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Billing and Volunteers Substantially Reduced School-Located Influenza Vaccination Costs, 2 Oregon Counties, 2010-2011

Patel, Suchita A., DO, MPH; Groom, Holly C., MPH; Cho, Bo-Hyun, PhD; Martin, Kelly, MPH; Moore, Robert, MD

Journal of Public Health Management and Practice: November/December 2018 - Volume 24 - Issue 6 - p 558–566
doi: 10.1097/PHH.0000000000000710
Research Reports: Research Full Report

Background and Objectives: After the 2009 pandemic influenza seasons, the financial sustainability of school-located vaccination (SLV) clinics drew much attention. This study estimated and compared the labor costs of SLV clinics and reimbursements for influenza vaccinations for students attending 5 schools in 2 Oregon counties during 2010-2011.

Design/Setting: Using a biweekly, Web-based survey, staff and volunteers prospectively tracked the time they spent on SLV clinic planning, implementation, and billing. They also tracked claims submitted and reimbursements by payment source.

Main Outcome Measure: We report labor hours and associated costs for implementing school-based vaccination clinics; number of claims submitted and the reimbursement rate; and total and net costs.

Results: In county A, 260 doses were administered at a total cost of $5009 and received $3620 in payment. For county B, 165 doses were administered at a cost of $5598 and received $3807 in payments. With billing, the net cost per dose decreased from $19.74 to $8.57 and $38.08 to $16.17, for county A and county B, respectively.

Conclusions: Reimbursements reduced cost per dose by 48% across SLV clinics across both Oregon counties. Local health departments can bill local health insurers to offset costs for implementing school-based vaccination clinics. Efforts to set up billing processes require dedicated billing staff who can effectively manage claims submission processes with multiple health insurers.

Center for Disease Control and Prevention, Atlanta, Georgia (Drs Patel and Cho); Center for Health Research, Kaiser Permanente, Portland, Oregon (Ms Groom); and Marion County Health Department, Oregon (Ms Martin). Ms Groom was previously with the Center for Disease Control and Prevention, Portland, Oregon. Dr Moore was previously with the Yamhill County Public Health Department, Oregon.

Correspondence: Holly C. Groom, MPH, Center for Health Research, Kaiser Permanente, 3800 N Interstate Ave, Portland, OR 97217 (

The first 2 authors contributed equally to this manuscript; Suchita A. Patel was formerly known as Suchita Lorick.

The authors gratefully acknowledge the Oregon Immunization Program for initiating this pilot project and for supporting their efforts to evaluate the program. The authors also thank the following individuals for their close involvement in the project; Rosa Durand and Mai Cao, for their dedicated efforts to track and record claims data; Drs Garrett Asay and Mark Messonnier (CDC) for their economic expertise; and Nina Pagadala Bobowski (previously with CDC) and Jennifer Hendricks (ORISE) for their support in managing data collection and synthesis.

No conflicts of interest reported except by Holly Groom for financial support from Merck for an unrelated study.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.