J. asked an awesome question yesterday about COVID testing:
I thought testing was covered by insurance. Can you please explain, David?
There are three different types/regulatory categories of testing for COVID. Each have their own quirks, desired technical specification and regulations that drive payment.
DIAGNOSTIC TESTING is testing done to give an individual a yea or nay on whether or not they are currently infected. Diagnostic testing is on the recommendation or supervision of a licensed medical professional. These tests are desired to be highly specific and highly sensitive. We really want to get the results right. These tests are overwhelmingly lab PCR tests with a sample coming from a swab stuck up your nose.
The CARES Act mandates that these tests are provided to individuals with no cost sharing. These are the “free” to the patient tests.
SCREENING TESTS are tests performed on people without clinical recommendation. My parents’ tests that I described yesterday are basically the epitome of this test archetype. A good analogy from a payment perspective is the company required drug screen as a condition to be hired. In that case, the company, not the insurer, pays as the test is not medically indicated but is part of a normal business practice. The NFL is a good example of mass, recurring screening tests being used with the intent of stomping on viral outbreaks at one, two or three cases instead of twenty, thirty, or forty cases. Here frequency of testing and rapid result reporting is more important than accuracy. A mediocre test done daily and reported within a cup of coffee is vastly superior to a perfect test done weekly with results coming back three days after the specimen was collected. Someone who has a presumed positive test today can get cleared with follow-up PCR diagnostic testing or by several days in a row of a negative screening result.
SURVEILLANCE TESTS: These tests are used to inform policy responses. Results are not reported back to any specific individual. For instance a pooled PCR test strategy for a college campus would allow for most dorms to be cleared at a point in time while saying that the 3rd Floor of East Rich Donor Tower is an emerging cluster. 3rd Floor ERDT would then be subject to a swarm of individually identifiable testing to figure out that there are five infected students in two suites that share an air conditioner and those individuals and their close contacts would be isolated and treated as appropriate.
Communities can also do non-individualized surveillance. Influenza Like Illness tracks the percentage of people who present to emergency rooms with symptoms that look like the flu. Covid Like Illness is a new metric that tries to do the same as ILI but for COVID. Communities that run their own sewage system are beginning to track virus levels in their waste water to identify background prevalence and hopefully isolate any sub-regional hotspots. This allows for more fine-grained strategic responses to the situation on the ground. These tests are also not paid for by insurers.