9_PatientAccess

9. Address potential patient access limitations

Insurance coverage and affordable testing

Consideration

Critical decisions must be made regarding funding, billing, and test provision for patients without insurance.

Voices from the Field

“Every community needs a community testing site that people can access regardless of their ability to pay”
“In no case do I think … a person should have to decide do I go get tested for COVID or do buy groceries for my family this week.”
“Even if the insurances don't pay for it at this point in time, we are continuing to do the testing. We are not refusing anyone because of the lack of ability to pay.”
“If you are asymptomatic and just want to get tested for peace of mind, your asymptomatic test isn't covered.”
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Standing orders

Consideration

Standing orders can facilitate testing for persons without a primary care provider.

States interested in implementing standing orders may find examples from other states they can adapt.

Voices from the Field

“The commissioner called me on Thursday or Friday and said we need a standing order in place by Monday, can you work that. So, I rapidly looked around … literally Googling state standing orders for COVID testing and found several … I literally lifted [state’s] copy and pasted and tried to make it more relevant. We worked on it over the weekend and we have a signature on it by Monday.”

Literacy levels

Consideration

Consider reading levels of materials related to your OSCTC.

Voices from the Field

“We offer an online assessment that we have ensured the questions are at a third-grade reading level or below to ensure that ease of use for the user”

Patient physical or mental limitations

Consideration

Family members can provide assistance with testing.

Consider providing handicap access.

Voices from the Field

“…the very elderly … may have dexterity issues with unwrapping the swab or actually collecting the sample or if they're extremely ill … They usually have someone in the car with them that drove them to the site. And if they're comfortable, they will usually allow that family member or friend to do the sample collection for them because it's a nasal swab.”
“We have chosen a building which shows that from the front there is ample handicap parking and handicap access to the building where we have a lot of patients who have special needs, so we were very intentional… a lot of our population is Medicaid Medicare, so we wanted to make sure that they would have ample ability to get to the site.”
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Translation

Consideration

Many states are producing their own set of translated materials — there are opportunities for sharing among states in lieu of each state creating their own.

On-site interpretation services may be needed.

Voices from the Field

“ … [the] site for translated materials… No standard, crazy… we’re trying to get it as 8 or 10 languages and making the flyer in those languages… we need to do a lot better job of coordinating getting in one place its very kind of very scattershot right now.”
“We have on-site interpretation so that we can ensure that there is someone who can provide language capabilities.”
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Scheduling

Consideration

Try to have morning, evening, and weekend options for testing to accommodate work schedules.

Regular testing schedules can improve community awareness of OSCTCs.

Voices from the Field

“We have heard issues of the time that a person can be tested because they may not get off work until a certain time”
“We try to support those local less populated areas by creating some level of consistency in those markets where we would have mobile vehicles that rotate….we worked with the state and local government to create access points on certain days of the week so in this particular county, they knew that we would have a place open every Monday for the next 8 to 12 weeks … just having that bit of consistency for that population.”
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Transportation challenges

Consideration

Consider working with VNAs to help ensure testing access for homebound persons.

A walk-up option (vs. drive through) can support persons who don’t have a vehicle.

Place OSCTCs on or near public bus lines, or partner with a transportation service to bring patients to your OSCTC.

Co-locate your OSCTC with an FQHC, which are already required to be within a certain mile radius of public transportation.

Voices from the Field

“We had folks who were homebound and couldn't make it to any of our testing sites … we partnered up and trained our VNA agencies to do the testing for us … for individuals who couldn’t leave their homes."
“We created a walk-up event that people can walk up to …tents that had a plastic shower covering, like a screen between you and that provider, to register you, to get you your samples collected…”
“We intentionally kept one location because it is very on the bus lines”
“We have 2 testing sites that will coordinate rides for people.”
“FQHCs have to be located within a certain mile radius of a major transportation line… that is coming in handy now for these testings”
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