Sat. Sep 24th, 2022
Doctor in protective gloves examining and organizing test kit for COVID-19 in laboratory.
enlarge Doctor in protective gloves examining and organizing test kit for COVID-19 in laboratory.

Tang Ming Tung | Getty Images

The failure of the COVID tests in the US has come in phases. First, there were not nearly enough tests due to mounting policy errors and supply chain issues. As the delivery problem gradually came under control, it was replaced by backlogs in processing: When things soared in the summer, many people had to wait a week or more to get results back. A national survey in August found that only 37 percent of people who got a nasal swab got results back within the two days it takes for effective contract detection, while nearly a third of the tests took longer than four days. This delay meant that, as Bill Gates colorfully told WIRED’s Steven Levy in August, “The majority of all American testing is completely junk.” The root of the problem, Gates said, was that the federal reimbursement rate for the labs processing COVID tests is the same no matter how long the results take. Change that, he argued, and the lab processing tests “will sort it out overnight.”

A new bill should make Gates’ idea a reality. On Thursday, Mikie Sherrill, a freshman New Jersey congressman, introduced the SPEEDY Act, which would link federal fees to test result rates. (Its full name is the “Strictly Pay for Efficient and Expedited Delivery of Your (SPEEDY) COVID-19 Test Act.”) At the start of the pandemic, the government paid about $51 per test for people covered by federal health plans. (The average marginal cost of a standard PCR test varies, but in a high-volume lab it will cost about $40.) To encourage labs to expand their capacity, the Centers for Medicare and Medicaid Services (CMS) have stated that increased to $100 in April. Under the SPEEDY Act, tests yielding results within 24 hours would be awarded $125; within 48 hours, the current $100 rate would apply; and for results within 72 hours, labs would revert to the pre-April fee. The government would not pay at all for results that come back after 72 hours. (To prevent labs from simply giving up the tests after that window closes, the law would require them to still process the tests to participate in Medicare.)

“A turnaround time of more than 72 hours is virtually useless,” said Sherrill, whose staff consulted with public health experts about the bill. Someone waiting for a negative result may be unable to return to work and miss out on a paycheck. Meanwhile, they and their contacts could be spreading the disease.

The industry disagrees with Gates’ criticism or Sherrill’s proposal. “The claim that labs would speed up COVID-19 testing if they weren’t reimbursed for tests done outside a certain time window is blatantly false,” wrote Julie Khani, president of the American Clinical Laboratory Association, the trade group that includes testing. . giants LabCorp and Quest Diagnostics, in an emailed statement. “The proposal you describe goes against our collective goal to expand testing capacity, fails to address the underlying factors that influence turnaround time, and threatens access to testing for highest-risk populations.”

Khani didn’t elaborate on what exactly needs to be addressed for faster results, but experts have complained several times about a lack of chemical reagents, lack of the expensive machines needed to read the tests, lack of staff trained to read them. to use machines, and lack of certified lab spaces. The theory behind the SPEEDY Act is that linking payment to test result times and offering a bonus for extra fast turnaround times will give labs the right incentive to invest in those resources.

It is difficult to accurately estimate the magnitude of the test delays. There has been no national survey since August. Anecdotally, it remains trivially easy to find examples of people waiting four or five days for results. Without rapid test results, it is impossible to monitor the spread of the virus, and by extension, contain it.

“If you’re talking about tracing contacts and how quickly you find people who have been exposed, even a day or two can be a lot,” said Emily Gurley, an infectious disease epidemiologist at the Johns Hopkins Bloomberg School of Public Health. By the time most people with symptoms come for a test, she explained, they’ve just started infecting other people. If the test takes several days to process, those people are likely already contagious by the time the result comes back. Multiply this by thousands or millions and it makes the task of detecting and controlling outbreaks nearly impossible. “A lot has been invested in contact tracing programs — building them and hiring and training people — but as good as those programs are, if the test results are late, they will never be as effective.”

The law would only apply to federal benefits, not private plans or tests purchased by state and local governments. But because Medicare and Medicaid together insure a third of Americans, and the federal government also covers the tests for the 9 percent of Americans who are uninsured, that’s nearly half of the market. Meanwhile, federal health programs are shaping what’s happening in the private sector. “Medicare is ultimately how we drive a lot of the changes in the medical system, even for the non-Medicare patients,” said Ashish Jha, dean of the Brown University School of Public Health and one of the experts who advised on the issue. bill. “Private payers generally don’t negotiate every single service. They usually negotiate a wide range of services and use the Medicare payment schedule as a starting point. That means whatever Medicare pays for this test will also trickle down to what private insurers pay for it.

As with any bill introduced in a divided Congress a month before Election Day, the prospects of the SPEEDY Act becoming law are uncertain. Sherrill’s two co-sponsors, Suzan DelBene of Washington and Terri Sewell of Alabama, are fellow Democrats. But she is optimistic she can gain widespread support and is eager to improve testing before the winter months spark a potentially devastating new wave of virus.

“I think it should have a lot of attraction for two parties,” she said. “Making sure we have access to testing across the country, making sure you know the contours of the disease — that’s kind of a cornerstone of a pandemic response.”

This story originally appeared on wired.com.

By akfire1

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