ANOTHER COMMON ANTI-VACCINE ARGUMENT
By Erin K Costello
Anyone who spends time on Facebook has likely seen a post show up in their timeline accusing doctors, usually pediatricians specifically, of making all sorts of money by pushing vaccines on their patients. Anti-vaccine activists spout this as proof that vaccines are dangerous, it’s all about money, and that you shouldn’t trust your doctor. The specifics in this argument are almost comical. In fact, I have often wondered if it started off as poe, but became so widespread that people began to believe it. The errors and omitted data in this argument are so vast that it’s difficult to debunk their claims in a short blog post. So, in the interest of a good thorough debunking, this may be a long post, but it won’t be an anti-climactic one!
Let’s begin with the claim itself. In a recent posting by V accine Impact the site referenced an article written by a veteran anti-vaccine activist named J.B. Handley. In this article Handley shared an image from the Blue Cross Blue Shield (BCBS) incentive PDF file, as well as a link to the PDF file itself (image found pictured here in the top left hand corner). Directly under the image and PDF link posted in this article Handley makes the following claim:
"Blue Cross will give your pediatrician $400 per child that has received 100% of the 25 vaccines they recommend by the age of 2. Incredible!!!
Pediatric practices, according to this study average 1,546 patients per doctor.
This means that a 5-doctor pediatric practice, if they reach 100% compliance on vaccinations, will receive a bonus of just over $3,000,000 (that’s not a typo, my math is right, that’s $3 million bucks!!). Does your pediatrician have a conflict in considering the benefits and risks of vaccines?"
Right off the bat he is misinterpreting the data and pulling out stats that don’t apply here just so he can exaggerate the math for a rather sensible incentive program in hopes readers will view it as a a sinister plot against Americans. He created shock value statistics. To begin with, the program doesn’t require 100% of the target panel to comply to these qualifications. It requires 63% as shown on the bottom of the image in the horizontal column listed as “Target: COMM.” He also figures out the bonus figure of $3,000,000 by using the estimated 1,546 total patients per doctor for a 5 doctor practice. His math is grossly wrong, misleading, and incomplete. Let’s see if I can do any better.
First, let’s establish some more up to date figures on annual patient panels per doctor. In 2012 Annals Of Family Medicine wrote an article estimating a reasonable patient panel size for primary care physicians who carry out various degrees of team based task delegation. The data analyses used were collected from Duke University investigators. I could write an entire post based on this article alone because I found it oddly fascinating. I highly recommend you follow the link to read the specifics and their conclusions. For the sole purpose of my current focus however, I’m only going to cite relatable findings addressed in the article, such as the following:
“The average time per patient per year needed for preventive, chronic, and acute care services derived from the Duke estimates was 0.71 hours, 0.99 hours, and 0.36 hours, respectively, for a total of 2.06 hours of service per year per patient. Using the assumption of 2,025 work hours per year per primary care physician and the same age-sex distribution of the patient panel used in the Duke analyses, 1 physician could reasonably care for a panel of 983 patients under a nondelegated primary care mode. Under the most ambitious assumption about the degree of delegation possible (delegated model 1), 1 physician could reasonably care for a panel of 1,947 patients. Models with less service time delegated by physicians result in intermediary estimates of panel sizes: delegated model 2 results in a panel size of 1,523, and delegated model 3 in a panel size of 1,387.”
To summarize, one physician who doesn’t delegate any preventative, chronic, or acute patient services to other health care professionals who may be employed as part of the medical staff (i.e. RNs, NPs, PAs etc..) could reasonably tend to an annual panel size of 983 patients according to the Duke estimates. One physician who has a high degree of task delegation could reasonably tend to an annual panel size of 1,947 patients, where a medium degree of task delegation by a single physician could sustain a panel of 1,523, and a low degree of physician task delegation would find a panel size of 1,387 attainable.
Seeing as how I’d like to avoid persuasive Handley-like math attempts, plus taking into account these figures address physicians in general instead of solely those working in pediatric medicine, and considering those specializing in pediatrics are also likely to cover all degrees of task delegation, I’m going to use all four amounts above by labeling them as follows:
ND 983 (no task delegation), LD 1,387 (low task delegation), MD 1,523 (medium task delegation), and HD 1,947 (high task delegation).
If we factor these figures with the target goal of 63% instead of 100%, and apply that 63% to the whole patient panel estimate like Handley did, we end up with the following bonuses;
For ND: $247,716
For LD: $349,524
For MD: $383,796
For HD: $490,644
BUT WAIT! There’s more! These figures would still be inaccurate since not all patients would meet the qualifying age. Only patients who receive the vaccinations listed in the image on or before their second birthday qualify to be counted. According to the American Academy of Pediatrics the average annual well visit per pediatric office for patients age two is 24.6%. For example, the age qualifying 24.6% of the ND 983 patient total would then become only 231.818 patients. Of the now 241.818 patients the 63% that are required to have the necessary shots would then become 152.34534 patients who qualify for the bonus. Once you multiply the new qualified amount of patients by $400 you end up with a possible bonus of $60,938.14. The rest of possible bonuses per task delegation are as followed:
LD would be $85,982.90
MD would be $94,413.82
HD would be $120,698.42
BUT WAIT! There’s more! Since this incentive program is restricted to only those insured by BCBS, every age qualifying patient would have to be insured by BCBS for those new figures to be correct. Let’s say 10% of age qualifying patients are insured by BCBS, which according to Vaxopedia is a high estimate. At 10% this brings the qualified patients down to just a handful. The estimated BCBS insured patients in ND would be 98.3. Of the 98.3 BCBS patients the 24.6% that are estimated to be age qualifying is now 24.1818. Now our target minimum of 63% becomes 15.234534 eligible patients. The possible incentive amount is now $6,093.81. The new possible incentive amounts per task delegation are as followed:
LD would be $8,598.29
MD would be $9,441.38
HD would be $12,069.84
BUT WAIT! There’s more! What if every US pediatrician met these new criteria listed above? As of 2011 there were 91,915 physicians in the US that identified as pediatricians, pediatric medicine, or pediatric surgical according to the American Academy Of Pediatrics. By these figures the minimum bonus to be paid out to physicians in each task delegation, assuming every doctor met the qualifying criteria, would be as follows;
NOW, let’s try that again but with using Handley’s figures and interpretation on this program. He claimed that the average doctor sees 1,546 patients and that if 100% of this figure was vaccinated then the doctor would receive a $400 bonus for every single patient. That would mean one qualifying doctor would be awarded a bonus of $618,400. If every pediatrician in the US met this 100% Handley-interpreted criteria, then the total maximum annual amount possible to be paid out by BCBS would be $56,840,236,000. Think about that for a moment. In the one country where health coverage is a for profit business, anti-vaccine activists believe there’s a physician incentive program that is leaving a health insurance company open to the possibility of having to pay out almost $57 trillion dollars annually as a bonus. As if that isn’t an adequately insane belief on its own, it gets worse. Anti-vaccine activists believe the actors in this theory of theirs know that vaccines cause physical injury to many who receive them, and that these “vaccine injuries” then require new and additional medical care that the insurance companies will have to pay for through medical claims. Let me say that one more time. The anti-vaccine community is arguing that the US based for profit health insurance companies are paying for vaccines, paying possible incentives that total to almost $57 trillion dollars a year for administering these vaccines, just so they can then have to pay for the consequences of said vaccines in medical claims, and they are doing this because they are a bunch of corrupt greedy capitalists.
BUT WAIT! There’s one more! None of these figures even apply since the BCBS incentive program is only available to Michigan state BCBS physician providers, and only if they choose to participate. If anti-vaccine activists had only paid attention to that one little detail I could’ve avoided having to do a shit load of math just now..
Can you see why I once believed this argument against vaccines had to be poe?