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Report (OEI-07-13-00310)

06-24-2013
Potentially Improper Frequency of Pneumococcal Vaccinations for Medicare Beneficiaries

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Summary

WHY WE DID THIS STUDY

Current vaccination recommendations state that individuals without immunocompromising medical conditions should receive a single pneumococcal vaccination at the age of 65 years or older and that individuals with immunocompromising conditions should receive a second vaccination 5 years after their first. Medicare instructs providers to administer a pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history in the past 5 years. Vaccination is intended to reduce the risk of contracting serious disease, but vaccination is not without risk. In 2012, the Vaccine Adverse Event Reporting System, a national vaccine surveillance program, reported more than 1,000 adverse events associated with the 4.6 million pneumococcal vaccinations for Medicare beneficiaries between 2007 and 2011.

HOW WE DID THIS STUDY

We obtained all Medicare Part B claims from the National Claims History File for the period 2007-2011 for the three different types of pneumococcal vaccine-PCV7, PCV13, and PPSV23-and the administration of the vaccine. Using this claims data, we reviewed the frequency of pneumococcal vaccinations for beneficiaries age 65 and older without immunocompromising medical conditions to detect beneficiaries receiving vaccinations more frequently than recommended. We then limited our review to claims for beneficiaries who were eligible for Medicare by age alone and whose diagnosis codes indicated vaccination against Streptococcus pneumoniae. We limited the period of review to 5 years and allowed for one vaccination of each type per beneficiary. Our calculations as to whether a given vaccination constituted a second (or greater) vaccination of the same type were based on the order of occurrence for each vaccination.

WHAT WE FOUND

Of the 4.6 million beneficiaries receiving a pneumococcal vaccination from 2007-2011, we identified 122,498 beneficiaries who received multiple pneumococcal vaccinations of the same type. Medicare allowed a total of $234 million for pneumococcal vaccinations in outpatient settings, of which nearly $7 million was for two or more pneumococcal vaccinations, and their administration, of the same type for the same beneficiary within the 5-year period. For beneficiaries who received repeat vaccinations of the same type, 43 percent received repeat vaccinations from their same providers.

WHAT WE CONCLUDE

We support CMS and CDC/ACIP in their vaccination goals and efforts, but the data suggest a need to educate certain providers about repeat vaccinations more often than recommended. The data also suggest that 43 percent of the unnecessary vaccination could be reduced through providers' reviewing the medical history of established patients. Tools, such as electronic medical records, may assist in this effort.

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