Navigating Troubled Waters: The Case for Making Patient Navigation Reimbursable

Navigating Troubled Waters: The Case for Making Patient Navigation Reimbursable

David L. Graham, MD, FASCO

@davidgrahammd
May 31, 2016

At my previous job, the impetus for creating a patient navigator position was the complexity of scheduling everything that had to be done for women with a new diagnosis or possible diagnosis of breast cancer. A true multidisciplinary clinic with surgeons, radiation oncologists, etc., on site was subsequently established but, at that time, appointments had to be made in a number of different departments. Having that single person with the expertise to get things arranged efficiently was immensely beneficial to our patients. When that person was also a nurse, they became an additional resource to the woman.

The popularity of these navigator programs quickly grew. Their scope has expanded beyond the arena of breast cancer and now have become an expected part of any cancer center, large or small. As with any new concept or program, the question always arises of its benefit and how it can be quantified. After all, these programs cost money—staffing costs, office costs, administrative costs, and other overhead are required.

There are reports of an analysis of time from abnormal chest x-ray to start of treatment for lung cancer being decreased from 64 to 45 days when a navigator program was initiated.1 In Vancouver, the use of nurse navigators working with patients with lung cancer not only decreased wait times but also increased the frequency of molecular testing.2 A randomized trial showed that the addition of a nurse navigator improved the patient experience and reduced problems in care.3 Despite these results, navigator services have yet to be recognized as a reimbursable benefit. In general, for a program to get the attention and, dare I say, the respect that can lead to reimbursement, a benefit in survival needs to be shown.

At the 2016 ASCO Annual Meeting, Abstract 6510 will be reviewed during Saturday afternoon’s Poster Session. Drs. Marc Kowalkowski, Derek Raghavan, and colleagues report data from the Levine Cancer Institute regarding the impact of a nurse-led patient navigation program. (To offer full disclosure, this is where I now work.) The authors performed a retrospective cohort analysis of 477 patients participating in the navigation program as compared to a matched cohort of 408 patients not participating in the navigator program. A wide breadth of malignancies were included in the cohorts, including AML, esophageal, pancreatic, liver, myeloma, lung, and others. Median survival in the patient navigator group was significantly increased by 26 days, from 329 to 355. The odds of dying in the first 12 months were increased by 37% in those patients not served by the navigator programs.

This level of increased survival seen in a new drug would generally be enough to obtain FDA approval and, thus, insurance reimbursement. Is it time we hold this same standard to insist on reimbursement for this aspect of patient care?

References

  1. Kunos CA, Olszewski S, Espinal E. Impact of nurse navigation on timeliness of diagnostic medical services in patients with newly diagnosed lung cancer. J Community Support Oncol. 2015;13:219-24.
  2. Zibrik K, Laskin J, Ho C. Implementation of a lung cancer nurse navigator enhances patient care and delivery of systemic therapy at the British Columbia Cancer Agency, Vancouver. J Oncol Pract. 2016;12: e344-9.
  3. Wagner EH, Ludman EJ, Aiello Bowles EJ, et al. Nurse navigators in early cancer care: a randomized, controlled trial. J Clin Oncol. 2014;32:12-8.

 

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