13_Financial

13. Financial viability / sustainability

Operating at a loss

Consideration

Many facilities are taking a loss for COVID-19 testing but continue doing it because they see the benefit in their communities.

Voices from the Field

We are not refusing anyone because of the lack of ability to pay…at this point in time … we are doing this because it's the right thing to do for our community.”

Unreimbursed expenses - Sample collection costs

Consideration

Some OSCTCs are not being adequately reimbursed for the sample collection process.

Staffing to the lowest level of licensure may help.

Voices from the Field

“Insurance reimbursement for COVID testing is trying to mimic strep testing which doesn't have any insurance reimbursement for specimen collection because the assumption is, you have an office visit around it. You don't have an office visit round COVID testing”
“So now you have, “will you pay for sample collection?” as a question. So, right now that is not necessarily agreed upon across payers. CMS has said they'll pay about $25 for sample collection so the clinic itself is getting $25 and then the lab gets reimbursed for the process of processing that test… $25 per person is not enough to break even if you're having to schedule and result and manage that whole patient record.”
“If they got a small compensation fee for collecting the sample or something like that and that's where I think it could make a difference.”
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Building in clinic visit

Consideration

Incorporating a clinic visit into the sample collection process can add additional reimbursement.

Voices from the Field

“…if we have three vital signs, and a provider is assessing that patient, they are listening to their lungs… we can bill for that visit. It isn’t an expensive visit but still a visit. Whereas, if we don't get vitals or have clinical support to do the testing, it is not a billable visit.”

Facility fees

Consideration

Sites may explore whether they can collect facility fees to help increase reimbursement.

Voices from the Field

“We try to look for opportunities to collect additional revenue … we will look to see whether we can collect some type of facility fee.”

Other unreimbursed expenses

Consideration

Scheduling, marketing, education, and other hidden costs are often not reimbursed.

Voices from the Field

“There's just a ton of hidden work behind it. You can run a thousand cars through a COVID test site, but you have to figure out how you're going to schedule them, you have to figure out how you're going to collect that individual’s information, how you're going to make sure they get their COVID test results and can isolate and quarantine and all of that information that's important for the health department. And there's no reimbursement for all of those hidden costs…”
“...that does not even account for things like the staff that are needed to run the sites, security, tents and all those things that you have to have, like food for the people that work there, all the costs and stuff.”
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Philanthropy

Consideration

Philanthropic partners can ease financial burden on states and health centers.

Voices from the Field

City and State support

Consideration

City and state financial support is available to help some OSCTCs, but long-term sustainability is uncertain.

Some OSCTCs are using tobacco settlement funds.

Voices from the Field

“The city government here is supplementing us for our workforce costs to help us stay whole…”
“For the most part the city has done a great job in ensuring that we have financial security for those things. But it's been on a month to month basis.”
“The municipality is paying for the drive-thru.”
“Our Governor is been very proactive and very aggressive in what he has said yes to and then said we’ll figure it out on the back end understanding that hopefully payment will come in one form or another”
“The state is saying that they are going to cover the testing for all the employees up to a certain amount of time.”
“we funded a lot of the money for this from the tobacco tax money that we had in the county and that is what got us going.”
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Federal support

Consideration

Federal support is available to help some OSCTCs.

Long term sustainability of federal funding source remains questionable, and there is still significant confusion around what support is available, particularly around FEMA.

Voices from the Field

“A lot of funding coming in from the federal government helps …for COVID testing that can really help you be able to pull some of these projects off.”
“...some combination of CARES Act and some ELC [Epidemiology and Laboratory Capacity]….supplemental funds for the state”
“We’re using our CARES money.”
“I don't actually know if we have been paid or reimbursed through FEMA…this seems to be kind of a gray area.”
“There is also FEMA in all of this, but no one quite understands FEMA… There are such payment delays in some of this stuff. Even our lawyers, all of these folks have been trying to figure out how to nationally access that.”
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Health insurance

Consideration

Insurance reimbursement rules vary considerably by state and payor.

Capturing insurance card details incorrectly can lead to a missed opportunity for reimbursement.

Insurance companies can mitigate time-consuming reimbursement issues by designated lump funds for OSCTCs, without requiring insurance details from patients.

Voices from the Field

“We are using a very fragmented Healthcare System that has different reimbursement rules just based on what your plastic card says and when we can't actually touch that plastic card and scan it and make sure we get all that information, we're relying on the individual to call out the numbers, to even understand where to look on their card to tell you what kind of insurance it is and then, they come and get their sample and they leave and you're stuck with incomplete information and you then can't get reimbursed.”
“... guidance on payment around it and that varies state-by-state, especially for the Medicaid populations.”
“... the challenge of how do you actually get the 15 different digits accurately and the person’s first and last name has to match the card exactly … the things that cause rejections of claims are happening so much more often in this kind of touchless drive through setting where they’re not your patients of record and you don't really have enough time.”
“Because we're having to collect insurance information it takes us between 10 and 15 minutes just to schedule one drive through test… that's not practical”
"We are hoping that, we can get some larger insurance players in the state or in our county to put money into a fund that will support COVID testing so we don't have to actually go through the individual reimbursement process unless, you’re having an office visit and then it would be incorporated in that.”
“The health plans clearly aren’t accustomed to paying for public health and other functions outside of the individual and it has been a big point of contention and a lot of dialogue.”
“The bottom line is that we need to sit down with those commercial insurers. They need to pony up the money to pay for COVID testing…”
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