Several questions have come my way recently about what kinds of job opportunities might exist for patient advocates. I refer people to an article I’ve written elsewhere, but the real answer is – to be a true advocate, you must analyze who is paying for your services, and what your responsibility will be to them.
Finding an Employer
In 2011, most of the job possibilities for patient advocates are found either with hospitals or insurance companies. Hospitals have, for a long time, employed patient advocates, sometimes called patient representatives, who are tasked with helping patients. And word comes from an AdvoConnection member, through our Forum, that beginning in 2014 with healthcare reform, insurance companies will be required to have patient navigators on their staffs if they want to participate in insurance exchanges. Some have already begun to hire advocates.
One of our APHA members asked me about these differences a day or two ago… So I thought I would share my reply with you.
She had called on a nursing home to see if they had interest in recommending her services to the families of some of its residents. The nursing home director replied that they had a team of geriatric case managers they worked with – and asked what services she, the patient advocate, could provide that GCMs could not.
Since she really couldn’t come up with a useful answer, she asked me if I knew the differences in service offerings….
A few thoughts:
1. The first, obvious answer is that a patient advocate is available to assist anyone of any age – not limited to someone who is elderly, or at least over a ‘certain age,’ as a geriatric case manager would be.
2. Part of the answer depends on who’s paying the tab for the advocate’s or care manager’s services. If the nursing home or the county or state’s social services department is paying the tab, then the GCM is the not the patient’s advocate – she is beholden to the nursing home or the taxpayers. On the other hand, if the GCM’s services are paid for by the family or the patient, then they, too, are performing patient advocacy services.
3. Most Geriatric Care Managers don’t focus strictly on healthcare. Their work is usually broader, at least in the beginning, with some emphasis on finances, housing, and other aspects of life that change as we age.
4. Our APHA member advocate might have stumbled on a good marketing idea, however… but not the way she thought. We can guess that geriatric care managers may not have the skills or the interest in providing some services patient advocates provide every day, such as hospital bedside monitoring, or doctor appointment accompaniment. It could be that patients’ advocates and geriatric care managers are “coopetition.” (Read more about coopetition in The Health Advocate’s Marketing Handbook.
5. One way patient advocates and geriatric care managers are identical: they are both included and invited to participate as members of The Alliance of Professional Health Advocates. As independent practitioners who serve patients, we want to be sure families find the help they need for their loved ones.
Do you know of additional differences or similarities? Please share them with us.
In the process of writing about Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSA) I began looking at what constituted a “qualified medical expense,” which is the list of the products and services the IRS lets us pay for tax-free. They are those expenses that we can either claim on our taxes, or pay for through the use of an HSA, MSA or FSA. (What would the IRS ever do without acronyms? But I digress…)
After looking at the list of expenses, I began to wonder whether a patient / taxpayer who hires and pays for a health or patient advocate can deduct that expense from their taxes or account? Are we, as advocates who improve their healthcare experiences, deductible expenses?
So I went straight to the IRS horses to see what would come from their mouths… and what came from their mouths were big, loud question marks. They don’t know. Advocates might be a deduction. Or they might not.
Frustratingly, the process to figure out an answer requires people willing to test the system, at their own expense, which culminates in a “ruling.” And even then, when there is a ruling, the answers might change. (Is this a great country, or what?)
The best way to explain this is to use a metaphor – a parallel situation that resulted in a ruling. Acupuncture.
Years ago, patients began to deduct the cost of acupuncture from their taxes. Once in awhile, one of those patients got audited. For the first dozen or hundred or thousand (who knows?) the deduction was not allowed because there was no “ruling.” After awhile, there were enough people who fought for the deduction (paying their CPAs or lawyers to do so) that the IRS finally came up with said-ruling that said, “OK – acupuncture is now included on the list of qualified medical expenses (AKA deductions.)”
So, a couple of notes:
The CPAs and lawyers who successfully got acupuncture reviewed did so by showing evidence that acupuncture has a medical benefit. (ha! If your doctor doesn’t believe in the value of acupuncture, you can tell him it must work – because the IRS says so!) Our patient advocacy parallel would be that we need to show that patient advocates provide a medical benefit.
Individuals can ask their CPAs and lawyers to ask the IRS for a “private letter ruling.” That would mean that, before the patient deducts something, he asks the IRS to rule on it. (I thought about doing this on behalf of AdvoConnection’s member advocates, however IRS Guy told me it has to be done by individuals, on a case-by-case basis, and cannot be done on behalf of an organization’s members.)
I reviewed the publications put out by the IRS and found a few parallel expenses that are allowed. From IRS publication 502, I see Christian Science Practitioners (who, like advocates, are not licensed), Nursing Services (these services also do not require a licensed nurse, but can provide everything from true medical services to washing and grooming) to (you’ll love this) guide dogs. When I asked IRS Guy about guide dogs, he said they are deductible because they assist patients who are blind to get the care they need. Honestly, of all the goods and services on that entire list, that is the best parallel for health and patient advocates – guide dogs. (In my own humble opinion.)
It seems clear that in order to become a bona fide tax deduction, a few things are going to have to happen.
1. Patients will need to begin deducting advocate services in order to test the system.
2. Some patients, early adopters, are going to end up paying tax and penalties for their advocacy services because no ruling will yet exist.
3. Those patients should be able to find a CPA or lawyer to help them fight the extra tax and penalty by showing the parallel services that already exist on the allowable deductibles list, and using stats that show that patient advocates do improve a patient’s medical care.
4. Eventually it seems like advocate services will be able to be deducted – but (like everything else) it will take awhile.
So — that big disclaimer! — I’m not an attorney, nor am I a CPA… but it’s a fair question that deserves more review, plus brave patients and caregivers who are willing to be the deductions guinea pigs by claiming these very important and necessary medical services patients’ advocates provide.