As policy experts cling to pay-for-performance (P4P) as an indicator of healthcare quality and shy away from fee-for-service, childhood immunization rates are being utilized as a benchmark. At first glance, vaccinating children on time seems like a reasonable method to gauge how well a primary care physician does their job. Unfortunately, the parental vaccine hesitancy trend is gaining in popularity. Studies have shown when pediatricians are specifically trained to counsel parents on the value of immunizations, hesitancy does not change statistically.
Washington State Law allows vaccine exemptions on the basis of religious, philosophical, or personal reasons; therefore, immunizations rates are considerably lower (85%) compared to states where exemptions rules are tighter. Immunization rates are directly proportional to the narrow scope of state vaccine exemptions laws. Immunization rates are used to rate the primary care physician despite the fact we have little influence on the outcome according to scientific studies. Physicians practicing in states with a broad vaccine exemption laws is left with two choices: refuse to see children who are not immunized in accordance with the CDC recommendations or accept low quality ratings when caring for children whose parents with beliefs that may differ from our own.