INFLUENZA VACCINATIONS OF WASHINGTON-STATE MEDICARE BENEFICIARIES SEEN BY PHYSIATRISTS IN THE OUTPATIENT SETTING IN 1994

Objective: To compare influenza vaccination billing rates for patients seen by physiatrists with those of four other specialties: neurology, rheumatology, family practice, and internal medicine. Design: Retrosp ective cohort analysis using Medicare billing data. Patients: 234,164 Medicare outpatients seen in Washington state between September 1 and December 31, 1994. Results: Based on Medicare's billing data, only 6 o f 99 physiatrists ordered vaccinations, and they immunized only 159 (6 %) of the patients seen. An additional 1,109 (42%) patients seen by ph ysiatrists were vaccinated by other physicians. Physiatric patients we re less likely to have been vaccinated than those seen by internists, family practitioners, or rheumatologists (p < .002), but equally likel y as those seen by neurologists (p = .07). A significantly smaller per centage of physiatrists ordered vaccinations than all other specialtie s (p < .04). Utilizing pre-existing survey data, the misclassification rate (those immunized but not billed) was estimated at 22% of our ori ginal cohort. Thus, approximately 800 patients, one third of those see ing physiatrists, may not have been immunized. We estimated the increa se in hospitalization costs to be $117 per nonvaccinated patient (tota l >$90,000). Conclusions: Missed opportunities for Vaccination by phys iatrists appear to be more frequent than in other specialties and have potentially large health and economic costs. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physi cal Medicine and Rehabilitation.