OIG report outlines testing decline for numerous medical conditions during pandemic

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A preliminary analysis of clinical laboratory tests paid by Medicare medical insurance during the first 10 months of the COVID-19 pandemic found significant decreases in testing for numerous conditions.

The report, released Monday by the U.S. Department of Health and Human Services Office of Inspector General (OIG), refers specifically to laboratory tests billed to and paid for by Medicare Part B -- insurance that covers medically necessary lab tests when a doctor or other practitioner orders them for the diagnosis, prevention, or treatment of a disease or the assessment of a medical condition.

“From March through December in 2016, 2017, and 2018 and for the pre-pandemic period (in 2019), the number of beneficiaries who received lab tests paid for by Medicare decreased by 1% or less in each year,” the report said. “However, for the pandemic period (in 2020), the number of beneficiaries who received lab tests decreased by about 9% compared with the pre-pandemic period.”

To compare the number of beneficiaries who received lab tests during the two periods, the audit did not cover COVID-19 tests released in 2020, which included diagnostic tests to identify active COVID-19 virus infections and antibody tests used to identify the immune response from previous COVID-19 virus infections or immunization.

During the pandemic period, the number of beneficiaries who received Medicare Part B lab tests decreased for all types of tests that were part of the analysis. The number of beneficiaries with some chronic medical conditions that are common among Medicare beneficiaries, such as diabetes, kidney disease, and heart disease, dropped by a larger percentage than the average.

For example, the number of beneficiaries with type 2 diabetes who received lab tests from March through December 2020 was almost 4.43 million, a drop of 14% compared to almost 5.15 million from March through December 2019.

Similarly, the number of beneficiaries with chronic kidney disease fell 11% and those with chronic ischemic heart disease fell 19%, although from a significantly lower overall base number of beneficiaries.

The report also uncovered the following trends during the pandemic and pre-pandemic periods:

  • The number of beneficiaries who received lab tests had the highest percentage decreases during the first three months of the pandemic compared with the same months during the pre-pandemic period.
  • For almost 90% of lab tests for which the number of tests performed had decreased during the pandemic, the number of beneficiaries who received those tests decreased by more than 10%.
  • Rural and urban dwellers had similar percentage decreases.
  • Women and men had similar percentage decreases.
  • The number of beneficiaries who received lab tests decreased among all race or ethnic groups.

The OIG report noted that during the pre-pandemic period, Medicare spent $6.6 billion for 419.9 million lab tests received by 26.1 million beneficiaries. By comparison, during the pandemic period in 2020,  Medicare spent a total of $5.5 billion for 358.4 million lab tests received by 23.7 million beneficiaries. 

For the pandemic period in 2020 compared with the pre-pandemic period in 2019, Medicare spending decreased by about 16% and lab testing overall decreased by about 15%.

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