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From Health Law Daily, June 25, 2013

Medicare providers should review patient records to prevent inappropriate repeat vaccinations

By Michelle L. Oxman, JD, LLM

From 2007 through 2011, more than 122,000 Medicare beneficiaries over age 65 received repeat vaccinations to prevent pneumonia that were medically inappropriate and potentially harmful, according to an evaluation by the Office of Inspector General (OIG) (OIG Report, No. OEI-07-13-00310, June 25, 2013). The OIG found that 43 percent of the repeat vaccinations were administered by the same provider who administered the first vaccination.

Standards for repeat vaccinations. There are three vaccines commonly used to prevent pneumonia, specifically, PCV7, PCV13, and PPSV23, which contain seven, 13, and 23 strains of the pneumococcal bacteria, respectively. Both PCV13 and PPSV23 contain serotype 19A, currently the most commonly found serotype; 19A is often highly resistant to antibiotics. The guidance on vaccinations issued by the Centers for Disease Control (CDC) recommends PPSV23 for all individuals age 65 or older and for younger adults at high risk for pneumonia. One administration is usually sufficient for the lifetime of a 65-year-old patient. However, the CDC “Pink Book” recommends that individuals with compromised immune systems receive a second PPSV23 at least five years after the first.

Risks of vaccination. As of 2012, the adverse event surveillance program records reflected that Medicare covered the 4.6 million pneumonia vaccinations for seniors during the five years that OIG reviewed. The records reflect about 1,200 adverse events that were reported. About 400 of the affected patients visited the emergency room, and about 40 of them were hospitalized. Twelve of the reported events were life-threatening.

Inappropriate repeat vaccinations. The OIG reviewed more than 8.7 million claims for pneumonia vaccinations administered to Medicare beneficiaries age 65 or older. The review revealed that more than 122,000 of these beneficiaries received at least two vaccinations. Although it could not identify the provider in about 8 percent of claims, 43 percent of the repeat vaccinations were administered by the same provider that administered the first. Although the OIG did not know the immune status of the patients, all of the repeat vaccinations were medically inappropriate because they were administered less than five years after the first.

There were two areas where the OIG found unusually high numbers of repeat vaccinations. About 122,500 elderly Medicare beneficiaries received two or more administrations of PPSV23 from about 25,000 providers. About 53,000 were administered by the same provider as the first. The number of repeat administrations ranged from two to 14; 754 were administered by one home health provider in Colombia, Maryland. In addition, a provider in North Palm Beach, Florida administered 41 repeat PPSV23 vaccinations. It also gave 33 repeat PCV7 vaccinations to 32 patients; all but two had received the first vaccination from the same provider. The total cost to Medicare was about $6.9 million.

Presumably, the providers would have records of each vaccination they administered to each beneficiary. Apparently, some providers did not check their records. The OIG did not make any specific recommendations to CMS, but expressed hope that the increasing use of interoperable electronic health record systems should alleviate the problem.

MainStory: TopStory OIGReports AuditNews PartBNews

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