vendor Distributor, please check with your distributor for current payment terms.

2020-2021 Flu Vaccine Pre-Book Deadline Extensions

Sanofi Pasteur

The Flu vaccine pre-book deadline has been extended to April 30, 2020 for those who have not yet confirmed reservations for the 2020-2021 flu season.

AstraZeneca

The pre-book deadline to reserve FluMist doses for the 2020-2021 flu season has been extended to May 31, 2020.

If there are any changes or updates to this information, we will be communicating that accordingly.

Resources to Help Address COVID-19 Challenges

We have been pulling resources together from various experts to help you address challenges in the most financially impactful areas of running a practice. We hope these will be helpful in managing through this crisis:

  • Patient Care/Revenue
  • Staffing
  • Rent
  • Supplies/Vaccines

The resources have been posted to a newly added section of our website and will be adding and updating as more resources become available.

COVID-19 Resources and Updates from CPP

Vaccine Vendor Updates Due to COVID-19

Due to challenges related to managing the Coronavirus outbreak, the influenza vaccine manufacturers have extended the pre-book deadlines for the 2020-2021 flu season:

  • Sanofi Pasteur – Deadline extended to April 30, 2020 for those who have not yet confirmed their reservations.
  • AstraZeneca – Deadline extended to May 31, 2020.

We are also working with our vaccine vendor partners to determine what can be done to ease the vaccine-related financial burdens facing practices at this time. Pfizer has provided the following update:

Effective March 26, 2020, all open invoices dated January 1, 2020 or later for Pfizer vaccines for physicians, clinics, and group practices will automatically have an additional 30 days payment terms added to them. No action is required on your part. No new invoices will be issued so we recommend you simply make note of the additional 30 days on your current invoice. Additionally, all NEW orders for these customers placed between March 26 and May 31, 2020 will have extended payment terms of 105 days with the 2% prompt pay discount. Please click here for more information.

We will communicate more as specific solutions are developed. Stay tuned!

Resources to Help Address COVID-19 Challenges

Below are some great resources we pulled together from various experts to help you address challenges in the most financially impactful areas of running a practice. We hope these will be helpful in managing through this crisis:

Patient Care/Revenue

Telephone Triage Protocols

Medicare Telemedicine

COVID-19 Coding

Staffing

Family First Coronavirus Response Act – National Compliance Update

Rent

Economic injury disaster loans (declared disaster area 1) for small businesses

Landlord negotiation – We are hearing that some landlords are open negotiating rent payment during this time. Clearly this will depend on existing contracts and relationships. Article from the National Law Review

Vaccines

Vaccine Storage Emergency Plan (CPP blog post)

CDC Maintaining Childhood Immunizations During COVID-19 Pandemic

We have posted these resources to a newly added section of our website and will be adding and updating as more resources become available.