Sounding the Alarm About False Positives

There are false negatives; there are false positives; there are untested individuals with disease.

 I am in the process of developing a 90-minute COVID-19 webinar for ICDUniversity in December to outline new codes and updates, and my inbox is replete every day with articles about the coronavirus.

On Sunday, I took a walk with my husband and had to grab a surgical mask from his stash in his car, because all my handsewn masks were in the wash. I had to take it off after a short while, because it smelled so vile that it literally made me want to vomit. He donned it and assured me that that was what those masks always smell like.

The Cleveland Clinic no longer allows providers to wear homemade or store-bought masks; they are mandated to wear surgical masks, although an email from them just this morning encouraged the general population to wear a cloth mask or face covering when out. Thank goodness I no longer practice clinically!

How this relates to the topic at hand is that a study came out recently, produced by 13 academic medical centers in 12 states, noting that 6 percent of 3,248 participants had SARS-CoV-2 antibodies even though they had not been aware of contracting COVID-19. The findings also showed that:

  • Healthcare providers (HCPs) who reported always wearing face coverings when interacting with patients had lower seroprevalence than those who did not; and
  • HCPs who reported a shortage of personal protective equipment (PPE) at their medical centers were more likely to have detectable antibodies than those who had ample supplies.

Forty-four percent of the approximately 195 members of the serology-positive group “did not believe that they had previously had COVID-19.” I wondered, were some of these false positive antibody tests? This reminded me of other instances of false positives in the news, such as with professional sports teams and at colleges. I’m quite attuned to this ever since my father’s false=positive PCR testing debacle.

This led me to research false positives in PCR testing, and I found an article in The Lancet noting that false-positive COVID-19 tests in the United Kingdom are becoming increasingly likely, with substantial consequences at the personal, health system, and societal levels. It makes sense – more testing, even with a low false-positive rate, will lead to more false positives by the law of numbers.

One of the references from The Lancet article was another article centering on the false discovery rate, which is the proportion of positive test results that are false positive, and its relationship to prevalence, which is the percentage of population currently infected. If the positivity rate is low, even a small false-positive rate can produce a large false discovery rate.

I am really hesitant to sound too loud an alarm about false positives. I would rather have people take a false positive test seriously than have a person with asymptomatic COVID-19 spreading it around because they blew off a positive test as being incorrect. I am afraid, however, that the statistics about COVID-19 are somewhat inaccurate. There are false negatives; there are false positives; there are untested individuals with disease.

The death rate may be inaccurate, but over 230,000 people have died in the U.S. For every person who dies, 19 more have required hospitalization. Many of those will have permanent or long-lasting heart, lung, or neurological damage, including strokes. It is important to remember that COVID-19 isn’t a binary “dead” or “fully recovered” situation.

The studies are incontrovertible in that wearing face coverings save lives. If 95 percent of us wore masks, the total number of deaths would drop by almost half. Vaccines aren’t immediately forthcoming, and adoption of vaccination is likely to be feeble. A large World Health Organization (WHO) study just came out suggesting that remdesivir, one of the drugs which President Trump received when he had COVID-19, does not reduce mortality.

Thanksgiving and Christmas are coming. It is going to be a long, hard winter. Listen to the science, Tony Fauci, and me: practice handwashing, crowd avoidance, physical distancing, and wearing a mask over your nose and mouth. Stay safe.

Programming Note: Listen to Dr. Erica Remer report this story live today during Talk Ten Tuesdays, 10-10:30 a.m. EST.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Erica E. Remer, MD, CCDS

Erica Remer, MD, FACEP, CCDS, has a unique perspective as a practicing emergency physician for 25 years, with extensive coding, CDI, and ICD-10 expertise. As physician advisor for University Hospitals Health System in Cleveland, Ohio for four years, she trained 2,700 providers in ICD-10, closed hundreds of queries, fought numerous DRG clinical determination and medical necessity denials, and educated CDI specialists and healthcare providers with engaging, case-based presentations. She transitioned to independent consulting in July 2016. Dr. Remer is a member of the ICD10monitor editorial board and is the co-host on the popular Talk Ten Tuesdays weekly, live Internet radio broadcasts.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Leveraging the CERT: A New Coding and Billing Risk Assessment Plan

Frank Cohen shows you how to leverage the Comprehensive Error Rate Testing Program (CERT) to create your own internal coding and billing risk assessment plan, including granular identification of risk areas and prioritizing audit tasks and functions resulting in decreased claim submission errors, reduced risk of audit-related damages, and a smoother, more efficient reimbursement process from Medicare.

April 9, 2024
2024 Observation Services Billing: How to Get It Right

2024 Observation Services Billing: How to Get It Right

Dr. Ronald Hirsch presents an essential “A to Z” review of Observation, including proper use for Medicare, Medicare Advantage, and commercial payers. He addresses the correct use of Observation in medical patients and surgical patients, and how to deal with the billing of unnecessary Observation services, professional fee billing, and more.

March 21, 2024
Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets

Explore the top-10 federal audit targets for 2024 in our webcast, “Top-10 Compliance Risk Areas for Hospitals & Physicians in 2024: Get Ahead of Federal Audit Targets,” featuring Certified Compliance Officer Michael G. Calahan, PA, MBA. Gain insights and best practices to proactively address risks, enhance compliance, and ensure financial well-being for your healthcare facility or practice. Join us for a comprehensive guide to successfully navigating the federal audit landscape.

February 22, 2024
Mastering Healthcare Refunds: Navigating Compliance with Confidence

Mastering Healthcare Refunds: Navigating Compliance with Confidence

Join healthcare attorney David Glaser, as he debunks refund myths, clarifies compliance essentials, and empowers healthcare professionals to safeguard facility finances. Uncover the secrets behind when to refund and why it matters. Don’t miss this crucial insight into strategic refund management.

February 29, 2024
2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

2024 ICD-10-CM/PCS Coding Clinic Update Webcast Series

HIM coding expert, Kay Piper, RHIA, CDIP, CCS, reviews the guidance and updates coders and CDIs on important information in each of the AHA’s 2024 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 15, 2024

Trending News

SPRING INTO SAVINGS! Get 21% OFF during our exclusive two-day sale starting 3/21/2024. Use SPRING24 at checkout to claim this offer. Click here to learn more →