Cordata recently hosted a webinar addressing the financial toxicity that’s endemic to today’s healthcare system. Financial toxicity is often associated with oncology due to both the severity of a cancer diagnosis and the high – and sometimes stratospheric – cost of treatment.
Financial barriers to treatment are not new. Back in August of 2009, Oncology Times published an article revealing that cancer patients demonstrate more anxiety over the cost of treatment than over dying from their disease. Financial toxicity is a proliferating side effect of complex disease (cancer, chronic heart failure, stroke, etc.) treatment for both patients and programs. And with the impending “cancer tsunami” as Baby Boomers age, navigating oncology care is only going to become more complex. With a growing underinsured patient population and rising costs of care, the need to prepare patients for financial burdens is urgent.
Dan Sherman, MA, LPC, the webinar host, has a unique and insightful perspective on best practices for counselling patients on the ins and outs of healthcare finances. He is the founder and president of The NaVectis Group, a consulting company that assists providers in implementing financial navigation programs in oncology and has published articles in the Journal of Access Management, Oncology Issues and ASCO’s Journal of Oncology Practice.
The presentation focused on how to support patients as they deal with the financial issues surrounding complex disease diagnosis and treatment. Navigators are a big part of alleviating these stressors, no doubt, but the scope of the problem is daunting. Consider:
- A full 42% of insured cancer patients faced heavy financial burdens, according to a report published in The Oncologist in 2013
- Patients with high co-pays (more than $54) were 70% more likely to discontinue treatment within six months, as confirmed by a 2014 study in the Journal of Clinical Oncology
- As of 2012, average out-of-pocket expenses per oncology patient is $4,727, according to Cancer, a figure that is surely significantly higher in 2017. The same study found that the likelihood of the out-of-pocket expense being at least 20% of income is 75% higher for Medicare oncology patients.
Those statistics speak to a troubling trend: many oncology patients are more scared about the financial implications of treatment than of dying from the disease. It’s no secret that cancer and other complex diseases are often accompanied by depression and other mental comorbidities. Patients are more likely to become non-compliant with their treatment plans and potentially refuse further care if they fear going into debt or depleting savings.
Research has shown that pre-screening for distress is beneficial for patients’ wellbeing. Sherman suggests that the solution for financial distress should be addressed the same way. The situation can also be compared to an anesthesiologist seeing a patient before surgery. We don’t safeguard the patient with anesthesia after the surgery, but beforehand. Then why do so many patients only receive financial counselling after treatment, once the high cost of care has been incurred.
Mr. Sherman also suggests that the average $4,700 in out-of-pocket expenses can be partially attributed to under-qualified financial counselors who may not understand the nuances of the healthcare system. Guidelines for hiring financial counselors are surprisingly lax. The knowledge gap often results in patients losing out on opportunities to reduce their financial burden by getting the most out of their insurance or other methods. And with 50% of Medicare beneficiaries falling below 200% of the federal poverty line (KFF, 2014), it’s clear that many people who desperately need help simply can’t get it.
The general consensus is that providers must be more proactive concerning patients’ financial counselling. Doing so will not only result in less stress for patients and better outcomes, but cost savings for providers, a lighter workload for social workers, increased patient satisfaction scores and a significant decrease in bad debt and charity.
You can watch the full webinar here.