Pediatric health system captures cost savings with use of AccuVax
Executive Summary
A large pediatric health system in Florida, demonstrated significant costs savings throughout their vaccine management workflow after performing an internal cost analysis of their implementation of the AccuVax® Vaccine Management System. The cost analysis compared their vaccine management costs pre and post implementation of AccuVax to determine effectiveness of the new system throughout their locations. In summary, the analysis resulted in a total monthly savings of $60,720 for the pediatric health system across all locations. The cost savings per location ranged from $831 to $3,119 per month, with an average cost savings of 61% per location. The analysis pinpointed three key areas in vaccine management that AccuVax addressed, and due to their reduction in costs, attributed to average savings recognized per location per month of:
91% reduction in vaccine management time, averaging $469 per location per month
80% reduction in vaccine waste and loss, averaging $840 per location per month
25% reduction of vaccine administration errors, averaging $313 per location per month

Overview
As the largest privately-owned primary care pediatric system in Florida, with more than 200 providers and 34 locations throughout the state, their mission is to enhance the lives of all children and their families with the highest quality pediatric healthcare.
In 2018, the Clinical Services team performed an internal cost analysis initiative to determine the dollar savings impact of their newly implemented vaccine management system, AccuVax, as it compared to their prior management workflows. For accurate cost comparisons, the analysis focused on three main areas in their vaccine management workflow; time, waste, and administration errors of vaccines. The overall cost analysis shows that savings were proportional to the number of doses administered per day and the size and number of storage units located at the location.
The analysis was performed at all 34 locations using several measured inputs and location-specific data points. The measured data included the average number of doses administered per day and the offsetting costs associated with the number of vaccine storage devices used at each location. The other measured inputs included the weighted average price of a vaccine dose (based on the purchase price and each location’s monthly utilization of each vaccine), and the overall vaccine waste rate and administration error rate documented by the pediatric health system each year. In addition, the average hourly rate for a nurse manager and the number of working days per month the location was seeing patients.

The Results
Management Time
The first area measured in the cost analysis focused on the cost of time required to manage vaccines at a location. Each location employs a primary nurse manager, who is responsible for managing the location’s entire vaccine inventory. These vaccine management responsibilities include temperature monitoring and uploads, stock distribution and rotation, monthly counting and reconciling, and excursion event management. Detailed below are average times spent on vaccine management tasks before and after AccuVax by a nurse manager.

On average, the nurse manager at each location reduced their weekly time by 4.5 hours. When looking at a specific location, “Location A,” providing an average of 170 doses of vaccines daily, the time saved and costs associated with time saved on vaccine management tasks of a nurse manager demonstrated $125 per week or approximately $500 per month in savings when implementing AccuVax at “Location A”.

Vaccine Waste & Loss
The analysis also measured the impact of reducing vaccine waste and loss using AccuVax. The American Academy of Pediatrics (AAP) refers to vaccine waste and loss1 as it relates to inventory uncompensated loss due to expiration, vendor error, theft, and administrative error. This includes drawing up the vaccine and having the patient refuse and having to waste the drawn-up vaccine. Further waste and loss can be contributed to compromised vaccines when exposed to temperature excursion events that require quarantine and removal from use.
The pediatric health system applies a general waste and loss rate to any type of event that vaccines are uncompensated. The annual waste rate is set at 0.5% per total administered doses.
To accurately calculate the dollars lost due to vaccine waste and loss, the weighted average cost of a vaccine dose must first be determined. The pediatric health system established this weight cost by applying their vaccine purchases prices with the utilization of each vaccine they administered across all location.

Based on the utilization percentages and the purchase prices of each vaccine, the weighted average cost per dose value is:
Weighted average cost per dose: | $103.60 |
Applying the average doses administered per day at “Location A,” along with the weight average cost per dose and waste rate, there was the ability to capture savings of $1,750 per month when using AccuVax units.

MAJOR LOSSES
During the cost analysis exercise, the pediatric health system documented their major loss events in the 12 months prior to implementation. These events were incurred costs by the pediatric health system are in addition to the costs measured above in the routine vaccine waste and loss.

During the 12-month post-AccuVax implementation, the pediatric health system documented 2 excursion events. This resulted in TruMed® Systems, Inc. financially compensating them under the AccuVax agreement that provides vaccine insurance for vaccines stored and managed in an AccuVax unit.
Administration & Billing Errors
Finally, vaccine reimbursement dollars lost due to administration errors or billing inaccuracies were measured pre and post AccuVax implementation. The Institute for Safe Medication Practices (ISMP), manages the National Vaccine Errors Reporting Program (VERP), providing a means for healthcare professionals to report actual errors. This program reports the most common type of vaccine administration errors and the percentage of total errors.
Wrong vaccine (24%)
Expired vaccine or contamination/deterioration (14%)
Wrong age (13%)
- Extra dose (10%)
- Wrong dose (9%)
- Vaccine/component omission (e.g., only diluent or a single component of a two-component vaccine administered) (8%)
- Wrong time or interval (7%)
- Wrong patient (4%)
Wrong route (1%)
Other (10%)
Every administered error prevents or delays a healthcare provider the ability to recoup the administered vaccine cost and charge for the time and resources required to administer the vaccine.
The pediatric health system practices rigorous process and procedures to minimize these types of administration errors. However, even with their high-quality efforts, the 12 months prior to AccuVax, an average error rate of 0.50% was occurring on their immunization efforts.
In order to determine the average loss in reimbursement per dose due to these administration errors, the analysis applied 105% of the weighted average cost per dose and added an additional $15.00 for the administration fee. This calculation provided an average total reimbursement per dose of $123.63. Applying this error rate and average loss in reimbursements to “Location A,”, they were able to recoup an average of $653 per month.

Across all locations, AccuVax was able to exhibit eliminating an average of 25% of all vaccine administration errors or billing inaccuracies. There is potential for future reimbursement recoupment due to on-going efforts to develop an integration between the pediatric health system’s EHR and the AccuVax. This integration, still under development, will provide the ability to automatically select vaccines based on provider orders, perform additional patient safety checks such as age and interval dose checks, and automatically document administered vaccine information in the EHR patient record. This integration is projected to possibility eliminate up to 91% of vaccine administration errors, which could be a monthly average of $854 of reimbursements recouped per location.
Conclusion
In summary, the pediatric health systems’ cost analysis of AccuVax Vaccine Management System identified significant cost savings for the business. This analysis displays a total monthly savings of $60,720 across all 32 of their locations using AccuVax. The cost savings per location ranged from $831 to $3,119 per month, with an average cost savings of 61% per location and this analysis pinpointed three key areas in vaccine management that AccuVax addressed, and due to their reduction in costs, attributed to average savings recognized per location per month of:
91% reduction in vaccine management time, averaging $469 per location per month
80% reduction in vaccine waste and loss, averaging $840 per location per month
25% reduction of vaccine administration errors, averaging $313 per location per month
References:
- American Academy of Pediatrics: The Business Case for Pricing Vaccines. https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/immunizations/Practice-Management/Pages/knowing-cost.aspx
- The Institute for Safe Medication Practices (ISMP), manages the National Vaccine Errors Reporting Program https://www.ismp.org/resources/ismp-national-vaccine-errors-reporting-program-2017-analysis-part-i-vaccine-errors
