Maintaining and Expanding Access to COVID-19 Testing: The Critical Need for Sustainable Reimbursement

September 03, 2020 Categories: ACLA Blog, ACLA News, Reimbursement and Coverage, Featured News

Since the start of the pandemic, ACLA laboratories have focused on developing and offering a range of new tests and techniques to directly support patients in need, including the first at-home specimen collection kits, COVID-19 specimen pooling and the launch of novel RNA extraction methods. All of these innovative testing methods are designed to speed up turnaround times and maximize the use of supplies needed to run each test. At the same time, laboratories have been working around the clock to handle the unprecedented demand for PCR tests, processing more than 37 million tests to date. 

We are acutely aware of the serious nature of this pandemic and the responsibility of our industry in supporting nationwide efforts to prevent and mitigate the spread of COVID-19. Yet, as the U.S. faces a staggering and growing death toll from COVID-19, we are deeply concerned some experts are pushing drastic proposals, including slashing reimbursement for labs that do not meet certain turnaround deadlines. Penalizing labs for extended turn-around times fails to acknowledge the range of factors that impact testing and would do nothing to improve the supply chain. 

Proposals that penalize labs for factors outside of their control – including the global demand for testing supplies and the uncontrolled spread of the virus – would have an immediate and chilling effect on patients’ access to COVID-19 testing. These plans would also do nothing to address the fundamental supply and demand challenges that limit labs’ ability to expand and speed up testing nationwide.

Labs’ turnaround times are significantly impacted by demand, which fluctuates based on the continued spread of the virus. ACLA has long encouraged strict accordance to public health recommendations, including social distancing and mask wearing, in every community as the best way to address this problem. Further, since labs do not order tests, they are unable to control the ongoing influx of patient specimens for testing. ACLA has called for robust adherence to clear ordering guidelines for clinicians so those providing COVID-19 testing can better manage demand and prepare for potential surges in testing needs and ensure high-risk patients can access the testing they need. 

In addition, the global demand for testing supplies, including reagents and pipette tips, remains a challenge. Indeed, over the past several months the supply scarcity has periodically limited labs’ ability to use the full scope of their testing capacity. 

Finally, if labs are forced to absorb the full costs of tests performed, some laboratories will need to make difficult decisions about whether they can sustain their capacity, continue to develop new testing methods or perform testing at all. For example, the initial low Medicare reimbursement rate was a major barrier to entry for some laboratories in the early stages of the pandemic. Sustainable reimbursement allows labs that otherwise may be sidelined due to cost to bring COVID-19 testing online and further expand capacity. Notably, CMS’s April decision to increase reimbursement for high-throughput PCR testing helped enable a near immediate uptick in capacity. 

While turnaround times have been significantly reduced, it’s important to acknowledge a test result’s value is its accurate and reliable diagnosis – information that expands our knowledge of the disease, informs our pandemic response and supports safe return-to-work efforts. 

As we continue to respond to the changing testing environment, ACLA encourages every lab with the appropriate expertise to increase COVID-19 testing capacity. To do so, it’s critical that sustainable and predictable reimbursement for COVID-19 testing remain in place and that policymakers continue to prioritize federal funding to expand testing to millions of Americans. 

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