Adult Immunization: Strategies That Work
Public Health Strategies
The Peer Review Organization of New Jersey, Inc.

Background
Strategies
Implementation
Resources Required
Barriers
Results
CDC's Basic Strategy

Background
The Peer Review Organization of New Jersey--known as The PRO--is a health care quality improvement organization that works collaboratively with physicians, providers, and consumers to accelerate improvement in the quality of care provided to Medicare beneficiaries. The PRO performs this work under a contract with the Health Care Financing Administration (HCFA)--the federal agency responsible for administering the Medicare and Medicaid programs.

In 1994, The PRO developed a statewide influenza prevention program whose chief aim was to increase Medicare reimbursement to health departments for the cost of influenza vaccination, which most health departments had been swallowing in the past. The program was very simple and effective. In addition to The PRO, the other key players in the project were Xact Medicare Services, which is the Medicare Part B insurance carrier for the state of New Jersey, the New Jersey Department of Health and Senior Services, and local health departments throughout the state.

Strategies

Established a Partnership for Prevention to develop a statewide coalition of physician, provider, and consumer agencies to join the Fight the Flu effort. The Partnership established objectives for the Fight the Flu project:

• To increase the number of doses of influenza vaccine given to Medicare beneficiaries that were paid by Medicare in 1994 as compared to 1993
• To increase the number of health departments in New Jersey that had Medicare provider numbers for administration of doses of influenza vaccine in 1994 as compared to 1993
• To increase the number of claims for doses of influenza vaccine submitted by New Jersey's health departments to Medicare in 1994 as compared to 1993.

Sponsored a series of workshops to which New Jersey's health departments and other mass immunization providers were invited. Representatives from Xact Medicare Services took the health departments through the application process to become Medicare providers and then explained the roster billing process in detail. They also demonstrated the electronic billing process for those health departments that had computers.

Provided health departments with the name of a contact person to help with claims submission.

Provided bulk quantities of promotional brochures and posters published by The PRO's Partnership for Prevention to health departments, offices on aging, places of worship, pharmacies, senior groups, visiting nurse associations, hospital-based senior outreach programs, the New Jersey Section of the National Council of Negro Women, and others. Materials included a Directory of Flu Shot Clinics.

Published articles on influenza vaccine and the 1994 Influenza Prevention Project in The PRO's newsletter for Medicare beneficiaries and for the health care community.

Prepared and advertised via press releases to provider organizations an Influenza Prevention Packet, which outlined strategies for implementing influenza prevention programs in the acute care and physician's office setting.

Resources Required
The Medicare carrier provided 80% of the labor for the workshop, since they hold similar workshops regularly. For the rest of the 1994 Influenza Prevention Project, Mary Jane Brubaker estimates that total staff time (including the project manager and writer) was the equivalent of one person at 1/2 time for 6 months. Total clerical staff time was estimated at 5 hours/week for three months. Total budget for The PRO only (not including salaries or costs underwritten by the other partners) was approximately $60,000 for the entire project.

Barriers
Some health department claims were denied by the Medicare carrier because the patients immunized were members of managed care plans and should have been immunized by their managed care plans. The PRO is working with managed care plans in New Jersey to identify possible resolutions to this problem.

Another barrier is that several health departments do not bill the carrier in a timely manner. This has a direct impact on the accuracy of the state's influenza immunization statistics for the Medicare population. The Health Care Financing Administration has instituted measures to simplify the billing process which hopefully will encourage health departments to bill influenza immunization claims in a more expeditious manner.

Results
Results are based on The PRO's goal to increase Medicare reimbursement to New Jersey's health departments.

*Prior to 1994, many of New Jersey's mass immunizers had been administering flu shots without Medicare reimbursement. The workshops conducted by The PRO enabled agencies to receive reimbursement for a service many were already providing.


CDC Recommends this Basic Strategy:

• Get support of key departments, agencies, and individuals
• Establish coalitions with key stakeholders
• Encourage local agencies to become Medicare (vaccination) providers and file claims for services provided to beneficiaries
• At delivery sites, organize clinic systems to support activities to enhance service delivery--involve all key personnel
• Establish Continuous Quality Improvement systems.

This page last modified on August 2, 2001