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Payment, Practice, Patient Protection Collide

It looked like one of those slam-dunk legislative proposals. SB 173 by Joe Simitian (D-Palo Alto) cruised through the Senate Committee on Health on a 7-1 vote.

No one expected much opposition in a hearing yesterday before the Senate Committee on Appropriations. In fact, committee chair Christine Kehoe (D-San Diego) started to move along after the bill’s presentation without asking if anyone was opposed to the bill. “Oh, there is opposition?” she asked.

There was.

Several physician association representatives testified against the bill, which requires practitioners to notify mammography patients if their breast density is at a high level.

“The payer mandate was taken out of this bill,” Carolyn Ginno of the California Medical Association said.

That means that women could be financially responsible for costly followup scans when they’re not medically necessary, Ginno said.

“We’re talking about millions of women. And with breast density [issues], the false positive rate is doubled.”

There’s a capacity issue, according to Shannon Crowley of the American Congress of OB/GYNs — that is, whether there are actually enough radiologists and primary care providers in California to handle the large increase in workload that could stem from implementing SB 173.

“It’s more business for us,” Crowley said, “so if we were just looking at self-interest, we’d be in favor of this. But we need to look at all of the risk factors.”

Those factors include radiation exposure from additional screening and possible infection or hematomas from biopsies — which are not large risks, but should only be taken when they’re necessary, she said.

“We think that singling out one particular risk factor in legislation is a mistake,” Crowley said.

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Capitol Desk Public Health