Why did the OIG conduct this audit?
Clinical laboratory (laboratory) tests, when used properly, are important because they provide healthcare professionals with information to prevent, detect, diagnose, treat, and manage disease (including the management of chronic medical conditions). These conditions have health impacts and economic costs, and prevention can reduce costs. To help contain the spread of COVID-19, federal, state, tribal, and local government agencies have implemented community mitigation activities, including some orders or warnings to residents to stay home. These and other factors may have contributed to Medicare beneficiaries receiving fewer clinical services, including laboratory tests. Our preliminary analysis of lab tests billed and paid for by Medicare Part B found reductions in the number of beneficiaries receiving lab tests compared to a similar period before the pandemic.
Our objective was to identify changes in the number of beneficiaries who received Medicare Part B lab tests during the first 10 months of the COVID-19 pandemic—specifically, the number of beneficiaries who received: (1) all lab tests and (2 ) tests associated with certain chronic medical conditions (i.e., diabetes, kidney disease, and heart disease) common among Medicare beneficiaries.
How the OIG did this audit
Our audit covered Part B claims for laboratory tests provided from March through December 2019 (“pre-pandemic period”) and from March through December 2020 (“pandemic period”).
What the OIG found
During the pandemic period, the number of beneficiaries receiving Medicare Part B lab tests has decreased to: (1) all lab tests and (2) lab tests associated with certain chronic medical conditions (i.e., diabetes, kidney disease and heart disease) common among Medicare beneficiaries. From March through December 2016, 2017, and 2018, and pre-pandemic (in 2019), the number of beneficiaries receiving Medicare-paid lab tests decreased by 1% or less each year. However, for the pandemic period (in 2020), the number of beneficiaries who underwent laboratory tests decreased by about 9% compared to the pre-pandemic period.
Our comparison of the numbers of beneficiaries who received lab tests during the pandemic and pre-pandemic periods identified the following trends: (1) The number of beneficiaries who received lab tests had the largest percentage reductions during the first 3 months of the pandemic period , when compared to the same months during the pre-pandemic period; (2) for nearly 90 percent of lab tests for which the number of tests performed decreased during the pandemic period, the number of beneficiaries receiving those tests decreased by more than 10 percent; (3) for gender and residential location (i.e., rural or urban) demographics, during the pandemic period, the number of beneficiaries who received lab tests saw similar percentage reductions for each category within the corresponding demographic (i.e., the female and male genders had similar percentage reductions); (4) For the race or ethnicity demographic group, during the pandemic period there was more variation in percentage reductions in the number of beneficiaries receiving lab tests for each category (for example, the Hispanic or Latino category had a greater percentage reduction than than the white category); and (5) the number of beneficiaries with diabetes, kidney disease, and heart disease who received common laboratory tests for these conditions declined during the pandemic period. The results of our data analysis suggest that the COVID-19 pandemic contributed to these reductions. Lab testing is important for beneficiaries with chronic medical conditions, which are associated with hospitalizations, billions of dollars in Medicare costs, and deaths.
What the OIG recommends
The information contained in this report is provided for informational purposes only and therefore the report does not contain any recommendations. The Centers for Medicare and Medicaid Services chose not to provide comment on our preliminary report.
Filed under: Centers for Medicare and Medicaid Services