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Breast cancer screening program reopens

Published: December 1, 2010 | No Comments

A state program that screens low-income women for breast cancer has reopened this week, 11 months after the Schwarzenegger Administration suspended new admissions to save money.

As of Wednesday the Every Woman Counts program is accepting new applications for women age 40 and over who want to have a mammogram screening for cancer.

“Our top priority is to provide breast cancer screening services to as many low-income California women as possible under the Every Woman Counts program,” Dr. Mark Horton, director of the Department of Public Health, said in a statement. “We are very pleased to be able to reopen the program to qualifying low-income women age 40 and older. Early detection can save a life, and I strongly encourage all eligible women to take advantage of this service.”

The program was established by the federal Breast and Cervical Cancer Mortality Prevention Act of 1990 and the state Breast Cancer Act of 1993.

The program is funded mostly by state tobacco tax revenue, and as fewer people smoke, that revenue has been declining. Faced with dwindling funds, the administration on Jan. 1 suspended new enrollment and announced plans to restrict mammograms under the program to women age 50 and over.

But state lawmakers objected to the changes, and as part of the budget negotiations, the program was restored to its former status. The administration agreed to changes that will save an estimated $14 million annually by ending payments to doctors and clinics to track the cases of women who tested negative for cancer. In addition, the Legislature added $20 million to the program’s budget.

The state expects to screen more than 300,000 women during the current fiscal year.

Women can call the program’s toll free number to determine if they are eligible (800) 511-2300.

–Daniel Weintraub

 

State pays millions to track women who test negative for breast cancer

Published: August 29, 2010 | Comments (3)

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.

 

Lawmakers pass bill to restore breast cancer screenings

Published: August 27, 2010 | 1 Comment

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.

 

LA cancer screening center closes doors

Published: July 29, 2010 | No Comments

By Megan Baier
HealthyCal.org correspondent

Megan Baier

Megan Baier

The Elizabeth Center for Cancer Detection in Los Angeles — one of the oldest cancer screening clinics in California — plans to shut down today after treating its last patients.

The center is a victim of Gov. Arnold Schwarzenegger’s decision to freeze enrollment in a cancer screening program for low-income women on Jan. 1 and pay for routine mammograms only for women after the age of 50. Those moves caused an abrupt drop in the Elizabeth Center’s patient load and revenues, which had already been strained as its costs exceeded what it was earning from the state.

Founded in 1944 by Elizabeth Mason Hohl M.D., the Elizabeth Center’s mission has centered on prevention and early detection of breast cancer since its inception. The Center has served over 750,000 women — most of them low-income — over its 66-year history.

The Every Woman Counts (EWC) program pays for mammograms and cervical exams for low-income women who are underinsured or uninsured. Nearly 9 out of 10 patients treated at the Elizabeth Center were covered by that one program. In 2009 alone 13,000 women received mammograms at the center.

Medi-Cal reimbursements are lower than reimbursements from private insurance companies and because of the high proportion of patients treated at the Elizabeth Center who are not privately insured, the Center has had to find other sources of income to supplement the reimbursements it got from the state Medi-Cal program.

The Elizabeth Center owned and sold property at 3rd and Loma in Los Angeles in the 1990s and moved to a single location at 1127 Wilshire Blvd, near the Good Samaritan Hospital just west of downtown. The money the center made off the sale of those properties has been providing additional funding to the center since 1997.

Donald Cook, the Executive Director of the Elizabeth Center, said he knew the center could not continue on the path it was on, even before the crisis brought on by the governor’s decision to freeze enrollment in the program that was the center’s major source of income.

“We knew three to four years ago,” Cook said. “We need to get out of this box. We are too dependent on Medi-Cal”.

Cook and the Center’s directors looked for funding elsewhere, from the Los Angeles County Board of Supervisors to the state and all the way up to the federal government, but were not able to get assistance.

If the Center were going to stay open, it would have to serve a smaller proportion of women insured by Medi-Cal or the Every Woman Counts program and a larger proportion of privately insured women.

“We have got to change to 25 percent Medi-Cal, not by eliminating low-income women, but by bringing in insured women” Cook said.

The eligibility changes that took effect Jan. 1 severely limited the population that could access the Elizabeth Center’s mammogram services. So far in 2010, the volume of patients the center serves is down 60 percent, Cook said.

Since January, the Elizabeth Center has been paying more and more out of its own reserves to stay open and has run out of money to do so any longer.

The closure is likely permanent, Cook said.

“It would take a miracle to stay open,” he said. Cook estimates it would take about $2 million for the center to reopen, but once equipment is sold and staff are gone, that prospect is very unlikely.

The Elizabeth Center’s mission is to catch breast cancer in its early stages, while patients have a high survival rate. Cook says, “Early detection is our best weapon today and will be for a long time.”

While the Elizabeth Center may be the first cancer screening clinic to close its doors, the enrollment freeze in the Every Woman Counts program its taking its toll throughout the state.

Deb Weintraub of Susan G. Komen for the Cure in Los Angeles county said the cuts to EWC have resulted in an increasing number of low-income women going with out screenings.

“Ultimately it will cost the state more money,” she said, since decreased access to mammograms will likely result in cancer being caught in later stages when treatment is more expensive. “Prevention is so much more cost effective.”

“Access for proper health care in LA county is disappearing,” Weintraub said, and “really it is the poor women of California who are losing out.”

 

Cancer screening clinics might shut down

Published: July 20, 2010 | No Comments

By Megan Baier
HealthyCal.org correspondent

Megan Baier

Megan Baier

Hundreds of California clinics that provide low-income women with free mammograms and cervical exams are fighting to stay open this summer because of changes in patient eligibility rules and a state budget that is already weeks late with no deal in sight.

Gov. Arnold Schwarzenegger froze enrollment into the Every Women Counts program as of Jan. 1. At the same time, the minimum age to receive mammograms was increased from 40 to 50 years old.

Funding for the program comes mainly from tobacco taxes that California voters allotted for health and environmental programs with the passage of Proposition 99 in 1988.

According to the Department of Public Health, in past years tobacco taxes from Proposition 99 have provided sufficient funding for the EWC program, but will not do so this year.

In previous years the program was guaranteed reimbursement by the state even when the budget was not passed, because the funding came from Proposition 99, which operates continuously whether a budget is in place or not. This allowed clinics to stay open and serve women throughout the summer months.

But this year, enrollment will not be reopened until a budget is drafted and the state decides how much funding to set aside for the program. As a result, women who were enrolled in the program prior to the eligibility changes will be able to receive follow-up screenings but no new screening are being scheduled.

And, since the budget has yet to pass, the state will not guarantee that all expenditures made in budget-less summer months will be reimbursed.

Clinics must either shut down until funding is restored or choose to float their program from reserves with the hope that they will be reimbursed by the state when a budget finally passes.

The California Health Collaborative manages EWC programs throughout the Bay Area and Northern California and will likely close next week because of the stalled budget, managers said.

Paying for operating costs until the budget is approved is risky since it could be weeks before the budget is passed and it is unknown how much the state will give EWC out of the general fund.

“It’s very expensive to float this,” said Barbra Clifford, a manager with the collaborative. Since July 1st the program has been struggling to survive without state funding. The Collaborative will be able to reopen when the budget passes, “the minute we get a contract,” Clifford says.

Others are not so lucky. The Elizabeth Center in downtown Los Angeles will close its doors permanently in August, according to its director. The clinic, which screened approximately 13,000 women for breast cancer last year, has only screened 2,900 women since January 1. To meet its costs and keep its doors open, the clinic must serve 1,000 women a month and has not been able to do so since enrollment was frozen.

Donald Cook, the managing director of the Elizabeth Center, worries that many women will go without screenings when the clinic closes. “When we go down, we don’t know where the women will go,” he says.

Cook stressed the importance of cancer screenings, calling them, “the only weapon we have against cancer.” According to the American Cancer Society, while women whose first-stage breast cancer is caught early are all but certain to survive, only 86 percent of women whose cancer reaches stage 2 before it is found will live for five years.

Heidi Souverille, the Community Health Supervisor at the UC Davis Cancer Center, said the cuts have been “devastating.” Communities that rely on the services provided by EWC will have to find new providers or go without the screening.

“The thing about breast cancer is that it can be a very treatable disease if it is caught early,” Souverille says.

Women who qualify for EWC are uninsured or their insurance does not cover screenings. “Medicare and Medicaid don’t pick up until diagnosis,” Souverille says, so many women depend on EWC for regular screenings. Many low-income women may not get diagnosed as early because of their insurance coverage and the new limitations on the EWC.

Assemblywoman Noreen Evans, D-Santa Rosa and Assemblyman Pedro Nava, D-Long Beach, are sponsoring AB 1640, which would unfreeze new enrollments and reduce the age requirements for mammograms back to age 40. The bill made it through the Assembly and is currently pending in the Senate.

The bill also attempts to direct more of the EWC funding to screenings and away from other non-clinical program activities like outreach and education, in an effort to avoid limiting eligibility and deliver the most cancer screenings possible.

 

Lawmakers try to restore cancer screening for uninsured women

Published: July 12, 2010 | 1 Comment

By Megan Baier
HealthyCal correspondent

Megan Baier

Megan Baier

A bill to increase access to breast and cervical exams for underinsured and uninsured women is making its way through the Senate.

The Every Woman Counts (EWC) program provides free breast and cervical exams to women who would otherwise not be able to afford them. The program serves approximately 350,000 low-income women throughout the state each year.

In December 2009 Gov. Arnold Schwarzenegger ordered major cuts to the program, raising the minimum age for mammograms from 40 years old to 50 year old and freezing enrollment into the program for the first six months of the year.

Because early detection of breast and cervical cancer are vital to patients’ survival, the cuts to the program will likely increase the number of women who die from cancer, according to the authors of the bill, Assemblywoman Noreen Evans, D-Santa Rosa and Assemblyman Pedro Nava, D-Santa Barbara.

Evans and Nava proposed AB 1640 to overturn the cuts to the program and reinstate health services for poor women. In addition, the bill would provide referrals, treatments, and patient advocacy.

The bill mandates that no more than 10 percent of EWC funds go toward administrative costs. It imposes tighter regulations on the program’s costs in order to rectify past mismanagement.

Supporters of the bill include the American Cancer Society and the Western Center on Law and Poverty. The bill faces no formal opposition but is likely to run into resistance later from the governor’s Department of Finance, which monitors state spending and defends his budget priorities.

An audit conducted by the California State Auditor at the request of Evans and Nava found that the program could redirect some of its federal money from outreach and training to direct services, providing enough funding for about 40,000 extra women to receive exams. But the state Department of Public Health, which administers the program, disagrees. Every year about 25,000 California women get breast cancer and about 4,000 women die each year from the cancer, according to the California Cancer Registry Report. Low-income and minority women are more likely to die from cancer.

The Assembly passed the bill on a vote of 56-12.

“We sent the governor a message that every woman still counts in California,” Evans said in a statement released by her office. “We cannot abandon poor women to die from treatable cancer. Poverty should not be a death sentence.”

But Evans might face more opposition in the state Senate than she did in the Assembly, where colleagues tend to give one another the benefit of the doubt on bills that spend money. A similar bill, SB 836 by Sen. Jenny Oropeza, a Long Beach Democrat, was held up in the Senate Appropriations Committee because of concerns about its cost.

 
 
 

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