A Patient Advocate's View

Will Patient Advocates go the way of the dinosaur?

“Greedy, Lazy and Cheap.” This was the title of a speech I gave to physicians back in the 1990’s when they had to decide if they would sign on to insurer panels. I pleaded with them to remember that if it looked too good to be true, then it probably was. But their greed clouded their judgement when the insurers told the doctors that they would give them an endless supply of patients, so that the doctors could just concentrate on being professionals and leave the business side to them. The physicians didn’t bother to read the contracts that said that the insurers could make any changes to the fees and terms at any time without notice. And they refused to hire people who could have helped them to understand the terms of the contracts. Even while the doctors would praise me for my interesting program, they ignored the warning as they marched off the cliff and lost not only their ability to set fees and define practice parameters, but even lost the title for which they had worked so hard, Doctor. Now they are known as Providers and their position as the trusted advisor to the patient’s health has been replaced by Physicians Assistants or Nurse Practitioners. No wonder people are turning to Patient Advocates to help them navigate the health care maze.

However, who is a Patient Advocate? I started my Private Professional Patient Advocate business in 2008 after using the title since 1976. Originally, doctors and hospitals paid for my services, but once the insurers took over their businesses, the ‘Providers’ and those paying for the insurance, mostly employers or Unions, were left hoping for the best or looking for lawyers. So, that’s when those who could afford it, looked for someone to help them when they couldn’t get the care they needed or found themselves stuck with unexpected bills.

Most advocates agree that over the past decade, few people knew that Patient Advocates existed. Also, there was no license or standard rate for their services. Just like the renaming and reassignment of roles for physicians, anyone could call themselves a Patient Advocate. Insurers and hospital systems took full advantage of the confusion and gave out these titles to advertise their customer service departments. Then, a group of Advocates got together and formed the Patient Advocate Certification Board. Here is the eligibility requirements for a person to call themselves a Board Certified Patient Advocate, which includes education, experience and a very difficult test. Many nurses and social workers are adding the BCPA to their names after becoming frustrated with the limitations being placed on their decision making. Social Workers who have masters degrees and accept Medicare reimbursement make a fraction of what a Private Patient Advocate charges.

Just as the stakeholders in the payer world (when the health system was described as consisting of patients – providers & payers} used a bait and switch methodology to get people to accept that they no longer had doctors, there is a new effort to usurp the term Patient Advocate. A recent article in the NY Times praised the role of the Patient Advocate in the hospital setting.

Big pharma is promoting a Healthcare Advocate Summit. Notice the juxtaposition of the word Patient and Healthcare when talking about who or what is being advocated for. The website for the Summit states in their lengthy mission that “The Advocate is the connector between securing clinical treatment for the patient using the appropriate procurement methods that ensures reimbursement for their health care organization, all while offering emotional support to the patients.” This leads me to remember the same kind of verbiage that was used when managed care was trying to cloud their intent to steer patients to lower cost services.

I’ve spoken to a few of my fellow Independent Patient Advocate business owners who came out of the practice management world. We can understand that nurses, social workers and customer service people who work in various health systems (hospitals, insurers, professional organizations or government) might believe that adding a billing code for Advocacy will raise their salaries. However, we caution them to look at how managed care contracting worked for the doctors and for the patients.

May 22, 2022 Posted by | Uncategorized | Leave a comment