Click here to access the CA Prenantal Screening program quick reference quide.
New requirements for nuchal translucency ultrasound under Ca. Prenatal Screening Program
We have become aware of a new program element and certification requirements for radiology groups who want to perform NT ultrasound for women under the Ca. Prenatal Screening Program. The individual radiologist/physician would need to be credentialed by either the Nuchal Translucency Quality Review (NQTR) or the Fetal Medicine Foundation (FMF). We have printed below an announcement from the program, and also included an attachment with additional details.
The Expanded AFP Screening Program is now the California Prenatal Screening Program. We are pleased to announce the addition of Integrated Screening, with a First trimester component, in late March 2009. By State statute and regulations, prenatal screening with maternal blood markers can only be performed by the California State Program. First trimester blood specimens combined with Nuchal Translucency (NT) measurements will provide a Preliminary Risk Assessment for Down syndrome and Trisomy 18. The NT ultrasound must be performed by a NT Practitioner credentialed by either NTQR or Fetal Medicine Foundation (FMF). A full list of registered NT Practitioners can be found at www.cdph.ca.gov/programs/pns. The California Prenatal Screening Program does not pay for the NT ultrasound exam, but we will pay for follow-up at a state-approved Prenatal Diagnosis Center if the pregnant woman is found to be at increased risk for one of the birth defects we screen for.
As I mentioned on the telephone call, we have been educating the NT Practitioners on how to use the State Program. They can become a Screening Information System provider and enter NT information directly into a website to receive a Preliminary Risk Assessment, or they can contact a Case Coordinator who will enter the NT information into the case or they can provide the NT information on a form that we designed (see attachment) to give the patient to take back to her prenatal care provider when she has her blood specimen collected. We developed a Quick Reference Guide to assist NT Practitioners (attached), as well as an on-line Manual and an ELearning course http://www.cdph.ca.gov/programs/pns/pages/ntpractitioner.asp.
Funds to be Available to All Physicians for Health Information Technology
The 2009 federal economic stimulus package includes $19 billion for health information technology (HIT), the vast majority of which will be directed to physicians to subsidize the purchase and usage of Electronic Health Records (EHR) systems. Beginning in 2011, qualifying Medicare providers stand to receive up to $44,000 under the program; qualifying Medi-Cal providers stand to receive as much as $65,000. These funds are predicated on physicians using EHRs, so practices and groups that already have purchased EHR systems can also qualify for funds. The CMA has made available some background information and tools applicable to all physicians;
Please visit the site here: http://www.cmanet.org/hit/
Screening Mammography for Every Woman Counts (EWC) program
The EWC is part of the Breast and Cervical Cancer Early Detection Program which is funded in part by CDC dollars and from Prop. 10 tobacco tax dollars. It provides education, screening, and therapeutic services for low income women who are not Medi-Cal eligible. The EWC does not currently cover digital mammography due to the fact that CDC does not see the cost benefit of digital for all women over analog mammography and lack of adequate dollars to pay higher cost. Analog machines are being phased out and EWC beneficiaries are having a hard time finding providers. It would cost the EWC program $2.3 million more to screen all their beneficiaries with digital vs. analog, i.e. $70 vs. $133 under Medi-Cal rates.
Last year the CRS supported AB 2887 which would have required EWC to cover digital mammography and pay a differential. The bill failed to pass the Assembly Appropriations Committee due to the increased costs and the lack of state funds for any program enhancements. The CRS met with EWC program officials last October to try and find a solution. Two years ago the CRS had convinced Medi-Cal to cover digital and to provide a payment differential. The problem is becoming more acute as more radiology groups are phasing out analog units. We have stated that radiologists can’t be put in the position of miss-coding the service they provide, e.g. bill for analog and perform digital, and that we can’t absorb the cost of this new technology in a screening modality that has its other challenges.
This year AB 369 (Nava) was introduced this year to try and deal with issue but solution is unclear since money is the problem and increased funding is unlikely. CRS is working with Susan Komen Foundation and the author to try and craft a solution but at this point it’s unknown what solution may be viable. Most of the EWC funding comes from the unallocated tobacco tax revenues and to increase EWC funding would mean that other funded programs would have to lose some degree of funding.
We would like to hear from radiology groups that are or have been mammography screening providers under the EWC and whether you have stopped participating or are still participating yet faced with the conversion to digital equipment. We would like to know who the radiology providers are and what they are doing. Please send an email to Bob Achermann at bachermann@amgroup.us.
