Opinion by Christi A. Grimm and Michael E. Horowitz
Updated: Fri, 09 Apr 2021 19:00:26 GMT
Editor's Note: Christi A. Grimm is the principal deputy inspector general of the Department of Health and Human Services and chair of the Health Care Subgroup of the Pandemic Response Accountability Committee (PRAC), which provides oversight of the federal government's coronavirus response and funds provided by the CARES Act and other related pandemic relief legislation. Michael E. Horowitz is the inspector general of the Department of Justice and chair of the PRAC. The views expressed in this commentary are their own. Read more opinion articles on CNN.
Even as the number of administered Covid-19 vaccines grows, America's need for reliable access to Covid-19 testing will extend well into the future. As the Centers for Disease Control and Prevention notes, early data suggesting fully-vaccinated people are less likely to spread Covid-19 are promising, but "we're still learning how well Covid-19 vaccines keep people from spreading the disease" as well as "how effective the vaccines are against variants of the virus." Given this continued risk, it is important that the federal government remains focused on testing.
Indeed, in January, the Government Accountability Office warned that without a comprehensive national testing strategy, "[the US Department of Health and Human Services] is at risk of key stakeholders and the public lacking crucial information to support an informed and coordinated testing response."
Around the same time, President Joe Biden announced actions as part of the National Strategy for Covid-19 Response and Preparedness to improve availability of tests and prepare for the threat of variants. These efforts focus on schools and congregate care settings, increasing manufacturing of tests and genome sequencing.
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.
First, at a macro level, the federal health care infrastructure is not currently designed for massive public health efforts. Data show most testing in the federal health programs was for the purpose of diagnosing current infections, as opposed to antibody tests that are primarily valuable for understanding the virus' epidemiology in the general population and identifying groups at risk for infection. This is not surprising. Many of these programs, historically distinct from the public health infrastructure, pay for services such as testing that are medically necessary and provided to individuals, rather than non-diagnostic testing done for public health surveillance purposes that meets broader public health goals. This continues to be the case during the pandemic as programs such as Medicare Part B cover only diagnostic testing. Moving forward, policymakers should consider how the federal health care system can better aid public health testing needed during a pandemic.
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.