How regulatory, price obstacles frustrate two counties’ COVID test goals

Montgomery and Chester counties want to do more tests in jails and nursing homes, but state and federal regulations are getting in the way.

Medical workers wait for cars to pull up to the swabbing tent at the city's coronavirus testing site next to Citizens Bank Park in South Philadelphia on Friday, March 20, 2020. (Tim Tai/The Philadelphia Inquirer via Pool)

Medical workers wait for cars to pull up to the swabbing tent at the city's coronavirus testing site next to Citizens Bank Park in South Philadelphia on Friday, March 20, 2020. (Tim Tai/The Philadelphia Inquirer via Pool)

UPDATED 9:40 a.m. Wednesday

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Montgomery County officials spent two days last week testing every one of the more than 900 people incarcerated at the county correctional facility for COVID-19.

Valerie Arkoosh, chair of the Montgomery County Board of Commissioners, said she decided to do that after hearing about hundreds of sailors on the aircraft carrier USS Theodore Roosevelt who tested positive — a young, healthy population.

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“When you see those kinds of numbers, I think we all have to pause and ask ourselves, as we did with our correctional facility: ‘What facilities under our jurisdiction should we be asking this question? Are there a bunch of asymptomatic positive people in that place?’ And, of course, the answer for us was yes,” Arkoosh said.

On Tuesday, Arkoosh announced at a press conference that of those tested at the county jail, 171 people, or around 18%, were positive for COVID-19.

The county recommends that any long-term care facilities, such as nursing homes, also test every resident and staff member, she said. And Montgomery County can help those places acquire the tests.

But it cannot mandate testing itself because the Pennsylvania Department of Health is in charge of licensing and regulations. So unlike with the jail, the county does not have the same direct authority.

“It’s been a bit of a frustrating situation for us,” Arkoosh said in an interview before the press conference. “The situation with long-term care in Montgomery County has been an extremely serious and challenging one.”

In an opinion piece for the Journal of the American Medical Association last month,

two health-policy researchers called nursing homes “ground zero” in the pandemic.

As of Tuesday, data compiled by the state showed 73 long-term care facilities and personal care homes in Montgomery County had COVID-19 cases, with 1,250 residents and 34 employees testing positive; 194 had died. In all of Pennsylvania, 452 of these facilities had COVID-19 cases, with more than 7,300 residents and 920 employees testing positive; 1,089 had died.

Given how serious the situation is, Arkoosh said, Montgomery County has formed teams of staff to go to long-term facilities that have been hit hard by the coronavirus to answer questions and ask about infection-control policies and use of masks, gloves, and other personal protective equipment. She said staff teams are also checking with smaller facilities where people live close together, such as behavioral health group homes.

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As of now, three or four long-term care facilities have followed the county’s recommendation and tested everyone, Arkoosh said, but she noted that she could not reveal which ones. She did say that just like with the county jail and the aircraft carrier, there are people who do not show symptoms but test positive for COVID-19.

“I’m not the least bit surprised, this is why I wanted to test everybody,” said Arkoosh, who is also a physician. “This is why I say over and over we need more tests … if we don’t have the testing, it’s like being a pilot flying a plane without radar on a moonless night.”

In the interview Tuesday, Arkoosh said the county ran into a price bump while trying to test everyone at the jail.

At first, BioReference Laboratories, which is doing COVID-19 testing for the county jail, said it would charge around $50 per test. But according to Arkoosh, after the Center for Medicare and Medicaid Services announced two weeks ago that it would nearly double the reimbursement rate for the tests in “a critical move to ensure adequate reimbursement,” the lab charged Montgomery County the higher rate of around $100 per test.

“And so because the lab was able to get twice more, they charged us twice more,” Arkoosh said. “So this is not an inexpensive undertaking, but I felt it was absolutely critical to do this.”

The county will be able to get reimbursed from the federal coronavirus relief fund, but it is still taxpayer money, she said.

PrimeCare Medical, the jail’s medical provider, acts as a middleman between the county and the lab. In an email to WHYY on Wednesday morning, PrimeCare CEO Thomas Weber said that the company will ask the county to reimburse whatever amount the lab charges, without additional markup, and that he does not know how much the lab will ultimately charge. Weber said the lab “has always treated our counties extremely fairly from a pricing standpoint” and “stepped up and provided sufficient tests on very short notice.”

WHYY has reached out to BioReference Laboratories for comment.

Chester County is also running into problems with testing workers at nursing homes and prisons.

Earlier this month, Chester County announced that it would do antibody tests for those groups and already had 10,000 test kits. That program is on hold, however, because the county does not have any labs that are approved to do antibody testing, an approval process that comes from the state Department of Health. A department representative said that, as regulators, the department and its lab cannot partner with other labs to oversee their testing.

In a statement, Chester County Commissioners Chair Marian Moskowitz said that “it is frustrating when we have a valuable tool that we can use, yet cannot start testing as quickly as we planned because of regulatory issues.”

As of Tuesday, data compiled by the state showed 28 long-term care facilities and personal care homes in Chester County had COVID-19 cases, with 315 residents and 37 employees testing positive; 72 had died.

In the meantime, the county is looking for other ways to start testing. In an interview with NPR’s Weekend Edition on Sunday, the chair of the House Subcommittee on Economic and Consumer Policy warned that most antibody tests are not being tested by the Food and Drug Administration. The company supplying tests for Chester County is waiting for emergency use authorization from the FDA.

This article was updated to include comments from PrimeCare Medical’s chief executive officer and further details from Montgomery County.

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