The American Academy of Pediatrics views retail-based clinics (RBCs) as an inappropriate source of primary care for pediatric patients, as they fragment medical care and are detrimental to the medical home concept of longitudinal and coordinated care. This statement updates the original 2006 American Academy of Pediatrics statement on RBCs, which flatly opposed these sites as appropriate for pediatric care, discussing the shift in RBC focus and comparing attributes of RBCs with those of the pediatric medical home.

OBJECTIVE: To understand the financial impact to providers for using a combination vaccine (Pediarix [GlaxoSmithKline Biologicals, King of Prussia, PA]) versus its equivalent component vaccines for children aged 1 year or younger.METHODS: Using a subscription remittance billing service offered to private-practice office-based physicians, we analyzed charge and payment information submitted by providers to insurance payers from June 2007 through July 2009. We analyzed provider and payer characteristics, payer comments, and the ratio of vaccine product to immunization administration (IA) codes and computed total charges and payments to providers for both arms of the study.RESULTS: Most providers in our data set were pediatricians (74%), and most payers were commercial (75%), primarily managed care. The ratio of the number of vaccine products to the number of IAs was 1: 1 in the majority of the claims. Twenty percent of claims were paid with no adjustment by the payer, whereas 76% of the claims were adjusted for charges that exceeded the contract arrangement or the fee schedule. Providers received $23 less from commercial payers and $13 less from Medicaid for the use of Pediarix compared with the equivalent component vaccines. The mean commercial payment was greater for age-specific Current Procedural Terminology IA codes 90465 and 90466 than for non-age-specific codes 90471 and 90472, whereas the reverse was true for Medicaid.CONCLUSIONS: Providers who administer vaccines to children face a reduction in payment when choosing to provide combination vaccines. The new IA codes should be monitored for correction of financial barriers to the use of combination vaccines. Pediatrics 2011;128:1087-1093

Physicians should always communicate the scope and nature of the physical examination to be performed to the pediatric patient and his or her parent. This statement addresses the use of chaperones and issues of patient comfort, confidentiality, and privacy. The use of a chaperone should be a shared decision between the patient and physician. In some states, the use of a chaperone is mandated by state regulations.

The American Academy of Pediatrics (AAP) has created numerous resources to help practices understand their costs to immunize and to lower those costs. This article lists those resources, as well as resources related to vaccine safety and storage and handling. ### Rationale Pediatricians must be savvy about the business aspects of their practices. The following resources facilitate calculating, understanding, and improving pricing, contracts, and coding. ### Know Your Costs #### Vaccines: A Survival Guide for Pediatric Practices (www.aap.org/immunization/pediatricians/pdf/Vacc\_survival\_insert.pdf) This resource helps practices determine their costs to immunize. Knowing costs is essential for negotiating favorable contracts. #### The Business Case for Pricing Vaccines and Immunization Administration (www.aap.org/immunization/pediatricians/pdf/TheBusinessCase.pdf) The Business Case estimates that 17% to 28% above vaccine product costs is needed to cover overhead costs. Recent studies with multiple pediatric and family practices found overhead costs in the same range. If determination of actual practice costs to vaccinate is prohibitive, then the estimates from this document can be used instead. #### Private-Sector Vaccine Price List (www.cdc.gov/vaccines/programs/vfc/cdc-vac-price-list.htm) Costs can be checked against the manufacturer's catalog price listed by the Centers for Disease Control and Prevention (CDC). ### Lower Your Costs #### Immunization Best Business Practices PediaLink Module (http://tinyurl.com/yzbm9nw) Preliminary data show wide variability in what it costs practices to immunize. The AAP recognizes that small practices may have trouble negotiating better reimbursement, and this module can help practices find ways to reduce costs, from ordering to administering vaccines. #### List of Group Purchasing Organizations (http://practice.aap.org/content.aspx?aid=2381) Group purchasing organizations combine buying power from multiple units, such as hospitals and smaller pediatric practices, to obtain better pricing for vaccines. The AAP has been collecting information on group purchasing organizations that report working with pediatricians, and Practice Management Online contains information … Address correspondence to Elizabeth Sobczyk, MPH, MSW, American Academy of Pediatrics, Immunization Initiatives, Division of Pediatric Practice, 141 Northwest Point Blvd, Elk Grove Village, IL 60007. E-mail: esobczyk{at}aap.org