The one fly in the ointment that I have run into is that the third party payors did not increase their DRG reimbursemnt to hospitals when the hepatitis B vaccine became routine. Although the wholesale price of Hep B seems small, it added up to a significant strain on the nursery's budget after a year. To alleviate the strain I started giving the first shot to low risk kids at the first weight check. I don't like twisting my schedule because of reimbursement, but it seemed harmless to the kids, so I did. David Tinkelman, MD