Markups, Supply Concerns Loom Over Federal Nursing Home Testing Push: ‘We Don’t Have Anything Like a Free Market’

The federal government on Tuesday announced a plan to send a new set of point-of-care COVID-19 testing devices, from the medical device manufacturer Abbott, to nursing homes starting next week. And while the new round of devices is welcome for skilled nursing providers, many of the questions around paying for supplies and using the devices remain unanswered.

For R. Tamara Konetzka, a University of Chicago professor who has been researching the impact of COVID-19 on nursing homes, the initiative is encouraging in some respects: It suggests that the Trump administration does recognize on some level the issues in testing supply chains, which “individual nursing homes cannot solve, and government action is essential” — and that there is recognition that SNFs at the highest risk are those in locations where COVID-19 is widespread.

“At the same time, I am disappointed that there is still no long-run plan to solve the testing supply chain issues,” she told Skilled Nursing News via e-mail. “These one-time shipments of testing supplies, while certainly helpful to the facilities that will get them, are temporary fixes. It’s not clear that repeat shipments will go to the same facilities. What happens when those supplies run out? Will additional supplies actually be available, and at what cost?”

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David Grabowski, a professor at Harvard University, had similar concerns.

“The administration has already announced that this will not be an ‘indefinite commitment’ and that nursing homes will likely have to purchase testing supplies directly later this year,” he told SNN via e-mail. “What happens if nursing homes are unable to secure rapid testing?”

Under the newest testing initiative, which was announced on September 8, the Department of Health and Human Services (HHS) will release approximately 750,000 point-of-care COVID-19 tests from Abbott to nursing homes, with the initial distribution targeting SNFs in counties with levels of COVID infections that the Centers for Medicare & Medicaid Services (CMS) has designated “red” or “yellow.”

The American Health Care Association (AHCA), which primarily represents for-profit senior living providers, expressed appreciation for the newest step, citing the importance of testing in stopping COVID-19 before it spreads.

“Given the vulnerable population we serve, the ability to frequently test residents and staff and receive reliable, rapid results is paramount,” the association said in a statement. “Access to testing means that long-term care providers can better identify who has the virus and make tactical decisions to protect residents and staff. The amount of time it is taking to receive PCR [polymerase chain reaction] test results is hurting the ability of long term facilities to fight the virus.”

Adm. Brett Giroir, the assistant secretary for health at HHS, acknowledged the difficult PCR turnaround times in discussing the point-of-care initiative Tuesday.

“If you can get a PCR test, get the results back within 24 to 48 hours, and meet the guidelines by CMS, then you should do that if they’re feasible and affordable,” Gioir said. “But for almost all nursing homes, this is not.”

The Abbott initiative is separate from — and in addition to — the shipments of point-of-care testing devices from manufacturers BD and Quidel that HHS announced in July. Under that testing plan, HHS expects to get devices from those two manufacturers to all SNFs with the appropriate waivers by the end of this month.

That plan was similarly welcomed by SNFs and long-term care experts alike, but with some questions about the logistical details, including questions about how facilities can integrate the tests into workflow and how they can procure additional supplies. The BD/Quidel initiative provides enough tests from the government to cover all residents and employees once a week for four weeks, but providers began reporting that the supplies to restock tests for the devices were coming up short.

There were also reports of the tests costing more than providers had expected. While Giroir said July 15 that subsequent tests could be secured for less than $25 each, providers said that each test kit had a higher price tag during a Wednesday press conference hosted by LeadingAge.

LeadingAge is a trade group that represents non-profit senior living providers.

Both Patrick Crump, the president and CEO of the non-profit senior living provider Morningside Ministries in San Antonio, and Julie Thorson, the president and CEO of Friendship Haven in Fort Dodge, Iowa, indicated they were told that each new rapid antigen test would cost $33 apiece.

And in a call announcing the Abbott initiative on September 8, a provider explained to HHS and CMS officials that their medical supply vendor was providing “really high” costs for the extra testing supplies, and asked whether it was cheaper to obtain them directly from BD.

“This was a problem that was alerted to us earlier today, and we’re investigating that,” Giroir said in response. “Right now, BD is only distributing through six suppliers — McKesson, Henry Schein, and a few others … we were made aware of their significant markup today. So we’re in the process of looking for alternatives.”

This issue of cost is one Konetzka also flagged, especially since facilities are going to be going through the tests at a rapid clip given requirements to conduct twice-weekly testing of staff in “red” counties and weekly testing in “yellow” counties.

Giroir said in the call announcing the testing that the direct shipments should continue weekly through November or December, but added that after HHS runs out, the initiative will “transition to the free-market structure.”

That worries Konetzka.

“I’m concerned about Girior’s phrase ‘As we transition to the free-market structure,'” she told SNN. “We don’t have anything like a free-market structure in the nursing home sector. We have providers that are almost completely dependent on public payment with administratively set prices and few options to increase revenues. And then we will have suppliers of testing supplies with little competition who can set prices where they want.”

Morningside has received a testing device at one of its locations with 200 kits initially, Crump said during the LeadingAge press conference.

“We have ordered additional test kits, and the expected date of receiving those continues to be delayed,” he said. “We’re being told right now that we should receive additional test kits near the end of September, which means right now we’re having to have contracts with outside labs to do our surveillance testing.”

Friendship Village has received a BD device with 600 test kits, which Thorson said “is not going to last very long” with 200 employees.

“We have also started are looking for contracts with outside laboratories, because — just because the kits aren’t available doesn’t mean we can stop testing,” Thorson said. “We have to find a way at $100 a test with outside labs to continue this.”

Those supply issues are a particular concern for Grabowski.

“Adm. Giroir has acknowledged there might be instabilities as the distribution channels are established,” he told SNN. “I am very worried that these instabilities could lead to COVID-19 nursing home outbreaks and deaths. For this reason, I believe the federal government should continue to supply rapid testing to nursing homes until the end of the pandemic.”