Recommendation:
Financial advocacy services are a critical component of oncology care to help mitigate the economic burden of cancer for patients, providers, and programs.
The Association of Cancer Care Centers (ACCC) recommends that every cancer program or practice offer financial advocacy services and identify a central system and/or dedicated staff member to coordinate and liaise with the oncology treatment team to ensure streamlined communication and access to needed care for the patient.
The American College of Surgeons Commission on Cancer, Optimal Resources for Cancer Care, 2020 Standards, under Standard 4.8 Survivorship Program, includes financial support services as a service that may be used by the survivorship program.
In 2018, ACCC released Financial Advocacy Services Guidelines, which outline the following goals for financial advocacy services:
ACCC offers an online Financial Advocacy Boot Camp, as well as robust resources through its Financial Advocacy Network, including peer-to-peer discussion forum. The GW Cancer Institute Oncology Patient Navigator Training is relevant to Financial Advocates.
There are no benchmarks for caseload or recommendations to show the number of financial navigators/advocates needed in a clinic. Caseload varies depending upon the clinic/facility size and the workload requirement for an individual navigator/advocate. Once a Financial Advocacy program is started, it is recommended to track metrics and pulse-check on a regular basis to identify increases or decreases in denial rates. Reasons for these fluctuations can reveal gaps that may demonstrate need for increased staffing.
Financial navigation/advocacy is not a reimbursed service. Providing financial advocacy services helps to reduce patient financial-related distress and mitigates the economic burden of cancer for patients and families, providers, and programs.
ACCC Member Program: St. Luke’s Mountain States Tumor Institute, Boise, Idaho
St. Luke’s Mountain States Tumor Institute (MSTI) launched its Patient Financial Advocate (PFA) program in 2009 within its five hospital-based clinics spanning over 300 miles. Since then, the PFA team has grown 33 percent. Claim denials have decreased and patient satisfaction and participation is up. The oncology care program is highly valued in the state for this total patient supportive care model.
The original goal of the St. Luke’s MSTI PFA program was to focus on the prior authorization process for oncology care and control claim denials. The outcome has been a stronger bridge between the billing office and the clinic, which has benefited all involved including the patient who now feels more supported.