The US’s Covid-testing failure has unfurled in levels. First, there weren’t shut to sufficient assessments, thanks to cascading coverage failures and provide chain points. Once the provision downside regularly got here underneath management, it was changed by processing backlogs: As instances soared over the summer time, many individuals have been having to wait every week or extra to get outcomes again. A national survey in August discovered that solely 37 p.c of individuals receiving nasal swab assessments have been getting outcomes again within the two-day window essential for efficient contract tracing, whereas almost a 3rd of assessments have been taking longer than 4 days. This delay meant that, as Bill Gates colorfully told WIRED’s Steven Levy in August, “The majority of all US tests are completely garbage.” The root of the issue, Gates stated, was that the federal reimbursement fee for the labs that course of Covid assessments is similar no matter how lengthy the outcomes take. Change that, he argued, and the labs processing assessments “will fix it overnight.”
A brand new House invoice would intention to make Gates’ thought actuality. On Thursday, Mikie Sherrill, a freshman congressperson from New Jersey, plans to introduce the SPEEDY Act, which might tie federal reimbursement to check consequence speeds. (The full title is the “Strictly Pay for Efficient and Expedited Delivery of Your (SPEEDY) Covid-19 Test Act.”) At the outset of the pandemic, the federal government was paying about $51 per check for individuals coated by federal well being plans. (The common marginal value of an ordinary PCR check varies, however at a excessive-quantity lab it runs at about $40.) To encourage labs to enhance capability, the Centers for Medicare and Medicaid Services (CMS) raised that to $100 in April. Under the SPEEDY Act, assessments that ship ends in 24 hours can be rewarded with $125; inside 48 hours, the present $100 fee would apply; and for outcomes inside 72 hours, labs would return to the pre-April reimbursement. The authorities wouldn’t pay in any respect for outcomes that come again after 72 hours. (To keep away from having labs simply hand over on assessments after that window closes, the legislation would require them to nonetheless course of the assessments so as to take part in Medicare.)
“A turnaround time of over 72 hours is pretty much useless,” stated Sherrill, whose employees consulted with public well being consultants on the invoice. Someone ready for a destructive consequence is likely to be unable to return to work, lacking out on a paycheck. Meanwhile, they and their contacts may very well be spreading the illness.
The trade shouldn’t be on board with Gates’ critique or Sherrill’s proposal. “The assertion that labs would perform COVID-19 tests more quickly if they are not reimbursed for tests performed outside a specific time window is flat out wrong,” wrote Julie Khani, president of the American Clinical Laboratory Association, the commerce group that features testing giants LabCorp and Quest Diagnostics, in an emailed assertion. “The proposal you describe works against our collective goal to expand testing capacity, fails to address the underlying factors affecting turnaround time and threatens access to testing for populations at the highest risk.”
Khani didn’t elaborate on what precisely would wish to be addressed for quicker outcomes, however consultants have variously complained a couple of lack of chemical reagents, lack of the costly machines wanted to learn the assessments, lack of employees skilled to use these machines, and lack of licensed lab areas. The idea behind the SPEEDY Act is that tying cost to testing consequence occasions, and providing a bonus for further fast turnarounds, will give labs the correct incentive to put money into these assets.
It’s laborious to get a exact estimate of the extent of testing delays. There hasn’t been a nationwide survey since August. Anecdotally, it stays trivially simple to discover examples of individuals ready 4 or 5 days for outcomes. Without quick check outcomes, monitoring the unfold of the virus, and by extension containing it, is unimaginable.