US may require Medicare-certified hospitals to offer flu shots

May 3, 2011 (CIDRAP News) – Thousands of hospitals and other healthcare facilities that participate in Medicare and Medicaid would be required to offer flu vaccination to all patients during flu season under a new federal proposal.

The Centers for Medicare & Medcaid Services (CMS) unveiled the proposal Apr 29, saying it would increase access to flu vaccine, reduce flu-related sickness and deaths, and help reduce healthcare disparities. The proposal would affect about 16,700 hospitals, rural health clinics, Federally Qualified Health Centers (FQHCs), and kidney dialysis centers, according to a draft Federal Register notice.

"Today's proposed rule will expand Medicare beneficiaries' options for where to receive a flu shot during flu season," CMS Administrator Donald M. Berwick, MD, said in a news release. "The new requirements would make flu shots available in more of the health care facilities that Medicare beneficiaries are most likely to visit, including hospitals and rural health clinics."

Under the plan, all patients would be offered a flu shot between Sep 1 and the end of February, unless vaccination is medically contraindicated. Patients could decline the shot. The facilities would also be required to offer the shots during a flu pandemic.

CMS estimates that under the rule, the total proportion of patients in affected facilities who ultimately get a flu shot each season could increase from the current 40%—the approximate coverage level for the general population—to about 60%. The agency estimates that the rule could lead to the vaccination of about 18.2 million patients in the affected facilities, but says that without the proposed rule, some of these would get a flu shot elsewhere.

CMS will take comments for 60 days after its proposal is published in the Federal Register. The proposal says the agency's aim is to implement the requirement by this coming fall, in time for the 2011-12 flu season.

The types of facilities to be covered by the requirement and their estimated numbers are:

  • 5,100 hospitals, including short-term acute care, psychiatric, rehabilitation, long-term care, children's, and cancer hospitals
  • 1,300 Critical Access Hospitals (CAHs)—generally small, isolated rural hospitals that receive cost-based reimbursement to prevent them from closing
  • 3,800 rural health clinics
  • 1,100 FQHCs—clinics that serve an underserved area or population and offer a sliding fee scale
  • 5,400 end-stage renal disease (dialysis) centers

The proposal notes that nursing homes have been required to offer flu vaccine to their residents since October 2005. In recent years, about 91% of nursing home patients have been vaccinated, it says.

CMS believes that many facilities that would be covered by the rule already offer annual flu shots, but they would need to develop and implement appropriate policies and procedures, the agency said.

The agency estimates the costs associated with the requirement at about $330 million a year, which would be offset by estimated quantifiable benefits worth roughly $830 million a year, including a $710 million reduction in medical costs and $120 million worth of time savings for patients.

The American Hospital Association (AHA) is currently reviewing the CMS proposal, an AHA official told CIDRAP News today.

"We are still reviewing it but this is something that could be difficult to implement and we are going to reach out to our members to get their input," Marie Watteau, the AHA's director of media relations, commented.

She said she did not have any information on what proportion of hospitals may already have a policy of offering flu shots to all patients.

See also:

CMS draft Federal Register notice

Apr 29 CMS news release

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