Since the beginning of the month Dr. John Waits has asked parents to confirm that their child will receive the COVID-19 vaccination.
“Instantly you see the body language and you get a sense of where we’re going,” says Waits, a family medicine physician and CEO of Cahaba Medical Care in Alabama. The conversations don’t usually end in a “heck no,” he says, but they don’t often end in an immediate vaccination, either. Across Cahaba’s network of 17 health clinics and several visits to local schools, Waits and his team have vaccinated about 150 children since Nov. 2, the day the Centers for Disease Control and Prevention (CDC) recommended the COVID-19 vaccine for kids ages 5 to 11.
“One of the challenges of the pandemic that’s made it so hard for public health is that people just want to get back to their doctor and hear their doctor talk about it, and then kind of think about it,” Waits says. “That’s not the speed we need to continue to flatten the curve.”
Another challenge: Unless a patient actually receives the vaccine, Waits and his staff usually don’t get paid for the time spent counseling them about it. All that unpaid time makes for tough finances—especially for community health centers, like Cahaba, which often operate on thin margins and treat underserved populations, and which public health experts say are crucial to getting more Americans vaccinated.
It has already been a difficult task to get children vaccinated. The progress of the COVID-19 vaccine has significantly slowed down after an initial surge in interest for young children who were eligible within the first ten working days. Just 1 out 5 children received their first shots more than a month after the initial spike in interest. significant disparitiesThere has been a split in the states that some state report 25% of children are vaccinated, while others say less than 10%.
Omicron is gaining momentum in the U.S., and Omicron cases are increasing during holiday parties. President Joe Biden encourages Americans to get vaccines as soon as they can. “We are looking at a winter of severe illness and death—if you’re unvaccinated—for themselves, their families, and the hospitals they’ll soon overwhelm,” he said on Dec. 16.
T.V. is a tool to encourage more vaccines.he Biden Administration announced earlier this month that it will now require Medicaid, the public insurance program for low-income Americans, to pay health care providers for simply talking with families about kids’ vaccinations. The new policy is still being implemented by states, but Medicaid covers more than 40 percent of all children in the United States. This could have a significant impact.
“This policy really just underscores the importance of vaccination education, how critical that is as a piece of what gets people to making that decision to go ahead and get vaccinated and how critical it is to combating mis- and disinformation,” says Dr. Cameron Webb, senior adviser for equity on the White House COVID-19 Response Team.
Physicians face a difficult battle
It is possible to easily vaccinate a large number of children. All vaccines are administered by primary care doctors and family medicine physicians, along with pediatricians. But the politics and urgency of administering the COVID-19 to kids makes it infinitely more difficult—and requires doctors to engage in fraught conversations before almost every shot.
Pfizer’s vaccine was approved by the Food and Drug Administration for children aged between 5 and 11 years. The agency declared that it was safe and efficient for them. Common side effects included fever, fatigue and headache. Americans, on the other hand, were somewhat ambivalent. While 63% of parents say they are confident the COVID-19 vaccines are safe for adults, just 52% say they’re confident for kids ages 12 to 17, and just 43% say they are confident it’s safe for kids ages 5 to 11, according to a Kaiser Family Foundation surveyPublished Dec. 9. Published Dec. 9.
Learn More In order to get COVID-19 vaccines for children, the health authorities will have to contact parents who are reluctant.
The most reliable source for information on Covid-19 vaccines is still the pediatricians. Overall, 77% of parents said they trust their child’s pediatrician or health care provider a great deal or a fair amount, and that trust remained high across party, race and ethnicity. This is something providers are aware of and want to exert their persuasive power on every family. However, they are sometimes short on time so try to get patients up to date with any medical treatment they have missed due the pandemic. They also want to find out why they are sick and make sure parents understand about their annual vaccinations.
“You make an audible on the line of scrimmage every visit. If somebody has got a lot of genuine questions and the conversation is going well, you steal an extra three or four minutes for the conversation, and you take it out of the next visit,” Waits says. A parent who seems really down might be able to move quickly, and he may revisit the matter again later.
Chief medical officer of National Association of Community Health Centers Dr. Ron Yee says it is important to take the time and listen to parents’When serving people on Medicaid or low income individuals, such as those with limited means, questions are especially important.. “Being able to have that extra time to spend with the patients and specifically the parents—of course, they’re going to be the ones who are being educated—that is really critical,” he says.
Long time coming
The pandemic was not the first time that providers have advocated for vaccination counseling reimbursement. Providers began to feel the need for reimbursement as the COVID-19 vaccination became more complicated.
“Vaccine counseling was kind of that low level background noise that we did, you know, three, four times a day. And now we’re doing this, if we see 25 patients a day, I’m probably doing it 15 or 20, plus a couple of phone calls a day,” says Dr. Jesse Hackell, a pediatrician who chaires the Committee on Practice and Ambulatory Medicine of American Academy of Pediatrics (AAP), a committee that has closely worked with the administration on vaccine rollouts for children. “With the urgency to get millions of kids vaccinated quickly, the volume of this has just skyrocketed, and it’s no longer the low level of background noise. It’s a real time consuming effort that we have.”
The American Academy of Pediatrics’ president praised the Biden administration’s action on reimbursing doctors for vaccine counseling, and other groups have been enthusiastic about the change too. Webb, COVID-19 equity adviser, states that among the many groups which consulted the Biden administration on the rule change was the American Academy of Family Physicians and American College of Obstetricians and Gynologists, as well as the American College of Physicians and American Osteopathic Association.
Vacheria Tutson is the director of regulatory affairs for the National Association of Community Health Centers. She says that her group met with representatives from the Centers for Medicare & Medicaid Services (CMS), to talk about reimbursement issues during the presidential transition period. “This is such a great step in the right direction,” she says.
The new policy will cover 100% of the costs for COVID-19 counseling sessions for Medicaid children. Medicaid is a federal-state joint program. This means that all state Medicaid agencies have to adopt it. Also, providers have to still learn it and document the process appropriately. The effectiveness of the program will depend on how much money staff can afford to provide counseling services and how many health centers they can keep. “The devil is in the details,” Waits says.
CMS called states to discuss the program last week. Webb said that the response was very positive. Webb has heard back from providers, who liked the changes but want to know if reimbursement is possible for other populations. “This is an important first step from a federal standpoint for us to see the impact here,” Webb says. “We’re always looking to do whatever we can to support providers who have been working so hard through this pandemic and so we’ll keep our eye out.”
The change does not cover patients who don’t have insurance, or those who have private insurance. Private health insurance companies are known to follow CMS guidelines, and some insurers might cover vaccine counseling for children after Medicaid has.
Until then, the community health centres face many financial difficulties as they continue to push for vaccination. “Health centers are often on very small budgets or margins,” says Yee of the National Association of Community Health Centers. It is important for community health centers to offer as many services and as much money as they can.
“If the staff is able to capture that and bill for it, then it helps the health centers. This helps them maintain their operations. That includes transportation, translation, enrollment—all those things help education,” he says.
Learn More Biden’s Health Equity Task Force Highlights Progress in Addressing COVID-19 Disparities
Encouragement to seek out more counselling
Wendy Williams is a Mississippi physician who has observed this phenomenon. Only 6% of Mississippi’s children have received their first shot. Dr. Wendy Williams is the chief medical officer of Coastal Family Health Center. This group includes clinics along the gulf coast. It treats a variety of patients, including many Spanish-speaking people, migrant workers, and people who are employed on the ships that dock in local ports. The Biden administration’s move to pay providers for the time they spend counseling patients could help if it goes smoothly, she says. Her clinics struggled to be reimbursed by the federal government during the pandemic. She claims that they have received reimbursements for between 30-40% and the remainder of the costs.
Williams is responsible for managing the budget of the center. He has had to sometimes worry about purchasing supplies and sending workers out to homebound patients. “You would love to go out and do everything for everybody. But you have to make sure that you can pay those people that are going out to do it too,” she says.
The administration is determined to address this issue. The White House hopes that this policy change, which targets Medicaid patients to reduce disparities between rural and communities of color in early vaccine months, will help prevent the same mistakes for children under its equity-focused COVID response.
“We want to make sure that providers know how much we value the counseling and the work that they’re doing,” Webb says. “And, at the same moment [we want to]Give them encouragement and motivation to keep going.”