‘It can make a world of difference’: How Mississippians are getting tested for COVID-19
By Erica Hensley and Aallyah Wright | May 7, 2020
CLARKSDALE — Health care workers at the Aaron E. Henry clinic set up three stations last Wednesday to prepare for drive-thru coronavirus testing: a station to screen for symptoms, a station for the nose swab test collection and a final station for patient education.
The advice given at the final station, which health care workers say is one of the most important, goes something like: “Stay at home while awaiting test results, continue monitoring certain symptoms, and seek accurate information online.”
“I think the main thing that everybody should be aware of is there’s no treatment for this. There’s nothing we can do,” said Dr. Sheon Mendoza, a physician at the clinic. “Once we tell you (that) you test positive, we can’t do anything. It does so many things to so many different people that it’s difficult to say what symptoms are what. That’s why we don’t try to go through all of the symptoms, we just go through the ones you need to be alarmed about and go to the emergency room for because we don’t have a vaccine.”
Scenes like these have played out for weeks at brick-and-mortar clinics and pop-up locations across the state as the coronavirus continues to spread in Mississippi.
Testing guidelines vary broadly across different Mississippi clinics and regions: Some tests are free, while others cost patients at least $400; some clinics require appointments and prior phone consultations, while others allow walk-up and drive-up options; some doctors require patients show COVID-like symptoms before administering a test, while others have no such standards.
Most who have been tested for COVID-19 do so with their primary care physician, which has been the advice from the state since Day One of the outbreak. Wanting to broaden testing access for folks with symptoms but without reliable access to a clinic, the state partnered with University of Mississippi Medical Center to scatter pop-up testing clinics across the state, using telehealth screenings to set up appointments.
But for thousands of Mississippians without health insurance, Federally Qualified Health Centers (FQHCs) like Aaron E. Henry provide the vast majority of the state’s free coronavirus testing that doesn’t require patients to show certain symptoms or appointments. In many ways, the state’s 21 FQHCs, each with multiple locations across its home region, are better poised than other providers to execute low-fi mobile clinics across rural areas in need because they’ve done this sort of community-based work for decades.
As of last week, Mississippi FQHCs, which receive federal dollars for increasing access to health care for under-insured and uninsured Mississippians, had tested around 2,000 people at no charge, according to federal data. Most of these tests were run at mobile drive-thrus dispatched across the state, with more than a dozen planned for the coming days.
In March, Congress passed the Families First Coronavirus Response Act and appropriated $1 billion for health care providers to test uninsured patients for COVID-19. Mississippi health care providers can request reimbursement through a federal web portal if they have treated or tested an uninsured patient for COVID-19 and agree not to bill the patient.
But while elected officials have repeatedly touted the free COVID-19 testing, and the state health department offers a list of nearly 200 medical clinics that have tested more than 13,000 patients over the last two months, the out-of-pocket costs for testing and office visits vary drastically by location, a new survey shared with Mississippi Today shows.
Mississippi Health Advocacy Program, a nonprofit focused on reducing barriers to health care in the state, recently surveyed the clinics listed by the state health department as providing COVID-19 testing and found stark inconsistencies in testing programs at clinics across the state.
Of the 150 clinics that responded to the survey, most outside the FQHCs said they were not actively participating in the federal testing reimbursement program, passing up dedicated revenue to help uninsured folks get tested. Only one-third of the clinics said they were currently seeking federal reimbursement for testing uninsured patients. The other two-thirds of clinics were either unaware of the program or not using it, and charging all patients full price for testing — usually consisting of a lab fee and office visit charge.
As for price, testing fees averaged $69 across all providers, according to the survey, with about a quarter of locations offering totally free tests and about 20 percent offering tests for sliding-scale fees or free up-front. About a dozen clinics said they were unsure of how much COVID-19 tests costs, and five clinics charge more than $200 for tests.
It’s unclear exactly how many Mississippians have had to pay for the tests out of pocket or how much insurers are covering. The state insurance commission has said insurers will cover testing, but based on MHAP’s survey, the visit and lab analysis are all viewed and billed differently.
Roy Mitchell, director of MHAP, said many clinics were suspicious of whether federal reimbursement would come, noting the Small Business Administration loan program’s lack of resources.
“The onus is now on Mississippi health care leaders to educate providers about the free COVID-19 test program and ensure Mississippians with or without health insurance coverage that they can seek COVID-19 testing and treatment without fear of being saddled with medical debt in these uncertain economic times,” Mitchell told Mississippi Today.
He added that many Mississippians work in high-exposure jobs but fall in the insurance gap: “The availability of free COVID-19 testing is particularly important to those Mississippians who are risking their health by staying on the job in grocery stores and pharmacies, home health workers in nursing homes, front office staff at hospitals and even the health clinics providing testing.”
Mississippi has steadily out-performed other states in total tests run, ranking consistently around the top 15 for most tests performed per capita, currently standing at about 2,700 tests for every 100,000 Mississippians. Testing is only as effective as its ability to identify COVID-19 cases and isolate them. Currently, the state’s coronavirus case-identification rate is 10.2 percent of all tests administered, while the national average stands at 12.3 percent.
But the number of tests completed any given day in Mississippi is highly variable. Sunday saw more than 3,000 tests, the most tests ever reported in a single day, but two days later showed just 631 tests reported, the fewest since daily testing data became available. Overall, daily tests averaged over a week are currently at 76 per 100,000 residents — still about half of where they need to be to safely reopen the state’s economy, according to health researchers.
In the month leading up to what state officials call the “long plateau” of COVID-19 cases in Mississippi, the state health department’s staff dedicated to the response more than doubled, from 230 staffers to 490 currently.
Much of the priority from that bulk-up was on testing, according to health department documents obtained by Mississippi Today. The documents show that over 100 health department employees and 40 Mississippi National Guard soldiers are dedicated solely to testing coordination, supply and execution.
Two major factors must be considered when analyzing testing: Who collects the test sample from patients’ nose or throat swabs, and which labs run the results to diagnose COVID-19.
Some Mississippi health care entities, like the Mississippi State Department of Health and the University of Mississippi Medical Center, are doing both: collecting samples and analyzing them.
But two other entities have received less attention: community health centers, like FQHCs, and commercial science labs, which partner with clinics to analyze lab tests.
Most FQHCs partner with commercial labs for test analysis, which has its benefits: the labs provide testing supplies, routine shipment schedules, testing guidance and often discounts for the clinics or postponed billing.
Though more than 80,000 Mississippians have been tested for COVID-19, commercial labs have performed 60,828 tests as of Wednesday, by far the most tests of any entity. The state health department’s lab has performed 13,461 tests, and UMMC has performed 6,113.
Output varies by lab. The state health department’s lab, which handled all of the tests for the state early on, is running about 160 tests per day over the last week, down from 207 daily tests the week prior.
Because the state lab prioritizes tests for hospitalized patients and health care workers, and UMMC focuses on its own patients and employees, most clinics and providers send samples to commercial labs such as LabCorp, Quest and American Esoteric Laboratories, known as AEL.
Testing demand has decreased in recent days, according to State Health Officer Thomas Dobbs, so the state reduced testing criteria at its pop-up clinics across the state to include people showing any symptoms of COVID-19 or with suspected exposure. Previously, those clinics required people to have a fever and severe symptoms.
The state health department’s lab can currently handle 650 tests per day, though Dobbs recently said testing capacity needs to improve, telling reporters: “We need to double (total testing) and do it faster.”
As of Wednesday, state-run pop-up clinics had tested 1,644 people around the state at 47 locations and 3,861 people at the state fairgrounds in Jackson, free of charge. UMMC, which currently runs the analysis for samples collected, communicates results with patients within a few days, according to data from UMMC. The hospital’s lab currently has a 12 percent identification rate for cases among all tests run, including tests it analyzes for its own patients, staff and other hospital systems.
At least five more pop-up test sites across the state are scheduled in the coming days, requiring advance appointments through UMMC’s screening app or phone line. UMMC’s test analysis is almost completely derived in-house, only needing a few outside supplies like swabs, and can run 630 tests per day.
On April 30, health care workers from Mallory Community Health Center, another FQHC, drove their mobile clinic to a Holmes County community center parking lot well outside of Lexington, the county seat.
Mallory’s CEO and lead physician Dr. Rozell Chapman said that while they prefer people have an appointment and are screened ahead of time, that barrier keeps patients out, adding he’s not sure testing is getting to people who need it most.
“The new mobile clinics are helping,” he said, noting this was only the sixth pop-up clinic they’ve done. “We’re getting better at the patient education piece,” though he adds that keeping supplies, as he watched nurses spray down their protective gowns with Lysol disinfectant, is a perennial problem.
FQHCs have a deceivingly simple goal: provide affordable health care and wrap-around services, like connections with social services such as food stamps or help with unemployment, to people who otherwise would lack access.
At least 350,000 Mississippians, or 12 percent of the state’s population, lack health insurance. The state’s uninsured rate is among the highest in the nation, though it has dropped by a third over the decade as previously uninsured people gained health insurance through the Affordable Care Act’s federal insurance marketplace. Public health policy analyses show that uninsured number could shrink by over a quarter, or 100,000 people, if the state expanded Medicaid eligibility.
The goal of FQHCs is central to strategies to improve health outcomes — it’s harder for someone to get and stay healthy if they don’t have health insurance, access to affordable medications and treatments, or everyday necessities in their own communities.
Different from private medical providers and testing pop-up clinics around the state put on by University of Mississippi Medical Center and the state health department, FQHCs do not require appointments at their clinics and have even broader criteria for getting tested.
And right now, the clinics’ mission is coming into acute focus as cases of COVID-19 continue to grow across the state, disproportionately impacting people of color.
Officials from the state health department have called the state’s disparities in COVID-19 cases along racial lines “very concerning” and “unacceptable,” saying that a major focus of the state’s pop-up testing is reaching areas with disparities where folks might not be tested otherwise.
By early May, of the more than 40 testing sites across the state, more than 90 percent have gone to counties that showed racial disparity in cases, meaning African Americans comprised a bigger proportion of all cases in that county than their population. As of May 1, African Americans bore a disproportionate proportion of COVID-19 cases in more than 80 percent of Mississippi counties.
So far, 74 percent of COVID-19 cases identified at FQHCs have been among African Americans, who comprise only 59 percent of the clinics’ testing.
As of Wednesday statewide, 57 percent of cases have been among African Americans, 33 percent among white people, 6 percent among the Hispanic population, and 4 percent among Asians, Native Americans and others, according to the state health department.
Black women in Mississippi have carried the largest burden of the disease, comprising 36 percent of all known cases and a quarter of all deaths.
Chapman, pointing to the rural farmland surrounding the mobile unit in Holmes County in late April, highlighted the numerous ways that adequate testing was vital to the state.
“Testing can bridge what the economy needs and what’s best for the health of our citizens,” he said. “Small towns like this, you can really keep (the virus) out and save a whole community. It can make a world of difference.”
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