A Shot in the Arm or a Kick in the Gut?

Blue Cross Blue Shield in Michigan provide $400 to doctors who fully immunize children by age 2.

By Jill Chapin

August 1, 2016

For people on either side of the vaccine debate, you might want to sit yourself down and compose yourself before you read any further.  For someone like me who often casts a cynical eye on the devious doings of various organizations, I was not prepared for this one because it involves our children.

I was directed to visit a PDF file of Michigan’s Blue Cross Blue Shield’s Physician Incentive Program.  What is available for all to see on page 15 is that BCBS pays pediatricians hefty bonuses based on the percentage of children they fully vaccinate by age two –  a  $400 payout for each child.  You can do the math: one hundred fully vaccinated patients is a $40,000 annual bonus; two hundred patients would be an $80,000 disbursement.

But according to the words of Blue Cross Blue Shield, pediatricians lose the entire bonus unless at least 63% of their patients are fully vaccinated, including the flu vaccine.

To be fair, just because this incentive hangs over the heads of pediatricians does not mean that they succumb to this temptation.  But it would be difficult to imagine doctors not even thinking about the rich rewards they would reap if they followed Michigan’s BCBS guidelines for vaccinating their young patients.

Unsuspecting parents have heretofore believed their doctors are advising full immunizations based solely, only and completely on what is best and safest for their children.  Now, they may be contemplating the unimaginable – that their advice just might also factor in their own personal financial gain.

Yet how would a parent know?  How could a parent dare to ask such an incendiary question: Do you receive a bonus if my child gets fully immunized by age two?

I decided to call my daughter’s pediatrician.  Although she is now 41, we both have always adored this guy, and I flat-out asked him the above question, taking care to make it about pediatricians in general instead of him in particular.  He said he never heard of it but he was interested in seeing the data if I should write an article about it.

I also called Blue Shield of California, Michigan’s Blue Cross Blue Shield, as well as the American Pediatric Association, but could not even get a prompt that would lead me to a live person.  I was able to speak to the executive director of the Michigan American Academy of Pediatrics.   She said that the incentives for giving vaccines are no different from how all physicians are paid.  She gave as an example how surgeons are paid in this same manner.  I asked her what if surgeons are -paid, reimbursed, incentivized – couldn’t get the exact terminology pinned down – if they perform five surgeries a month, but only three patients need it.  Could this cause two needless surgeries based on compensation for doctors from Blue Cross Blue Shield?

Instead of responding to this question, she repeatedly wanted to know my interest in this and who I represented.  She was getting agitated but to her credit, she stayed on the phone and addressed my questions. The most important question I asked was simply whether or not it would be in parents’ best interests to know if their pediatrician participates in this incentive program.  She would not answer this but suggested they call Blue Cross Blue Shield (in this case, Michigan’s) to see if they would answer this question.

I assured her that my only motive was to find a path for parents to get information of which they may be unaware.  Semantics about payment verses incentives was hotly contested; she said that vaccines are expensive for doctors to purchase; the implication was that without incentives, doctors would lose money on each vaccine administered.  This was so odd to me that I didn’t pursue this convoluted logic any further.

For those of you who still refuse to believe this is a huge conflict of interest and still feel positive about your toddlers’ intense immunization schedule during their first two years of life, you might ask yourself if you would be so trusting of someone energetically recommending a particular product if you knew he gets a finder’s fee for each product sold from his endorsement.  In this case, you’d only lose money if the product was a lemon; the stakes are a little higher with your child’s health.

I have no dog in this race.  What drove me to write about this is a growing concern that patients are unaware of incentives to doctors for prescribing drugs, whether or not they are needed or whether or not they are the best drug for them.

Even with all I have learned, I still am having difficulty absorbing this apparent truth.  But if I should continue to deny this is occurring in spite of all that I have discovered, then maybe Goethe had me in mind when he wrote, “We are never deceived; we deceive ourselves.”

Jill Chapin

Jill Chapin has been a guest writer and columnist in several Los Angeles area papers for over fifteen years. She has written a bilingual parenting book titled, "If You Have Kids, Then Be a Parent!" and a children's book entitled, "My Magic Bubble."

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