Current practices for screening and management of financial distress at NCCN member institutions

Nandita Khera, Jessica Sugalski, Diana Krause, Richard Butterfield, Nan Zhang, F. Marc Stewart, Robert W. Carlson, Joan M. Griffin, S. Yousuf Zafar, Stephanie J. Lee

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Financial distress from medical treatment is an increasing concern. Healthcare organizations may have different levels of organizational commitment, existing programs, and expected outcomes of screening and management of patient financial distress. Patients and Methods: In November 2018, representatives from 17 (63%) of the 27 existing NCCN Member Institutions completed an online survey. The survey focused on screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes about such practices. Due to the lack of a validated questionnaire in this area, survey questions were generated after a comprehensive literature search and discussions among the study team, including NCCN Best Practices Committee representatives. Results: Responses showed that 76% of centers routinely screened for financial distress, mostly with social worker assessment (94%), and that 56% screened patients multiple times. All centers offered programs to help with drug costs, meal or gas vouchers, and payment plans. Charity care was provided by 100% of the large centers ($10,000 unique annual patients) but none of the small centers that responded (,10,000 unique annual patients; P5.008). Metrics to evaluate the impact of financial advocacy services included number of patients assisted, bad debt/charity write-offs, or patient satisfaction surveys. The effectiveness of institutional practices for screening and management of financial distress was reported as poor/very poor by 6% of respondents. Inadequate staffing and resources, limited budget, and lack of reimbursement were potential barriers in the provision of these services. A total of 94% agreed with the need for better integration of financial advocacy into oncology practice. Conclusions: Three-fourths of NCCN Member Institutions reported screening and management programs for financial distress, although the actual practices and range of services vary. Information from this study can help centers benchmark their performance relative to similar programs and identify best practices in this area.

Original languageEnglish (US)
Pages (from-to)825-831
Number of pages7
JournalJNCCN Journal of the National Comprehensive Cancer Network
Volume18
Issue number7
DOIs
StatePublished - Jul 2020

ASJC Scopus subject areas

  • Oncology

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