Decoding HHS's Announcement Ending Vaccination Incentives

Is This the End of Vaccination Incentives?

You may have heard that HHS made an announcement that they are going to stop reporting on vaccinations for children in the Medicaid and CHIP programs. There was a lot of noise pertaining to the statement about “not incentivizing vaccines at the federal level”. There are some issues with that statement that I’m going to unpack today.

This program is the reason why I had to quit my job in 2021. It is the reason why healthcare workers have been mandated to get vaccines as a condition of employment for over a decade. The policy comes from Medicare. It is not the hospital’s making the policy on their own. Any health care entity that is billing to Medicare is subject to this vaccination incentive policy. The policy still stands. I just checked and the VBP program is still in effect. Under this policy, any health care entity that is part of Medicare or Medicaid, must report flu and COVID-19 vaccination status for employees as a condition of payment. The vaccination status of children is also tracked through the Medicaid and CHIP programs. Providers in the program are incentivized to report vaccinations and vaccine status in the same way.

There is a bunch of good news to cover from the announcement. CMS will be moving into incentivizing physicians to provide informed consent, alternative vaccination schedules, and even to collect information on hepatitis B. It might not have a huge impact, or an immediate effect. There are multiple reasons for this, which I will discuss further.

Read on if you’re interested in learning about the HHS announcement and how CMS Medicare and Medicaid incentivizes vaccination and vaccination status reporting for children and adults. There were and still are incentives for health care providers to vaccinate patients.

On the first page, I'd like to draw your attention to the fact that it says quality measures. We're going to get into the quality measures quite a bit. CMS has issued this state health official letter to provide 2027 updates to quality measures for both adult core sets and child core sets for the Medicaid and CHIP programs. Quality measures are data points within a medical record that are used to determine health outcomes and ensure providers adhere to a certain quality standard. Core sets are a list of data points that are extracted for quality reporting purposes. The two terms are almost synonymous with little differences between the two. It's not just about monitoring quality, it's also about incentivizing behavior.

On page two, you can see this policy was born under the Affordable Care Act. Adult and child core sets were updated because they are following the health of children all the way through adulthood in the Medicaid program. For those who don’t know, Medicare is typically for patients over 65, and Medicaid is for patients who are under age 65 with no other insurance. Medicaid and CHIP are both programs for otherwise uninsured people under age 65, including children. It is a way to provide insurance for those who don’t have it.

Generally, the same laws and policies apply under both programs.

The Secretary of Health and Human Services, who is currently RFK Jr shall publish recommended changes to the core measures. Therefore, It is not news the policy was updated. However, if the former HHS Secretary Alex Azar were making these decisions, the result might look a lot different. I know there’s a lot of naysayers who think this is going to be all bad news. I do see some positive trends coming out of this but it’s not all good either.

On page 3, you will note that they are stopping reporting for childhood vaccinations and the monitoring of childhood vaccination status. They’re also adding tracking of chronic diseases which they have not been interested in doing before. CMS is also adding incentives for getting informed consent, providing information on alternative vaccination schedules, with emphasis on shared decision making. The update in policy is aimed at getting rid of the Dr. God complex or paternal doctoring where doctors know better than their patients and simply dictate life and death decisions without taking into account the patient’s preference. CMS is also adding quality measure reporting for hepatitis B. Placing focus on how hepatitis B is diagnosed and treated will provide evidence that could prove there is no risk that infants will develop hepatitis B without a vaccine given at birth.

Personally, I am not a fan of the tracking, and this program does not get rid of health care data tracking. The policy will lead to collecting much-needed evidence on the risk or non-risk of infants developing hepatitis B.

There is a provisional update to monitor and track pre and post-partum depression. Women suffering from pre and postpartum depression are frequently gas lit and the condition is under diagnosed.

The number one reason for issuing this letter is to announce the removal of tracking vaccinations and vaccination status for children and pregnant women under the Medicaid and CHIP programs. States may continue to voluntarily report on these data sets. The announcement does not remove incentivization programs at the state level. Some of those incentivization programs include the Meaningful Use Program and Social Determinants of Health or SDOH. No matter what policy is updated or changed, I still find the incentivization programs remain.

Interestingly, CMS will begin collecting the evidence for a vaccinated versus unvaccinated study. After Dr Paul’s study was retracted, I never thought I would live to see the day! As many of you may know, the requirement for newborns to receive a Hepatitis B shot was recently removed. The CDC childhood vaccination schedule was recently reduced from 72 down to 11 (diseases). All of these changes collectively are taking the teeth out of the death care system.

The problem statement that you may have heard on the news appears on page 5. “CMS does not tie payment to performance on immunization quality measures at the federal level”. Keyword at the federal level. States retain the ability to report these quality measures for value-based purchasing programs. VBP or Value-Based Purchasing programs are on the federal and state level, and they tie payment to performance by definition. CMS admits this is a federal guideline that states are free to ignore. It essentially amounts to writing each state an angry letter if they chose to go against federal guidelines. No other consequences will follow.

What they’re trying to say is after the update, we discourage payments tied to performance at any level. Medicaid is administered by the state. You cannot access it at the federal level. When I worked in the state of Arizona, there was an Arizona Medicaid. Every state has their own medicaid program. The statement is technically true only because they included “at the federal level”. Had they omitted that part, it would be a lie. Payment is absolutely tied to performance at both federal and state levels. HHS may have announced an intention to end vaccination incentives. Yet, payment to performance remains. Allow me to break it down.

This is an important issue because it affects every health care worker and child in Medicaid and CHIP programs. Once again, this was the reason why I had to quit working for health care in 2021, not as much due to the mandates, as it was due to vaccination bonus payments. It costs hospitals a lot of money when you don’t get your shots. You might remember how patients were labeled as unvaccinated during the pandemic, which may have been a death sentence. Some states have even developed child vaccination registries, so parents enrolling their children in daycare or school can look up the vaccination status of the other children before enrollment.

Immunize.org is a website where you can go and check the vaccine honor roll for hospital systems across the country. Only the top vaccinating facilities will appear. It is a useful tool you can use to check if your hospital (or one you might be considering going to) excels at vaccinating or not. Quality reporting are the metrics used to achieve honor roll status. Examples of quality reporting would be how well they vaccinate infants for hepatitis B, or how well they vaccinate their staff against flu.

On page 5 of the CMS announcement, it talks about value-based purchasing programs and payment being tied to performance. The quality measures are the data points that determine how well a provider or hospital will be paid under the Value-Based Purchasing program. Medical records are tied to data mining programs in order to report quality measures to various public health databases. Essentially, it is a behavior modification program. During the pandemic, the CARES Act was passed which awarded doctors and hospitals bonuses for COVID diagnosis, ventilation and administering remdesivir. The Value-Based Purchasing Program achieves the same end result. Good behavior is rewarded with bonus payments while bad behavior is punished by with-holding payments.

No sector of healthcare is spared from the value based purchasing program. The list includes Medicaid, skilled nursing facilities, dialysis centers, outpatient services, and even home health. In theory the program is supposed to keep healthcare costs down while maintaining good outcomes for patients. Positive outcomes are defined as patients not contracting hospital acquired infections or receiving injuries from falls during their stay. A key element of quality is patients must get discharged alive more often than not.

Did I mention the program is a way to manipulate behavior? More than anything the VBP program is about incentives for performing specific tasks. The task could be for information, reporting vaccination status, or providing certain interventions.

This is how it works,over the course of the entire financial year, all medicare and Medicaid payments are reduced by 2%. Doesn’t sound like a lot does it? I assure you, it adds up to billions. Healthcare providers will do anything to get that money back. Medicare sets that money aside in a group fund, like a tax. Payments for the whole financial year will be weighted based on their score. Each doctor or hospital gets two different scores. One that compares providers to others and one is measured against their own performance. They will be paid based on whichever score is higher. Low scores result in billions in lost payments. It is a strong motivator for any doctor or hospital that accepts medicare or medicaid to follow orders.

How are scores calculated? Hospitals are awarded points for achieving low death rates in the hospital.

Scores are calculated based on the quality measures such as mortality rate, hospital squired infections, patient safety, patient experience, and how efficient they are with their allocated funding. This is why hospitals will discharge patients to other places such as nursing homes. It is a way to avoid the death happening in the hospital which could reduce their VBP score.

Patient safety is the one where they bury the employee Covid-19 and flu vaccination core measure. It’s under safety because their rational is to keep patients safe from infection while hospitalized, the staff must be vaccinated. The concept of natural immunity doesn’t even enter the equation. People who have not been vaccinated have 15 times (heard that number somewhere) less chance of getting Covid but that doesn’t matter to the Medical Cult. CMS is not concerned with shedding either, just germ transmission (isn’t it the same thing?) This is why during the scamdemic each day the hospital admin sent notifications that remote staff weren’t taking their shots and we were grandma killers. Not getting our shots fast enough made our hospital score look bad by comparison to other institut. Since the hospital’s success or failure rides on the vaccination choices of their collective staff, it discourages individual choice. The VBP program is the reason why hospitals have been so feirce at firing employees who submit exemptions. To this day, health care providers remain selective about hiring people with vaccination exemptions.

When I say it costs hospitals money when employees don’t take their shots, this is the program I am referring to.

I mentioned a little bit about this program on the VAXXED bus. Normally hospitals get financially penalized for discharging patients too early. If patients are re-admitted within 48 hours of a discharge, Medicare can deny payment. It will also result in a low quality score under the VBP program.

If you recall the movie Office Space, the programmers ran a scam to extract pennies on the dollar from their firm. It was supposed to be such a small amount of money nobody would notice it was missing, but it ended up being a lot of money. They were about to get caught when Milton, the disgruntled man with the red stapler burned the building down and saved them. This document essentially highlights the CMS pennies on the dollar scam.

One more thing about how they calculate those pesky VBP scores, the total score is a TPS, or Total Performance Score. There are TPS reports just like in the movie Office Space! Deciphering what measurements go into the TPS is very complicated, similar to the American tax code.

You might have noticed the foreshadowing of measuring patient experiences as a quality measure. 30% os the TPS comes from a patient satisfaction survey called HCAHPS. Anyone who has been admitted to a hospital, delivered there, or had a surgery would have been sent the survey. Have you ever been to an auto repair place and the servide tech handed you a survey and tells you to mark all high marks?They do that because their hourly raises are dependent on those survey results. Just like the auto industry, healthcare workers raises are tied to HCAPHS survey results. Doctors and hospitals alike will go out fo their way to cater to patients desires in hopes of receiving positive results on the HCAPHS survey.

Rivier University wrote the following quote on the effect HCAHPS has on hospitals.

“Based on this study, the hospitals that have the best survival outcomes are not doing the best job of satisfying patients,” said Robert D. Lieberthal, PhD, the study’s lead author. This has led to hotel-like amenities at hospitals seeking to improve patient satisfaction scores on the HCAHPS. ” source

Being one to call a spade, a spade, I wrote in the HCAHPS program is a PR campaign tool for the healthcare industry. You can find it in chapter 6 of the COVID Code, below is a free excerpt. As you will see, the healthcare industry has collectively boarded the PR campaign train. All to manipulate patient perception in return for money. Not unlike operation Mockingbird.

For further reading, I suggest the below article from 2023. This is an important issue I have been tracking for years now. At the time, you may have concluded it was more lip service. If you did, that was exactly the point.

Returning to Healthcare Employment?

You may be asking, if the incentives to vaccinate both children and healthcare workers has been removed, is it safe to return to healthcare employment? personally, I had a moral issue with working in healthcare if both patients and staff being coerced into accepting shots they didn’t want. I believe in bodily autonomy.

Immunization incentives were a large part of vaccination status reporting. Getting labeled as unvaccinated during the scamdemic could have been a death sentence and that is why learning how this program works is so important. A genocide occurred behind hospital doors because physicians were just following orders. Entire institutions cancelled critical thought and just followed orders in concert. The VBP program I have highlighted for you today, is another program designed to make institutions continue just following orders.

Does the HHS announcement remove the requirement for healthcare workers to be vaccinated as a condition of employment? The policy should have stopped when CMS was told it does not have the authority to mandate vaccination as a condition of hire by the Supreme Court. CMS paused the program for one year after that.

According to mediSolv, the Covid-19 vaccination requirement for healthcare workers has been removed. CMS has a different story, yet again. The document showing which quality measures should be reported for financial year 2026 still include instructions to track Covid-19 and flu vaccination status of healthcare workers as a quality measure in the VBP program. It is possible the requirement to report vaccination status will catch up to the announcement in financial year 2027. Data is collected for a year before payments are adjusted. Watching Medicare’s future releases of “quality measure reporting” like a hawk is advised. You can count on me to keeps eyes on it.

The Future is Biometrics

Assuming states do remove the incentive for healthcare employers to vaccinate staff as a condition of hire, there is one more barrier to overcome. Many testing centers for medical licenses and the Medical organizations that use those testing centers are now requiring biometrics as a condition of licensing. Anyone who is currently licensed or certified is automatically grandfathered in but new students will be subject to biometric data collection. I can almost guarantee the new, younger crowd of medical professionals will be conditioned to submit to biometrics without question. It’s no coincidence I’m sure.

Biometrics can also be collected on patients using medical records. If you haven’t heard me say it before, please hear me now. When you get asked to have your picture taken for your medical record, I suggest you decline the photo op. That picture can be used to collect biomteric information which can be used to connect your identity to social media posts, or any number of other things. Don’t forget many hospitals have a Palantir program called Foundry built-in to the system. In addition, healthcare institutions must report data to the Palantir program HHS Protect. (it’s called something else now but it’s still there).

Overall the announcement is a win in my view. Getting rid of the VBP program would be ideal but it won’t happen overnight. Starting with key quality measures is the first and most logical step. It begins to remove the teeth from the program and sets the stage for more changes in the same direction. I doubt RFK jr could simply abolish the program with a wave of his hand, if anything I wish it would be the PREP Act. Removing the leverage for tracking vaccination status and introducing informed consent as well as alternative vaccination schedule conversations makes the healthcare system a little more humane.

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