Jun 5, 2020

Axios Vitals

By Caitlin Owens
Caitlin Owens

Good morning. Hope you're all hanging in there.

Today's word count is 1,228, or a 5-minute read.

1 big thing: Coronavirus diagnostic test pricing is relatively tame

A medical professional administers a coronavirus test at a drive-thru testing site run by George Washington University Hospital in Washington, D.C. Photo: Drew Angerer/Getty Images

Anecdotes of labs charging thousands of dollars for coronavirus diagnostic tests are the exception rather than the rule, according to data provided to Axios by a national health insurer.

Yes, but: Some labs that don't contract with the insurer charged rates that are multiple times higher than what Medicare pays for the diagnostic tests, and in some scenarios, patients may be at risk of receiving surprise bills.

The big picture: Axios received data from the insurer on the coronavirus diagnostic test claims it received in April from professional labs. The data doesn't include two of the five billing codes for coronavirus diagnostic testing, including for high-throughput tests, as they weren't widely used that month.

  • Some labs have negotiated payment rates with insurers. For those that haven't, Congress earlier this year required insurers to pay the labs' posted cash price, which some experts worried could essentially give labs a blank check.

By the numbers: In-network labs constituted the vast majority — 89% — of the 63,378 claims. These labs charged, on average, $163.91 per test, but the insurer actually paid a negotiated rate of $51.31 for each test, which is what Medicare pays.

  • Labs that were out-of-network but had posted their cash price charged, on average, $124.96 (244% of Medicare) per test, and made up 9% of claims. For claims above 200% of the Medicare price, the insurer attempted to negotiate the price.
  • Labs that were out-of-network and didn't post their cash price charged, on average, $176.96 (or 345% of Medicare) per test, and were only 2% of total claims. The insurer paid these labs the Medicare rate.

Yes, but: The labs that didn't post their cash prices and aren't reimbursed for the full amount that they charged may turn around and bill patients for the rest, said Loren Adler of the USC-Brookings Schaeffer Initiative for Health Policy.

Go deeper for details.

2. The long journey to herd immunity

Illustration: Sarah Grillo/Axios

The sought-after state of herd immunity — in which widespread outbreaks are prevented because enough people in a community are immune to a disease — is complicated by open questions about the effectiveness of a future vaccine and how COVID-19 spreads.

Why it matters: Unless a sufficient level of immunity is achieved in the population, the coronavirus could circulate indefinitely and potentially flare up as future outbreaks, Axios' Alison Snyder and Eileen Drage O'Reilly report.

Where it stands: The magic number often cited is a minimum of 60% of the population would need to have immunity.

  • Right now, antibody studies indicate the world isn't close to that threshold, NYT reports.
  • In hard-hit New York, for example, a recent study found 19.9% of people tested have antibodies to SARS-CoV-2. (Though even that is debated by researchers.)

The catch: Antibodies are only meaningful to herd immunity if they provide lasting protection from a virus after someone is infected or vaccinated. But with the novel coronavirus, it's unknown how much immunity a person has after being infected — and for how long.

"The biggest obstacle right now is that we have no vaccine. ... Then it will be distribution to the world's population. And, after that, you'd really be looking at [whether] the uptake is high enough or are there pockets of people who don't want to get the vaccine," said Amesh Adalja, a senior scholar at Johns Hopkins Center for Health Security.

Go deeper.

3. The latest in the U.S.
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Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Andrew Witherspoon/Axios. This graphic includes "probable deaths" that New York City began reporting on April 14.

The Department of Health and Human Services moved on Thursday to require that an individual's race, ethnicity, age and sex be submitted to the agency with novel coronavirus test results.

An NBA plan to send 22 teams to Disney World — the top 13 from the West and the top nine from the East — for an eight-game regular season beginning July 31, followed by a postseason, has been approved by the league's board of governors, the NBA announced Thursday.

House Democrats unveiled a five-year, roughly $500 billion transportation proposal Wednesday aimed at bolstering mass transit and creating carbon-cutting initiatives, Axios' Ben Geman reports. The bill arrives as mass transit agencies are struggling with a collapse in ridership from the coronavirus pandemic, and facing a tough future.

The Lancet medical journal retracted a study on Thursday that found that coronavirus patients who took hydroxychloroquine had a higher mortality rate and increased heart problems than those who did nothing, stating that the authors were "unable to complete an independent audit of the data underpinning their analysis."

Florida saw a sharp spike in coronavirus cases on Thursday, with 41 new deaths and just over 1,400 new infections.

The number of jobless applications has steadily declined after peaking at 6.9 million in late March, with 1.9 million Americans filing claims last week.

4. The latest worldwide
Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

Latin America, Africa, Asia and the Middle East all recorded spikes in coronavirus infections Thursday as cases spread to new hot spots worldwide.

Israel's Parliament shut down after a lawmaker contracted the virus, the New York Times reports.

New Zealand has gone 13 days without reporting a single new coronavirus case, the Ministry of Health confirmed on Thursday. Only one person in the entire country has the virus and they are not being hospitalized.

5. Jailing practices contribute to virus spread

Illinois zip codes with higher rates of arrests and inmates who have been released from jail also had higher coronavirus case rates, according to a new study published in Health Affairs.

Why it matters: Although many communities have sped up the release of low-risk offenders as a coronavirus mitigation tactic, that doesn't cover arrest or pre-trial detention practices.

The big picture: We don't yet know how easily the coronavirus will spread through the massive crowds of people protesting racism and police brutality. But we do know that it has spread very easily so far through prisons — and that more than ten thousand of these protesters have been arrested, per AP.

By the numbers: Jail cycling has accounted for 55% of the varying rates of coronavirus infection across Chicago zip codes and for 37% of the variance across Illinois, the study found.

  • Cycling through Cook County Jail was associated with 15.7% of all documented coronavirus cases in the state as of April 19.
  • "Jail cycling far exceeds race, poverty, public transit utilization, and population density as a predictor of variance," the authors write.

The bottom line: "It is possible that, as arrested individuals are exposed to high-risk spaces for infection in jails and then later released to their communities, the criminal justice system is turning them into potential disease vectors for their families, neighbors, and, ultimately, the general public," the authors add.

6. Americans assessing risk on their own

Illustration: Annelise Capossela/Axios

The U.S. is about to embark upon the most momentous social experiment in living memory: What happens when you take laissez-faire economic principles and apply them to public health?

Why it matters: When millions of people make their own individual risk/reward calculations, the result is superior to top-down decision-making by the government, Axios' Felix Salmon writes.

  • That's the central tenet of capitalism — but you'd be hard-pressed to find any epidemiologists making the same argument.

By the numbers: America continues to see tens of thousands of new coronavirus cases every day. Very few of them result in a comprehensive contact-tracing review. Given the amount of virus in the population, there's a non-negligible probability that any of us could be unknowingly infectious today.

  • Americans react to this uncertainty in line with their own idiosyncratic risk appetite.
  • As businesses reopen, decisions about things like whether to step into a crowded elevator will be made on a bottom-up rather than a top-down basis.

Between the lines: Governors can't simply decree that business is back to usual. So long as a significant proportion of society is unwilling to resume economic activity, employment and GDP will remain depressed.

The bottom line: Countries with more forceful and effective government responses have been able to bring the rate of infection down to a level at which most citizens can reasonably feel safe from the disease. That's not going to happen in the U.S. — and it's not going to happen in places like Brazil, India, or Mexico, either.

Caitlin Owens