Early in the COVID-19 pandemic, laboratories were focused on the capabilities needed to get them ramped up quickly to handle COVID-19 testing. As 2020 wore on, labs were challenged to keep up with significant fluctuations in COVID testing volume, as well as ongoing shortages in test supplies.
In October 2020, the Centers for Medicare & Medicaid Services (CMS) announced that starting January 1, 2021, Medicare will pay $100 per test only to laboratories that complete the majority of COVID-19 diagnostic tests on “high-throughput technology” and return results within two calendar days of the specimen collection date. Laboratories that take longer than two days to return results will only be reimbursed $75 from Medicare. CMS announced that this change was enacted to ensure patients who test positive can self-isolate and begin treatment more quickly.
In general, reimbursement compression has led to laboratories running on thin margins, so obtaining an additional $25 per test in reimbursement can make an impact on the financial sustainability of a lab. The CMS ruling means that laboratories with high throughout technology need to make sure they can consistently deliver COVID test results within two days to ensure maximum payment for their services. Labs with a nimble LIS and integrated revenue cycle management solution will be best positioned to retain full compensation for COVID-19 testing.
Testing Fluctuations and Turnaround Times Yield Opportunities
According the XIFIN Lab Volume Index, show to the right, laboratories continue to see large fluctuations in volume. For example, in one week early in 2021, molecular laboratories saw a 700% increase in week over week volume. In January 2021 overall laboratories saw an increase in disease and infection rates through most of the country. So, labs that have the flexibility to benefit from additional payment, particularly when volumes are high stand to benefit the most.
In addition to the CMS reimbursement changes, some states, such as California, have contracted with a small group of diagnostic companies to increase the volume of testing capacity and lower the testing turnaround time to as low as 24 hours in some cases.
Disruptive moves like these will create a larger gap between labs with highly flexible technology that can pivot to take advantage of these opportunities and those labs that cannot. There are also house bills, such as the “Strictly Pay for Efficient and Expedited Delivery of Your (SPEEDY) Covid-19 Test Act,” which would provide an additional $25 incentive for test results delivered within 24 hours.
The importance of labs being nimble during times of crisis cannot be overstated. Early in the pandemic, XIFIN clients needed to ramp up COVID-19 virus testing quickly to respond to the needs of the community — in as little as two weeks. It became the XIFIN team’s top priority to support our clients on these initiatives to stand up COVID testing. In fact, XIFIN LIS was configured and ready to go for COVID-19 testing in five days—well before the instrumentation was validated. XIFIN LIS also has a standard device interface enabling the system to consume data immediately, and it also accommodates new reporting requirements. To learn more about the initial response to get labs running COVID tests quickly, read our earlier blog post.
Ensuring Turnaround Requirements Are Met
Now, the focus is on supporting our customers to consistently be able to turn around testing results within two days. Fortunately, XIFIN LIS already has these capabilities built into the system. This includes robust specimen management, electronic ordering, workflow automation, and connectivity to other platforms. Telehealth platforms are a growing area of interest, particularly having the connectivity that would enable lab tests to be ordered directly from within a Telehealth platform, during the patient encounter. With COVID-19 lending impetus, telehealth is projected to continue to grow in interest and usage. Similarly, consumers soon will be able to initiate at-home test kit requests through a patient portal to the laboratory directly.
This ability to be flexible is an absolute necessity when it comes to standing up new tests quickly. The need for this is inevitable given that viruses will continue to proliferate. Viral testing is a growing market as both patients and doctors want to understand the specific strains impacting communities at any given time. Laboratories who have invested in this readiness are the ones that are now performing well, both in terms of handling volume fluctuations and maximizing reimbursement for their work.
XIFIN LIS is flexible and nimble, which allows our clients to adapt and pivot quickly when required, as in the case of a new COVID variant. The key to success in reducing test result turnaround time is the instrumentation interface. This interface is what lets accessions be processed on the instruments faster, with information passed back to the LIS faster, where in turn results are created and distributed back to the ordering physician—or the consumer—faster.
As COVID restrictions continue to loosen, routine testing for patients has generally returned to pre-pandemic levels. While the testing mix is still fluctuating, COVID-19 testing can become a revenue-generating opportunity for the nimble laboratory. It takes flexible systems to keep up with these changes as well as changing reimbursement rules and incentives.