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New Report Sheds Light on Effectiveness of Federal Government’s Response to Need for COVID-19 Testing

Labs, hospitals and other private sector providers have stepped up and performed heroic deeds in meeting the unprecedented demand for COVID-19 testing. State and federal health care agencies from across the country also stepped up to join in these efforts. And while the historic annals evaluating the overall success of these efforts remain to be written, a new report sheds light on the performance of the federal agencies. Here are the key takeaways:

The PRAC Report: Purpose and Methodology

The author of the report is the Pandemic Response Accountability Committee (PRAC), a new federal agency established by the CARES Act to promote transparency and perform independent oversight over spending of CARES Act and other related federal emergency bill funds. PRAC’s responsibilities include supporting efforts to “prevent and detect fraud, waste, abuse, and mismanagement [and] mitigate major risks that cut across program and agency boundaries.”

Published on Jan. 14, 2021, the PRAC report, aka, Federal COVID-19 Testing Report: Data Insights from Six Federal Health Care Programs, is a first of its kind, multi-agency analysis based on data compiled from six different Offices of Inspector General associated with a specific federal agency involved in COVID-19 testing in the seven months after declaration of the public health emergency, i.e., from February through August 2020, including the OIGs from the U.S.:

  • Office of Personnel Management (OPM);
  • Department of Defense (DOD);
  • Department of Health and Human Services (HHS);
  • Department of Justice (DOJ);
  • Department of Labor (DOL); and
  • Department of Veterans Affairs (DOVA).

To assess the agency’s COVID-19 testing performance, the PRAC Subgroup that wrote the report asked the OIGs six key questions:

  1. How many COVID-19 tests were administered, and when?
  2. Who was tested?
  3. What types of tests were administered?
  4. How much did the particular health care program pay for tests?
  5. In what health care settings did people access testing?
  6. How long did it take to return test results?

The 5 Key Findings

PRAC determined that, collectively, the six agencies paid for or administered 10.7 million COVID-19 tests, representing 12.7 percent of all coronavirus tests performed in the U.S. during the study period. Its findings with regard to testing characteristics are largely consistent with overall national trends. The five key insights:

1. People Tested

In terms of test subjects, the report found that the demographic characteristics, i.e., gender, age, and race or ethnicity of beneficiaries in two of the federal programs, Medicare Part B and the Bureau of Prisons, were generally proportional to the demographic characteristics of the populations those programs serve. Thus, for example, the 9 percent of Medicare Part B beneficiaries that identified themselves as Black/African American in the study data closely aligns with the nearly 10 percent of Black/African American Medicare Part B beneficiaries that received a COVID-19 test from all providers, i.e., other agencies, private labs, hospitals, etc. Similarly, the 33 percent of Bureau of Prisons subjects who self-identified as Hispanic/Latino in the study sample was just slightly above the 28 percent of all inmates who received a COVID-19 test that self-identified as Hispanic/Latino.

However, the other four federal health care programs analyzed (Veterans Health Administration, Federal Employee Health Benefits Program, DOL Workers’ Compensation and DOD Medical Treatment Facilities) had varying levels of demographic information available.

2. Types of Tests Performed

COVID-19 test types performed or administered by the federal agencies in the study also mirrored national testing patterns. The vast majority of tests were molecular viral but most programs also covered a limited antibodies testing. The breakdown:

Types of COVID-19 Tests Paid for or Administered by Studied Federal Agency

Agency Molecular Viral Antibodies
OPM 81 percent 19 percent
HHS (Medicare Part B) 86 percent 14 percent
DOL (Workers’ Comp) 95 percent 5 percent
VA (VHA) 95 percent 5 percent
DOD (Medical Treatment Facilities) 96 percent 4 percent
DOJ (Bureau of Prisons) 100 percent 0 percent
Source: PRAC

3. Testing Volume

Testing by the federal agencies in the study was consistent with overall U.S. testing patterns, with little done in the first months of the pandemic, followed by significant increases in volume through the spring and summer.

Source: PRAC

4. Test Reimbursement
During the study period, the six federal health care programs spent at least $659.5 million on COVID-19 tests for their beneficiaries. (This amount doesn’t include testing at the VHA for which no spending data was available.) Average costs for COVID-19 viral tests, which accounted for the vast majority of those the federal agencies in the study administered or paid for, varied by program. Four of the six programs—Medicare Part B, the FEHBP, Workers’ Compensation and the Bureau of Prisons—reported paying an average $69 to $130 per viral test processed at a commercial lab, with variances attributable to differences in product used, supplies involved and program reimbursement rules.
Of the programs that ordered and performed testing at facilities that they manage or operate, only two had data on average cost of viral tests. The DOD Medical Treatment Facilities’ average per-test cost for viral tests ordered and performed at its facilities was $57. The Bureau of Prisons’ average per test costs were $0 because tests were performed on site using testing machines and supplies from the Strategic National Stockpile provided by HHS free of charge.

5. Test Turnaround Time

Only three of the agencies—Bureau of Prisons, VHA and DOD Medical Treatment Facilities— furnished data on COVID-19 test turnaround time. However, those data were also consistent with national testing trends. Thus, the VA and DOD reported turnaround times of more than four days and three days, respectively, in March 2020. But by the end of July, turnaround time had dropped to around one day. The Bureau of Prisons reported that at some sites, test turnaround took as long as two weeks in July and August as demand began to spike. The Bureau of Prisons also used rapid molecular testing, which returned results in as little as 15 minutes.

https://www.pandemicoversight.gov/media/file/federal-covid-19-testing-report-data-insights-six-federal-health-care-programs (page 17)

Takeaway
While it’s not a comprehensive review of the entire federal government testing response, the report does provide valuable insight enabling Congress, federal and state agencies, health care entities and other stakeholders understand and plan for current and future response efforts. “Testing for COVID-19 is a critical component of the federal government’s pandemic response,” noted PRAC Chair Michael Horowitz in a statement on the day the report came out. “Today’s report examines the testing processes in multiple federal programs, providing a detailed look at testing trends, demographics, and spending.”

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