HealthyCal.org

By Megan Baier
HealthyCal correspondent

A state program that screens low-income women for breast cancer has been paying doctors and clinics $12 million a year to track women whose mammograms showed they were cancer-free.

The program – known as Every Woman Counts – stopped accepting new patients Jan. 1 because of a self-described lack of funds.

The $50 case management fees have been questioned by the Department of Finance, which says other big states don’t pay them, and the nonpartisan Legislative Analyst, which recommended eliminating them. The money saved could be used to once again offer mammograms to women who qualify for the program.

“It was troublesome to us when we learned how much money was going in to that,” said Lisa Murawski, an LAO analyst.

“We have this really limited pool of funds to serve people and we aren’t able to provide as many core services as we want,” Murawski said, “so we need to just think about the funds we have and how we can best use those.”

The Every Woman Counts program provides free mammograms and cervical exams for low-income women and has faced increasing demand for screenings, but has been unable to keep up with costs. The program’s budget comes primarily from tobacco taxes, which have steadily declined as fewer people smoke.

Last year the program had to ask the Legislature for a $14 million augmentation to its budget, which prompted Governor Arnold Schwarzenegger to freeze all new enrollment to the program and raise the minimum age to receive a mammogram from 40 years old to 50 years old.

The Department of Public Health, which manages the program, opposes the elimination of the case management fees. But as a cost containment measure, the department has recommended a tiered payment system that would lower the $50 case management fee on normal mammograms to $10. The proposal would save an estimated $9.8 million.

Case management fees cover the follow up costs after a mammogram—phone calls, referrals for abnormal findings, and data collection on the women screened.

The Legislative Analyst recommends abolishing fees for case management on normal mammograms all together, since a normal mammogram follow up only requires notifying the patient of her test results.

But Al Lundeen, a spokesman for the Department of Public Health, said the department believes that some follow up is necessary even in cases where a woman tests negative for cancer “to document complete cancer screening and diagnosis.”

In a review of the EWC program in May, the Department of Finance found that case management costs were increasing faster than clinical costs of mammograms. Since 2004, case management costs have increased 38 percent, while the cost of providing mammograms has only grown by 18 percent.

According to Lundeen, case management fees have increased faster than mammogram costs because of implementation of a computerized reporting system managed by UC San Francisco. According to Lundeen, the system has enabled providers to more accurately bill for services.

Although the department could reduce or eliminate the fees on its own, Lundeen said the department will not make any changes until the Legislature approves a budget and acts on the department’s recommendations.

Note: Correction appended at bottom.

By Megan Baier
HealthyCal.org correspondent

Legislation that would reverse major cuts to a program that provides free mammograms for low-income women passed unanimously through the Senate Thursday and was sent to an uncertain fate in the office of Gov. Arnold Schwarzenegger.

The Every Woman Counts Cancer Detection Program (EWC) provides mammograms and cervical exams to over 350,000 low-income women every year who are uninsured or underinsured.

But the program has been under pressure because most of its funding comes from state tobacco taxes, which have been declining as fewer people smoke.

In December 2009 the Schwarzenegger Administration raised the minimum eligibility age for the program from 40 years old to 50 and froze new admissions altogether. The freeze was supposed to last through July 1, the start of the new fiscal year, but has been extended because the state does not have a new budget.

Assemblywoman Noreen Evans, D-Santa Rosa and Assemblyman Pedro Nava, D-Santa Barbara are sponsoring AB 1640, which would make women 40-49 years old eligible again to receive mammograms again once the program is re-opened to new admissions.

An audit performed by the state auditors found that the EWC program, run by the California Department of Public Health (CDPH), was not reporting to the legislature annually as it is required to do and found the CDPH could not track how much money was being spent on specific activities within contracts and therefore could not determine the cost effectiveness of specific activities, like outreach or community education.

In addition to restoring eligibility for younger women, AB 1640 imposes tighter regulations on the EWC program, mandating that the Legislature and contractors with the program be notified of policy changes 90 days in advance and requiring CDPH to report to the Legislature annually.

State auditors found that the Department of Public Health could redirect funds away from non-clinical activities, including outreach, education and administration, to clinical activities in order to serve more women without spending more money.

The non-partisan Legislative Analysts Office (LAO) also found that close to $13 million could be saved if the program stopped paying doctors and clinics $50 per patient to track cases in which the woman tested negative for cancer.

Despite AB 1640 passing through the Senate and the Assembly unanimously, Evans and Nava may face likely opposition from Schwarzenegger and his administration, since they initially imposed the restrictions. The governor’s Department of Finance registered the only formal opposition to the bill in the Legislature.

NOTE: An earlier version of this story reported incorrectly that AB 1640 would re-open admission to the program. The bill would restore eligibility but that change would not take effect until a budget is passed and enrollment is opened again.