I hope my economist friends read this one. Maybe they can explain it with the 'dismal science'. Doctors knock Medicare vaccination payments as too low: CMS' refusal to increase immunization pay rates may hurt chances of reaching Healthy People 2010 goals.

In its recent proposed rule on the Medicare physician fee schedule for 2003, CMS increased payment rates for most immunizations but not for influenza, pneumococcal and hepatitis B vaccine administration. Physician practices may not be able to continue to absorb those losses along with increases in costs.

"When you consider the fact that physicians are facing financial pressure from so many sources, such as the reduction in Medicare payment for physician services and increasing medical liability insurance premiums, it's very difficult to handle inadequate reimbursement for individual services such as this one," said Ronald M. Davis, MD, a preventive medicine physician from East Lansing, Mich., and an AMA trustee.

Medicare pays just over $3 for flu, pneumonia and hepatitis B vaccination. The vaccines cost much more than that. Medicare gives one payment, they do not take into consideration the cost of the vaccine, nor the supplies needed. And they have the audacity to consider vaccination rates a quality indicator. I wish I were confused about this, but it is very clear, and very unfair.