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By Joseph Kim, MD, MPH, MBA
Last week nearly 100 financial advocates gathered in Philadelphia, Pennsylvania, for the September 29 ACCC Financial Advocacy Network Case-Based Workshop. Whether from academic research cancer centers or community hospitals or practices, participants unanimously agreed that the entire cancer community needs to invest more resources to improve financial advocacy services in cancer programs throughout the country.
During the workshop, participants discussed the practical challenges they face every day and shared creative approaches to helping cancer patients experiencing financial hardships. These included:
Navigating the Maze around Medicare. Open enrollment for Medicare starts October 15 and runs through December 7. This period is often a confusing time for Medicare enrollees and family members as they navigate the maze of options surrounding their healthcare coverage. During the workshop, participants discussed the pros/cons of Medicare Advantage for cancer patients and also touched on certain types of special enrollment periods (SEPs) that may open up based on unique circumstances.
For patients on Medicare with no supplemental coverage (i.e., no Medigap insurance), out-of-pocket responsibilities are to “typically pay 20% of the Medicare-approved amount for most doctor services.” When it comes to paying for the costs of treatment they are about to receive, these cancer patients are effectively underinsured. The resulting high out-of-pocket burden often leads to cancer patients to filing for personal bankruptcy.
Workshop participants agreed that cancer programs must take a more proactive approach when they see that a new patient on Medicare has no supplemental coverage. Hospital financial counselors often know to meet with such patients. Similarly, outpatient cancer programs must be sure to have reliable processes that trigger financial counseling referrals as soon as underinsured patients enter the system.
Another area of agreement: Cancer programs need to spend more time training their internal staff about the complexities surrounding Medicare coverage. Many consumers continue to confuse Medicare Advantage (also called Medicare Managed Care, Medicare Part C) and Medicare Supplement (also called Medigap or Medicare Select). A Medicare Supplement policy is different from a Medicare Advantage Plan. Medicare Advantage (MA) plans are ways to get Medicare benefits, while a Medigap policy only supplements an individual’s Original Medicare benefits.
Patient-Friendly Billing. Although financial advocates in cancer programs typically do not work in the hospital’s billing department, they may still be able to influence the type of billing process patients may experience. According to the Advisory Board Company, the average American has $1,766 in overdue medical debt. Several workshop participants described how they have been offering different loan programs for their cancer patients. Some financial institutions offer patients 0% interest loans and affordable monthly payments. One such program offered by many hospitals is run by ClearBalance, and this program has been shown to reduce bad debt and increase patient collections. Other similar programs are designed to achieve a friendly billing process for patients who are already experiencing a tremendous amount of psychological stress and financial hardship.
Playing an Active Role in the Care Team. Many financial advocates and financial counselors have formal training in social work or financial services, but some also come with a clinical background in nursing. At some programs, pharmacy technicians are also assuming the financial advocate role, focusing on finding assistance programs around oral oncolytic agents. Given that financial advocates and counselors often have diverse backgrounds, they can learn from one another and from members of the clinical care team. By playing an active role as a member of the cancer care team, financial advocates can help inform key decisions around the course of treatment and potentially improve the patient’s outcome around important psychosocial factors such as financial toxicity. In many cancer programs, financial advocates may not see themselves as integral members of the care team, but this culture is changing. Today, more financial advocates are attending tumor boards and speaking with clinicians to offer insights and assistance.
Since cancer care is rapidly evolving, hospitals and other cancer programs in the community must be properly equipped to ensure that patients receive the appropriate guidance and assistance as they prepare to start their treatment journey. Navigating the financial decisions around health insurance coverage remains confusing and many patients need help finding and applying for assistance programs.
ACCC Financial Advocacy Network Resources
ACCC remains committed to providing ongoing financial advocacy resources. Learn about the ACCC Financial Advocacy Boot Camp online training and additional ACCC resources to support financial advocacy services on the ACCC website here.
Guest blogger Joseph Kim, MD, MPH, MBA, is president of Xaf Solutions. Dr. Kim served as facilitator for the Philadelphia ACCC FAN Case-Based Workshop.
Blog post updated 4/26/2018