Can a True Patient Advocate Be Paid by Someone Else?

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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.

But here’s the problem with those jobs.

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Lessons from The Loss of a Patient

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Sooner or later, it happens to every patient advocate or navigator who works with patients on the medical aspects of their care (as opposed to other forms of advocacy, like billing or legal advocates).

One of “our” patients – someone whose hand we have held, who we have protected from problems in the hospital, who depended on our advocacy expertise as a way to make the rough road through disease and debilitation smoother… A patient we had built a comfortable and friendly relationship with, a patient we invested ourselves and our work in…

That patient dies.

And we feel like we have failed.

It’s the nature of advocacy work that patients don’t come looking for us until they have been diagnosed with something that will, perhaps, eventually end their lives.  That’s why they seek our help.  They are fearful, they don’t understand the overwhelming amount of information they are expected to immediately comprehend. They have decisions to make and feel incapable of making them.  They, or the caregiver who better understands their predicament, searches for, and finds, that one person who can help smooth the road…  the advocate.

And it’s our nature, as advocates, to want to rescue our patients from their fears and frustrations, and to save them from all that grief. But as one of my wise patient advocates friend reminded me,

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Doctor Recommendations – Do You? Should You?

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I was more than a little surprised in a conversation this week with an advocate who is not (yet) a member of AdvoConnection.  OK. That’s putting it mildly. I was actually stunned.

“Why do people feel well served by you?” I asked him.

“Because I have a beeline into all the good doctors,” he replied.  And when I asked him to explain further, he said it was because he knew the best doctors to recommend.

[Pause. Letting that sink in…]

In conversations with both long-time advocates, and lawyers, too… and honestly – what makes common sense – is that a patient advocate should never make a recommendation about a doctor.

Here’s why:

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Preparing Patients for Primary Care Troubles

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Good primary care physicians are becoming harder and harder to find.

You may not have noticed it yet, but I predict that a year from now we’ll find it almost impossible to find primary care doctors who are willing to take on new patients – at least any primary care doctor worth seeing won’t be doing so.

Smart patients AND their advocates know that today is THE day to be sure they have good relationships established with primary care doctors.

Why? Two major reasons:

First comes the fact that medical students spend some time in school, then choose their specialty area.  They contrast the excitement of surgery or saving a heart patient’s life, with the sniffly noses and broken legs of primary care. Then they figure out that as a surgeon or neurosurgeon,

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Patients’ Advocates in Hospitals – Going to the Line

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Updated March 2017

From time to time I hear from a patient who complains about a situation that occurred during a hospital stay – usually the spouse or child of a hospital patient.

The great majority of those notes say, “I spoke to the patient advocate in the hospital but they couldn’t do anything for me!”

When I reply, I explain that the hospital patient advocate works for the hospital – not for the patient. Hospital patient advocates usually report to the legal/risk management department in the hospital and get their paychecks from the hospital.  They help when they can, but the hospital gives them a line they just can’t cross.

That’s the fact I know.  And a couple of times I have met hospital “Patient Relations” people.  But until this week, I had never had occasion to try to work with them to help a patient.

This week’s hospital complaint email came from Donna (name is changed) who was a volunteer kidney donor to a friend – not even a relative – just a good friend.  She was flown from her home in another state to New York Presbyterian – Columbia late last summer, completed the surgery, and returned home.  Since then she has had a number of complications, she has been out of work, and she has been in pain.

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The Myth of Patient Advocacy Certification

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(Updated: April 2017)

Not a week goes by that someone doesn’t write to me asking about patient advocacy certification.  It’s confusing, because they read that there are courses that will help them become certified, and then they find other pieces I have written about the lack of a certification system.

So it’s time to clarify: There is a difference between earning a certificate – and being certified, even if Merriam Webster might tell you those two concepts are related.

“To be certified” carries with it an assumption that there is some sort of national (even international) standard set of skills, recognition, accreditation, or competencies and criteria that someone has met,developed or earned.  As if a national body of some sort has said “Yes – this person meets this high standard of education and capability, so we are blessing him or her with our certification.” “To be certified” may even mean to some people that some sort of governmental recognition in the form of a license or listing has taken place.

But there are no governments, nor nationally respected, nor generally accepted groups that have determined a group of standards, nor benchmarks, nor capabilities that supply a certification that is universally recognized. And that is the key:  none are universally recognized.

No such a certification exists – yet.*

The confusion comes from the fact… Continue Reading →

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Enough is Enough! Helping Elderly Patients Make Decisions

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One of our AdvoConnection members, Ken Schueler, shared a favorite article of his, published in JAMA a couple of years ago, and a good reminder of one of our roles as patient advocates.  Written by Dr. Jennifer M. Soyke, it tells about an elderly patient named Lisa who passed away from Genug Syndrome.

(Unfortunately, JAMA requires a subscription to read this piece in its entirety, so please forgive paraphrasing here – but I think you’ll get the point…)

Never heard of Genug Syndrome?  You won’t find it in the medical literature.

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What’s the Difference Between a Patient Advocate and a Geriatric Care or Case Manager?

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One of our AdvoConnection 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 case 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.  Our AC member advocate might have stumbled on a good marketing idea, however… but not the way she thought.  We can guess that geriatric case 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.

4.  One way patient advocates and geriatric care managers are identical:  they are both included and invited to participate as members of AdvoConnection.  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.

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