Testing Trends

Report Analyzes Federal Health Programs’ COVID-19 Testing Efforts in First Months of Pandemic

The COVID-19 outbreak caught the country and the world totally off guard. And even as the pandemic intensifies, the lessons from those first crucial months hold the key to managing not only coronavirus but also future public health crises, particularly with regard to diagnostic testing. A new government report offers sheds new light on one big part of the early efforts to meet the historically unprecedented demand for COVID-19 testing, namely, the role of federal agencies directly involved in administering or paying for tests. Here is a breakdown of the report’s findings and the insights it offers for mass scale testing efforts in both the near- and long-term future.

The PRAC Report

Published on Jan. 14, 2021, the Federal COVID-19 Testing Report: Data Insights from Six Federal Health Care Programs report is the work of the Pandemic Response Accountability Committee (PRAC). In case you have not heard the name, PRAC is 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. Its responsibilities include supporting efforts to “prevent and detect fraud, waste, abuse, and mismanagement [and] mitigate major risks that cut across program and agency boundaries.”
The report is an attempt to carry out that mission by evaluating federal government involvement in COVID-19 testing efforts from February through August 2020, the first seven months after declaration of the public health emergency. Although it is not a comprehensive in scope in the sense that it does not cover all agencies involved in testing, it offers a meaningful cross-section based on data supplied compiled from the Offices of Inspector General of six federal agencies that were directly involved in administration and/or reimbursement of COVID-19 testing, 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).

The 6 Questions PRAC Asked the OIGs

To assess the agency’s COVID-19 testing performance, the PRAC Subgroup that wrote the new 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 Five Key Findings

The PRAC report’s greatest value comes from its five key findings.

1. Demographics of COVID-19 Test Subjects

PRAC determined that, collectively, the six agencies that provided data for the report 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. So, who exactly were these people? The report found that the gender, age, race or ethnicity and other demographic characteristics of those who got tested under the participating federal programs largely mirrored the demographics of the entire population those programs serve. The most significant data came from HHS because of the 6.5 million people that got tested under these federal programs, 5.1 million were Medicare Part B beneficiaries. 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.

The DOJ was the only other federal agency that furnished useable data for this analysis. But that data followed the same basic pattern, with the 33 percent of Bureau of Prisons subjects who self-identified as Hispanic/Latino in the study sample being just slightly above the 28 percent of all inmates who received a COVID-19 test that self-identified as Hispanic/Latino.

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 assays but all of the other federal programs in the study (other than the Bureau of Prisons) also covered a limited amount of 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 does not 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 laboratory, 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.

Takeaway
While it is 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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