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What's Up? Lab Test Volumes in Recent Weeks

NEW YORK – Even as clinical laboratories have struggled to ramp up SARS-CoV-2 test capacity, routine and other testing has fallen off dramatically, leading to recent volume declines of 50 percent or more for many labs.

Some lab management groups said, however, that in the last three weeks they have seen a steady uptick in test volumes among their clients, suggesting that the industry, or at least parts of it, could be moving toward a recovery.

Labs began to see a large drop in test volumes in the second half of March as the SARS-CoV-2 pandemic took hold in the US. During Quest Diagnostics' recent Q1 earnings call, company President, CEO, and Chairman Steve Rusckowski, said it had seen a decline in testing of around 50 to 60 percent inclusive of COVID-19 testing. LabCorp similarly reported a drop in testing demand of around 50 percent to 55 percent by the end of Q1.

At the beginning of April, Kyle Fetter, executive vice president and general manager of diagnostic services at revenue cycle management and lab informatics firm Xifin, echoed the reference labs' reports, noting that his firm had seen drops ranging from around 20 percent to more than 50 percent depending on the type of testing.

Recently, though, Xifin has seen a rise in testing, with, according to the company's data, volumes beginning to go up again starting the week of April 6 through April 12. At the beginning of that week, test volumes were at just over 40 percent of their normal baseline (as established by average volumes in January and February of 2020) excluding SARS-CoV-2 testing and at 60 percent of baseline when SARS-Cov-2 tests were included. As of last week, test volumes for the company's clients had risen to 56 percent of their baseline excluding SARS-CoV-2 testing and to 91 percent of baseline with SARS-CoV-2 testing included.

When SARS-CoV-2 testing is included, Xifin's data shows that several categories of labs are currently above baseline testing levels. For instance, clinical labs are at 111 percent of baseline (with SARS-CoV-2 testing making up 47 percent of overall volume), while molecular labs are at 107 percent of baseline volume (with SARS-CoV-2 accounting for 38 percent of total volume).

Pain and toxicology labs, meanwhile, are at 55 percent of baseline volume (SARS-CoV-2 18 percent of total), pathology labs are at 62 percent of baseline volume (SARS-CoV-2 5 percent of total), and hospital outreach labs are at 92 percent of baseline (SARS-CoV-2 41 percent of total).

"We are seeing [testing] trickle back in," Fetter said. "I don't know that we are sitting here thinking that suddenly things are going to return to normal. But what appears to be happening right now is slowly, doctors' offices are getting reengaged and that means the [test] volumes are going to start to ramp back up again."

He noted that the uptick was more pronounced in some specialties than others, with, for instance, noninvasive prenatal testing and clinical genetics seeing solid rises in volume, while areas like anatomic pathology and toxicology remained sluggish.

Fetter said the company also saw differences based on geography, with testing appearing to return more rapidly in Midwestern locations compared to the coasts, though he noted that volumes are up somewhat even in the hardest hit parts of the country like the Northeast.

He suggested that in addition to the gradual reopening of doctors' practices, the rise in test volumes was driven by the fact that some patients can no longer safely delay testing they had avoided during the earlier weeks and months of the pandemic.

"You can only defer some of this testing for so long before it creates a more negative impact" than COVID-19 itself, he said. "Certainly, there is a lot of testing that goes on every day just to kind of keep people going, and that is the kind of testing that we are seeing start to return."

David Nichols, president and founder of lab services consulting firm Nichols Management Group, said that he had, likewise, seen a rise in test volumes among his clients in recent weeks but said that he believed much of this was due to a jump in SARS-CoV-2 serology testing as opposed to the return of routine testing.

He added, though, that routine testing volumes were "slowly returning, especially correlated to the resurgence of discretionary surgery" and other non-urgent medical procedures.

Nichols said his firm's client mix was roughly similar to Xifin's, though he noted that his firm might have a higher percentage of anatomic pathology business, which has been among the slower areas to return.

As the Xifin volume data shows, SARS-CoV-2 testing makes up a substantial portion of current lab volume, though Nichols said that he anticipated lab-based SARS-CoV-2 testing could dwindle in coming months.

"There has been a spike in the last couple of weeks due to antibody testing, but I don't think that is going to continue," he said, adding that he believed the spike was due in large part to people who had had colds or flu during the winter wanting to learn if they have been exposed to SARS-CoV-2.

"They went and got their antibody tests, and if it was negative, they aren't going to get tested again," he said.

Additionally, point-of-care and home-based protein antigen tests will likely compete with lab-based PCR testing for the virus in coming months, Nichols said, which could negatively impact lab volumes even as overall demand for SARS-CoV-2 testing rises. He said he also expected that Medicare pricing for SARS-CoV-2 tests will be reset at lower rates next year.

He suggested that longer term the virus would likely boost testing volumes, especially if, as some are predicting, infections recur on a seasonal basis much like the flu. In that case, he said labs would continue to see demand for SARS-CoV-2 testing and would likely see increased demand for respiratory test panels, as well, as many patients with respiratory infections and their doctors would feel increased urgency to more quickly determine the cause of their infection, and so, would be less put off by the copays and deductibles involved.

"You don't want to take advantage of a situation like this, but it is good for the public awareness of the [lab] industry, and it's good [long term] for the industry's revenue," Nichols said.