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LOUISVILLE, Ky. (WDRB) – A Metro government-run cancer screening program "needs improvement" after an audit found data on low-income patients' breast exams and other medical procedures weren't accurately logged in a state database.
The city's Office of Internal Audit also concluded that the Department of Public Health and Wellness didn't adequately monitor reimbursements and failed to follow state law by waiting, in some cases, months to pay invoices, according to the review of the federal- and-state-funded program from July 2010 to June 2012.
The report recommended "prompt" corrections to the department's oversight of the Kentucky Women's Cancer Screening Program, which targets uninsured or underinsured women with incomes well below the federal poverty level. Among other findings, auditors said "non-compliance issues may be systemic" and that the "potential for damage" exists.
Roughly one in 10 patient records entered into a state database had incorrect information about clinical breast exams, mammograms and other procedures, the audit found. Workers waited until the subsequent fiscal year to enter patient data into the Kentucky database in about 17 percent of the cases reviewed.
Those errors didn't necessarily compromise the treatment of patients, said Lavonne White, the health department's assistant director of clinical services. The database isn't accessed by physicians, who instead rely on medical records generated during the exams, health department officials said.
"Since we're not the providers, we're not the medical providers of the patients, none of those inaccuracies translated into poor care for the patient," she said in an interview.
The Louisville data and similar records provided by health departments across Kentucky are kept in the state database, which can be used to track patients' care and progress, said Dr. Kraig Humbaugh, senior deputy commissioner of the Kentucky Department for Public Health.
The state-collected data ultimately is reported to the U.S. Centers for Disease Control and Prevention.
"The data that comes out of this system is only as good as the data that gets entered into the system," Humbaugh said. State officials declined to comment specifically on the Louisville audit.
But there is a "real risk" to patients if information isn't entered correctly into the database, White said. Consider this scenario she describes:
A woman receives an "abnormal" breast exam, which triggers additional tests. But if the health department enters the result of the exam as "normal" into the state database, there is no additional backstop to ensure she is receiving proper care.
"If I was linked to a physician who was practicing poorly and he let it drop, then … we wouldn't be checking either," White said.
The health department requested the audit after a 2012 internal report raised concerns about the cancer screening program. Department's director Dr. LaQuandra Nesbitt "should be commended for proactively requesting the review," according to the audit.
The audit also reviewed contracts between the health department and local providers and discovered problems such as overcharging, by $10, the agreed rate for a mammogram; one instance in which a vendor didn't have a contract for the cancer screening program; and eight cases in which auditors couldn't match payments with their contract terms.
The department has since taken steps to improve the accuracy of the data it provides to the state. For example, information is entered into the state system no later than five days after the department receives it, and a random sampling of patient charts is done each month.
White said the program is "so much better, truly, from every aspect."
"We are able to really know that women are getting the standard of care that they are supposed to receive," she said. "We don't have to wonder if think or just hope that (a doctor) is doing the right thing. We know it. …"
"We know what is going on with the women that have been serviced through this program – and that, ultimately for me, is the measure. We know where the dollars are going."
The Susan G. Komen Breast Cancer Foundation's Louisville affiliate gave grants to the program in 2012 and 2013, executive director Lynda Weeks said. Weeks said she is "very comfortable" with the health department's response to the audit's findings.
"It appears to me, from what I'm seeing, that they have things in place to correct this," she said.