As the government works to expand and improve Covid-19 testing, federal health care programs’ experiences with testing during the early months of the pandemic are instructive. It is important that policymakers use this information to ensure that tests are effective, payment rates are set appropriately, testing efforts work as intended and testing is available to those most in need.
The Pandemic Response Accountability Committee, PRAC, created by Congress to conduct oversight of emergency pandemic spending and comprised of federal inspectors general, issued a January 2021 report, “Federal COVID-19 Testing Report: Data Insights from Six Federal Health Care Programs,” that analyzed Covid-19 testing data collected in several diverse federal health programs from February through August 2020 to provide policymakers with objective, data-driven insights. These programs administered or paid for Covid-19 tests in the populations they serve, including Medicare Part B beneficiaries, military personnel and federal inmates. The data illuminated potential gaps and offer four key insights that can help inform the way forward for both federal and non-federal testing programs.
Second, quick test results are imperative for patients and for an effective public health response. But information about test processing times was not readily available in all federal health programs included in the PRAC report. This meant that programs, including Medicare Part B and the Federal Employees Health Benefits Program, reimbursed providers of tests without knowing whether the tests were timely enough to enable people to make informed health care decisions such as whether to isolate from others. Some programs that collected data on test processing times reported improvements in the speed of testing over time. To further improve testing, public and private insurers should consider incentive payment structures that reward labs that return test results quickly. Also promising is the development of effective, affordable rapid point-of-care and home tests.
Third, the average costs for tests varied across federal programs. These variations likely reflect a number of factors, such as use of different types of tests, cost of supplies and the reimbursement policies for each program. However, given the sizeable taxpayer investment in Covid-19 testing, this variation warrants further study to ensure that payment for tests is economical and that programs are not overpaying for tests.
Fourth, the PRAC report found that, for programs with available data, Covid-19 test recipients generally represented the demographics of the populations served by those federal health care programs. This raises the important question of whether testing efforts targeted groups within these populations that are disproportionately affected by Covid-19. Programs collected varying levels of demographic data, making it difficult to assess equitable testing practices and access to testing. Government programs need access to more and better multi-dimensional demographic data (including race and ethnicity) about those receiving tests — such data could be available from sources including federal, state and local organizations. This information would inform policy decisions that target testing efforts and help further monitor public health in disproportionately impacted groups
The PRAC report does not tell the full story of Covid-19 testing nationwide, much of which occurred outside the selected federal health care programs. But it provides instructive data and points towards solutions. It also raises critical questions that decision makers should consider in further refining testing, especially as the country faces new variants:
- What factors may hinder the rapid development and deployment of Covid-19 tests?
- What payment policies are appropriate for testing during a public health emergency?
- What data is needed to ensure effective and efficient testing efforts?
- Will testing be available to populations most impacted by Covid-19?
As the PRAC report reflects, reliable, accurate and timely Covid-19 testing data can help end the pandemic. The time to consider these questions is now, while plans for more robust testing infrastructure are underway.