Healthcare facilities will need to expand their current COVID-19 testing capacity by at least 211 percent in order to even partially resume full services, including elective procedures and diagnostic services, according to new research from healthcare improvement company Premier Inc.
The survey data indicated that 80 percent of respondents would like to increase their ability to conduct on-site COVID-19 testing, and the main factors limiting these efforts are shortages of chemical reagents needed to perform the test (cited by 41 percent of respondents) and shortages of viral swabs (cited by 40 percent).
The research was conducted in late April and included responses from approximately 150 unique hospitals, integrated delivery networks and ambulatory surgery centers accounting for nearly 400,000 elective procedures per month.
According to survey data, 81 percent of respondents do intend to screen all employees for symptoms of COVID-19, including temperature and other symptom checks before resuming non-emergency procedures. However, given the limitations on testing supplies, only 32 percent said they will be able to proactively administer COVID-19 tests to all front-line healthcare workers, and only 22 percent will be able to test all ancillary employees such as foodservice workers or janitors.
Until supplies are more readily available, 44 percent said they would have to limit testing to employees that are symptomatic. Further, 59 percent of respondents said they would have to limit re-testing of front-line workers to only those that show symptoms of having contracted COVID-19.
On April 19, the Centers for Medicare & Medicaid Services (CMS) issued a set of recommendations on how patient care organizations could fully open their operations to elective surgeries, given compliance with certain requirements issued by the agency. For the guidance, CMS first referred to the White House’s phased approach for reopening the country, noting that once hospitals in a given state reach Phase One—passing the gating criteria related to symptoms, cases, and hospitals—then they can begin resuming elective surgeries. Related to testing specifically, the federal agency said, “When adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well.”
Undoubtedly, there is great desire on the part of healthcare organizations to reopen their institutions for elective procedures. It’s been estimated that for a typical hospital, these electives account for about 51 percent of their revenue. And beyond the financial impact on hospitals, these closings have led to patients losing out on important care, too. An Advisory Board executive recently told Healthcare Innovation that “People aren’t getting their cancer screenings and not willing to check out their chest pains. If they have minor pain in their knee, hip or foot, [for example], they’re not going to the hospital to check that out, even if it’s a hairline or compound fracture. So what we are likely to see is a lot of those ‘non-elective’ visits leading to significant medium-term complications.”
In the Premier survey, 87 percent of respondents said they intend to proactively administer COVID-19 tests to any patient admitted for an elective procedure, but only 27 percent said they would be able to proactively test patients undergoing a diagnostic service. Most respondents (54 percent) will continue to bar any family members or other visitors from the facility in order to reduce the risk of spreading infection and conserve available testing.
Today, according to Premier, 48 percent of respondents send COVID-19 diagnostic tests out to commercial laboratories for analysis and 49 percent conduct those tests on-site or at the point of care. Less than 3 percent of respondents reported leveraging at-home specimen collection. Twenty-two percent of serology (antibody) tests are sent out to commercial labs while 16 percent are conducted at an on-site central lab or at the point of care.
“A core component of any reopening strategy is broad testing capacity to minimize resurgence of COVID-19,” said Premier President Michael J. Alkire. “However, current restrictions on capacity and shortages of swabs and reagents force health systems to limit testing, prioritizing patients and front-line workers who are symptomatic. Even with these strict conservation protocols, capacity needs to at least triple before enough is available to support even a partial restoration of non-emergency services. This represents a major challenge to patient care, as an inability to offer elective procedures and diagnostics can mean a missed opportunity to detect preventable illnesses early or begin treatments that are necessary for health and wellness.”
