The Vaccine Xchange

The Center for Medicare and Medicaid Services (CMS) has long operated using a number of “core measures” to determine the quality of care provided by hospitals. This year, CMS is launching a new program through which hospitals will be rewarded according to how well they score on these core measures. Beginning October 2012, one percent of every hospital’s Medicare payments will be put into a national pool. Hospitals will compete against each other to receive a certain percentage from this pool by scoring a number of points on the core measures. These points will be based on their performance on the core measures and patient satisfaction. Hospitals will then receive a reward based on how high they score. Some hospitals will get nothing, while others could get more than the one percent that was withheld from their Medicare payments.

You may wonder what this has to do with issues like public health and vaccination. Surely, the spirit of competition will result in better and more efficient care, right?

You might be forgiven for thinking so. However, it seems probable that at least one side-effect of this program will be the penalization of hospitals that respect the patient’s right to making an informed choice. One of the CMS core measures calls for administering the influenza and pneumococcal vaccines to all hospital patients who meet the age and high-risk criteria, regardless of what they are actually being treated for.

Policies like this are likely to lead to more hospitals refusing to treat unvaccinated patients, or placing undue pressure on those who do not want to vaccinate. It also discriminates against those who receive Medicare and Medicaid by potentially forcing them to choose between necessary medical treatment and standing by their decision not to receive a vaccine. It is not surprising that once again, vaccines are basically being forced on those in our society who are less likely to be aware of their dangers – it is all too reminiscent of the proposal to test the anthrax vaccine on children in DC’s public schools.

The new policy also explains why there was a big push over the last year to license Prevnar-13, the pneumococcal vaccine, for adults. This program is a veritable boon for the pharmaceutical industry – only a few months after the vaccine has been approved for older adults (who can now be targeted for fear-mongering and marketing), it is now mandated for all older adults and high risk populations who are hospitalized and rely on Medicare. One has to wonder who came up with this policy, and what their connection was to the pharmaceutical industry – it is hard to believe a program so beneficial to the industry is completely independent of it.