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A summary of presentations from the weekly Summit partner webinars

November 2, 2023 – The latest Summit Summary

Influenza Vaccination Preliminary Coverage Numbers 2023–24 – Carla Black (CDC)

Carla Black, PhD, Epidemiologist, Immunization Services Division, CDC, gave a presentation on influenza vaccination preliminary coverage numbers for the 2023–24 season.

Weekly cumulative flu vaccination coverage by flu season, children 6 months–17 years, United States

  • Pre-pandemic season 2019–20 end of season coverage (May) in children was the highest from 2019-23
  • End of last season (2022–23) was below pre-pandemic 2019–20 season by about six percentage points
  • Coverage this season through October 21 is looking similar to last season so far at about 25% vaccinated
    • Early in season, so things may change
    • Currently, not on track to reach pre-pandemic rate

October 15–21 weekly influenza vaccination status and parental intent among children age 6 months–17 years

  • 7% of children have parents who say they that they are not going to get their children vaccinated
    • Children of White and Black parents coverage higher than children of Hispanic and other races
    • Rural children are more likely to not get the vaccine
  • 6% probably will get the vaccine for their children
  • 1% definitely will vaccinate their children
  • 7% have received the vaccine since July 1, 2023

October 15–21 weekly influenza vaccination status and intent among adults age ≥18 years

  • So far this season at 25% coverage, like child coverage
    • At same point last year, coverage was also at 25%
  • 4% probably or definitely will not get vaccinated
    • Younger adults most likely to not get vaccinated
  • 1% probably will or are unsure about getting vaccinated
  • 6% definitely will get vaccinated
    • Older adults more likely to get and express intent to get vaccinated

Weekly cumulative estimated number of flu vaccinations administered in pharmacies and physician medical offices by flu season, adults age ≥18 years, U.S. (through week ending October 14); source: IQVIA Pharmacy and Physician Medical Office Claims

  • 2020–21 season saw highest recent coverage based on claims data
  • End of last season likely similar to previous season or slightly lower – can be a lag in claims being reported
  • Did not reach 2020-21 season or pre-pandemic 2019–20 coverage
  • This season so far about 3 million doses lower compared to last season

Flu vaccination concerns and issues among adults age ≥18 years by demographics, omnibus surveys, October 5–9, 2023

  • Omnibus survey with 2,000 participants
  • People who say will probably or definitely not get vaccinated
    • They’re not worried about the flu/don’t need the vaccine (33%)
    • Say vaccine not effective
    • Don’t trust the government
  • People who probably will get vaccinated or already have
    • No particular concerns
  • Movable middle who are unsure or probably will get vaccinated
    • 28% have no specific concern or reason to not get vaccinated
    • Don’t have time or haven’t gotten around to it
    • 14% not worried about flu and side effects

Monthly cumulative flu vaccination coverage by flu season, pregnant persons 18–49 years, United States; source: Vaccine Safety Datalink

  • 2019–20 season highest coverage
  • 2020–21 season did not have a large drop
  • 2021–22 season (COVID-19 vaccine came out) saw drop in coverage among pregnant women
  • 2022–23 lower coverage at end of season than recent prior years
  • 2023–24 as of September, on track at about 17–18% vaccinated, at same point as last season but below pre-pandemic or 2020–21 levels

Summary

  • Child coverage like last season but lower than pre-pandemic
    • Five percentage points lower than 2019–20 season
    • Lowest intent for vaccination among parents of Black and White children who live in rural areas
  • Adult coverage is similar to last season
    • 30% probably or definitely will not get vaccinated
    • For those unsure, biggest concern is no time or not worried about flu, and side effects
  • Coverage among pregnant women is similar to this time last season but about nine percentage points below coverage in 2019–20 season

See CDC’s FluVaxView for more information.

Questions

 Q: Are we seeing differences between pharmacy and medical office vaccination rates?

Carla Black: I didn’t show the claim separately for pharmacies and medical offices, but you can see it on FluVaxView. We’re at about 15 million doses in pharmacies versus about 8 million in medical offices. There’s more of a delay in medical offices’ claims data so we know that number will continue to increase. At the end of the last few seasons, we’ve seen more vaccination in pharmacies. From a different survey last year when we asked about place of vaccination, there were about 50% vaccinated in pharmacies versus 30% percent vaccinated in a physician’s office, with the remainder being at workplace or at mass vaccination sites or some other place.

 

Q: Have you seen big swings this year in terms of place of vaccination?

Carla Black: We’ve seen swings before the pandemic, but I think it was about equal in pharmacies and physician offices. The physician offices have been creeping down and pharmacies have been creeping up.

 

Q: To what extent have concurrent flu, RSV, and COVID vaccination campaigns impacted flu uptake rates?

Carla Black:   We do not have any specific data to address this topic.  But, just looking at trends it doesn’t seem that COVID-19 vaccination itself has had an impact, and in the first year when COVID-19 vaccines were first introduced in December of 2020, we saw increases in the flu vaccine. That year I showed that we saw increases in flu vaccine overall. You can’t say it was due to the COVID-19 vaccine. That was also the year that it was messaging was that there could be a twindemic and that seemed to resonate more with adults. With kids we saw drops in coverage during the pandemic but that was really before COVID-19 vaccination and was likely due to a lot of other factors. It didn’t go back up, but it didn’t decrease further once COVID-19 vaccination was available. RSV vaccination is still low this season so far and it’s recommended for age 60+, which is the group that has high flu vaccination. I will say among pregnant women, we have seen decreases in coverage. Increases in vaccine hesitancy towards flu, tdap, and other vaccines recommended during pregnancy may be more related to pregnant women being recommended to get up to four vaccines during pregnancy.

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Respiratory Viruses Surveillance Update – Katie Tastad (CDC)

Katie Tastad, MPH, Influenza Division – Domestic Surveillance Team, CDC, gave an update on respiratory virus surveillance.

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See CDC’s new resource: Respiratory Virus Activity Levels.

Emergency department visits for viral respiratory illness

  • COVID-19 virus circulation has declined and starting to plateau in recent weeks
  • Flu and RSV are starting to increase
    • RSV mostly among children age 0–4 years
    • Mostly in southeast part of country
    • Some parts of country show RSV is surpassing COVID-19 for emergency department visits

Influenza Virologic Surveillance

  • Clinical lab data
    • Gradual increase in percent positive tests
  • Public health labs
    • Predominately influenza A (77% of specimens) – particularly A H1N1 (93%)

Percentage of outpatient visits for respiratory illness (ILINet)

  • Outpatient visits for influenza-like illness (ILI) trending upwards
  • Starting off slower than last season which had a very early start and early peak than previous seasons
  • Breakdown by age
    • All ages starting to trend upwards
    • Most pronounced in youngest age groups, age 0–4 years
    • Second most pronounced is age 5­–24 years

Weekly flu surveillance report prepared by the Influenza Division

  • Southeastern states are seeing increase in ILI
  • Alaska had high ILI level due to mix of respiratory viruses
    • Seeing high flu activity

Flu mortality from National Center for Health Statistics Mortality Surveillance System, as of October 26

  • Not seeing increases in flu mortality yet
  • No reports of pediatric deaths

Summary

  • Seasonal influenza activity remains low nationally with slight increases in some parts of the country
  • Nationally, outpatient respiratory illness is below baseline
  • Flu hospital admissions remains low
  • So far this season, most specimens tested in public health labs have been influenza A (77%), and of those most have been influenza A(H1N1) (93%)
  • No influenza-associated pediatric deaths reported for this season

Resources:

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Update on Billing and Coding Summit Products – Carolyn Bridges, Sarah Price, Jennifer Tinney, Mitchell Finkel, and Eric Crumbaugh

Speakers:

  • Carolyn Bridges, MD, FACP, Director for Adult Immunization, Immunize.org
  • Sarah Price, MSN-ED, RN, Director of Public Health Integration, National Association of Community Health Centers
  • Jennifer Tinney, TAPI Program Director, Arizona Partnership for Immunization
  • June Fisher, Lead, Value and Access-Vaccines, Sanofi
  • Mitchell Finkel, CPB, Consultant, Avalere
  • Eric Crumbaugh, PharmD, Medical Science Liaison, Great Plains/Midwest – Dynavax

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The summit task group focused on billing and coding because adequacy of payment and claims rejection are barriers to providers offering vaccination services. . For providers who are willing to offer vaccines in their practices, these documents are designed to help providers and patients information about the landscape regarding insurance coverage and vaccine billing to help avoid claims rejection and unanticipated out of pocket payments.

Sarah Price – NACHC, Update on Policy Issues Providing Vaccinations in FQHCs

Published White Paper: Strategies to Address Policy Barriers to Adult Immunizations in Federally Qualified Health Centers (September 2019):

  • Drafting updates to the White Paper post-COVID-19
  • Updated paper expected in early spring 2024 to include what has been learned post-pandemic
  • Updates
  • What are federally qualified health centers (FQHC)?
  • Explored FCA – coverage for providers who give vaccinations in FQHCs
  • Medicaid reimbursement – highlight case studies
  • Medicare
  • Coverage in pharmacies for shingles vaccine (no more co-payments)
  • Pharmacy techs can give vaccines
  • Drug discount program
  • Policies related to veterans and veterans accessing health centers
  • Medical assistants able to give vaccinations as a solution to increase access
  • Bridge program for COVID-19 vaccines
  • Funding mechanisms for specialized populations

Jennifer Tinney

Insurance Coverage of Adult Immunizations – algorithm to provide overview of vaccine coverage by insurance type

  • First step of billing is to figure out what type of insurance coverage the patient has
  • Guide for offices to see where to refer patients and which vaccines to give
  • First question: Does the patient have insurance?
    • No
      • Refer to the COVID-19 bridge programs
      • If they’re looking for other adult immunizations, refer to some of the county health departments/ manufacturer patient assistance programs
    • Yes
      • Look for commercial insurance – bill to medical or the pharmacy benefit
      • Medicaid – bill to medical or the pharmacy benefit
      • Medicare – determine whether to bill Part D or Part B based on the vaccine and other cirumstances

June Fisher and Mitchell Finkel

Top Questions on Coding and Billing for Vaccines: Avoiding Common Errors (web page not updated as of 11/3/23)

June Fisher

  • Update to coding and billing information on Summit website
  • Also updated vaccine administration information

Mitchell Finkel

  • Update focused on what has changed in the past couple of years
  • Update on changes in vaccine coverage landscape

Eric Crumbaugh

Presented information from new resource document on pharmacy-specific information on vaccine billing and coding process and by insurance type.

PDF will be included on Operationalizing Adult Immunizations in the 2023 Fall Season and Beyond Workshop in the resources section. The Coding and Billing for Adult Vaccinations web page will be updated. Web page is not updated as of 11/3/23.

The new document on pharmacy vaccine billing:

  • General overview of claims processing for pharmacy and in healthcare
  • First section talks about a pharmacy claim and how the claims are billed in real time (medical claims are not)
  • Summary of Vaccine Coverage Through Pharmacy table
    • Medicare Part B – covers flu, pneumococcal, COVID-19, and hepatitis B (intermediate- to high-risk for patients age 60+ and must be ordered by a Medicare provider) are all billed medical
    • Medicare Part D ­– covers all ACIP recommended vaccines with no cost-sharing to the pharmacy
    • Medicare Advantage with Part D – depending on MAPD, claims can be submitted through pharmacy (Part D) or medical (Part B)

Carolyn Bridges

Document on CPT coding scenarios, which focuses on billing for vaccine counseling when vaccines are not administered, was developed in 2019–20 in partnership with the American Medical Association

  • Talks about changes in procedural terminology
  • Focused on issues with vaccination of pregnant individuals
    • Reviewed by American College of Obstetricians and Gynecologists (ACOG) in October 2023
  • Focus is billing in the setting of counseling on vaccines particularly where spending a lot of time with patients talking about vaccines but no vaccines administered
  • Document will be updated and added to the website soon

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Announcements
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  • If you have any agenda items that you are interested in sharing with the Summit, please let us know and we can add you to an upcoming call as a speaker or panelist. Contact information: info@izsummitpartners.org.

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