Does your organization have a vaccine refusal policy?

Patients often refuse vaccinations for themselves or their children for a variety of reasons, and the rate of unvaccinated patients is apparent: 2019 has had the greatest number of reported cases of measles in the United States since 1992, according to the Centers for Disease Control and Prevention (CDC). 

The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders if their organization has a policy to work with patients who refuse vaccinations: 31% answered “yes,” while 69% answered “no.” Respondents were then asked to elaborate on their answers.

Respondents who answered “yes” indicated:

• We are pediatrics ... our policy is to discharge patients who choose to not vaccinate. It is made clear when establishing care.
• We offer counseling through the care coordinator.
• Parents have to sign a declination form indicating they have been informed of the risks of not immunizing.
• We allow parents and patients to opt out of vaccines.

Respondents who answered “no” elaborated:

• It is left up to each doctor to handle one on one most refuse these patients, but some tolerate a reduced schedule.
• We have vaccine schedules and state regulations regarding children who attend public school that we must follow. Outside of that, our physicians handle our goal is to provide education to patients and families.
• Patients are allowed to choose. 

This poll was conducted on June 25, 2019, with 904 applicable responses. 

It is important for medical practices to have policies and procedures to guide clinicians in handling patients who haven’t been vaccinated and present with infectious disease symptoms. This could be a safety issue for staff, providers and other patients of the practice. Having practice policies and procedures around vaccinations helps your staff understand precautions they may need to take and whether discharging patients for non-compliance is practice protocol.

There also are public health reporting considerations. The CDC and the Occupational Safety and Health Administration have numerous resources on these topics, including information on the Worker Infection Control Plan. Communicable diseases such as measles and mumps are required to be reported to your local health department and/or CDC.

Connect with your colleagues in the MGMA Member Community for more suggestions on how they are working through challenges such as vaccine refusal.

Additional resources

• Provider - Patient Relationship Termination Checklist (MGMA Resource)
• Provider - Patient Relationship Termination Sample Letter (MGMA Resource)
• The Power of Patient Engagement to Improve Patient Safety (MGMA webinar)
• Guidance for Talking with Patients about Vaccines (CDC Resource)
• Tips for Preparing for Questions for Questions Parents may Ask about Vaccines (CDC Resource)
• Fact sheet: If You Choose Not to Vaccinate Your Child, Understand the Risks and Responsibilities(CDC Resource)
• Manual for the Surveillance of Vaccine-Preventable Diseases (CDC Resource) – includes guidelines on how to manage a suspected case of each
• Infectious Diseases SER Background Document (OSHA Resource)
• Outline of Key Provisions in OSHA’s Infectious Disease Regulatory Framework (OSHA Resource)
• Refusal to Vaccinate Form (AAP Resource)

JOIN MGMA STAT

Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit mgma.com/stat. Polls will be sent to your phone via text message.

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