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Caught between evidence and a hard place



Published in the October 2005 issue of Today's Hospitalist

During the first meeting of the Fall 2005 Hospitalist CME Series last month, hospitalists got a glimpse of one of the quandaries of the new era of pay for performance.

During a review of community-acquired pneumonia, one of the speakers at the meeting noted that several studies have shown that giving senior citizens pneumococcal vaccine produces minimal, if any, benefits. He also pointed out that studies have found that the influenza vaccine does indeed provide a benefit to elderly patients.

While some hospitalists at the meeting wondered about the point—should they stop giving seniors the pneumococcal vaccine, for instance—there was more. It turns out that in its effort to build a pay-for-performance system, Medicare’s performance measures list the pneumococcal vaccine as a requirement, but they list the influenza vaccine as a mere recommendation.

It’s a good example of how the intersection of medical evidence and public policy can be messy. While some of the data are more than a decade old, and several of the studies are more than five years old, policy-makers clearly have yet to catch up to some of the evidence about vaccinations.

While hospitalists at the meeting were left with some important questions— is there any harm in giving elderly patients the pneumococcal vaccine, for example—they received yet another reason to give the fl u vaccine to patients with community-acquired pneumonia.

What’s the bottom line? For one, if you’re going to stay on the right side of Medicare’s performance measures, you need to give your CAP patients the pneumococcal vaccine. These measures, after all, will likely one day be used to decide which hospitals—and physicians—receive bonus payments.

As the evidence demonstrates, however, you also need to do right by your patients. And in this case, at least, that means giving individuals with community-acquired pneumonia the flu vaccine.

Edward Doyle
Editor and Publisher
edoyle@todayshospitalist.com



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