The VITAL Piece of Information the Press – and Many Patients AND Advocates – Are Missing

Soldiers march in formationIt happened one more time this week, frustrating me one more time this week, making me feel like a broken record again this week and then realizing…. hey! Why not make this point louder and clearer enough so that YOU can all be a part of my “point well spoken” army!

What am I talking about? The press – which has produced one more article this week about this “new career” of patient advocacy or navigation, making it sound like a grand dream come true for anyone who cares about helping patients. None of these articles have been realistic about the realities of employment, or the lack of employment, and the conflicts of interest that arise through advocacy employment.

What happens next is the many dozens of email inquiries I begin to receive about GETTING A JOB as a patient advocate.

But I digress…

So before I begin – please understand that the point of this post is to enlist you in the army of advocates who are going to make this VERY IMPORTANT POINT (VIP!). Please raise your right hand and swear that YOU will share this point with at least 10 other people this week …..

That is:

It’s about JOBs – who is EMPLOYED as a patient advocate vs who is SELF-EMPLOYED as a patient advocate or navigator. And then – the important follow-on point – that not all patient advocates and navigators are created equal. Therefore, patients cannot and WILL not be served equally as well by them.

That it’s not about their skill levels – instead it’s about the conflicts of interest that arise depending on WHO WRITES THEIR PAYCHECKS.

EMPLOYED patient advocates and navigators are employed by hospitals, large doctor practices and insurance companies.

SELF-EMPLOYED patient advocates and navigators are employed directly by patients (or someone whose primary interest is the patient.)

A patient advocate who is employed by another organization that will either MAKE MONEY or SAVE MONEY through recommendations made to that patient cannot and will not be an objective and useful resource for the patient. MAKING MONEY and SAVING MONEY on a patient’s care creates a direct conflict of interest when it comes to the needs of the patient.

The only patient advocate or navigator who can focus primarily on the needs of a patient is one who is being paid directly by the patient or someone who’s primary interest is aligned with the patient’s – like a loved one, or the patient’s employer, church, union, etc. Those advocates are all self-employed, private, independent advocates. Every one of them.

In previous posts I have called this the Allegiance Factor. When a patient advocate or navigator is paid by the hospital, then her priority allegiance must be to the hospital. These advocates are usually part of the Risk Management department of the hospital. It’s not that they don’t want the patient to find solutions. But it’s absolutely true that the patients’ solution is secondary to the institution’s needs. Thus it’s a conflict of interest.

The Allegiance Factor comes into play with health insurance companies that offer advocates and navigators, too. Insurers’ goals are to collect as much money in premiums as possible, and spend as little on care as possible. Period. No patient can be confident that an insurance company advocate will provide them with objective advice that isn’t tainted by their need to spend as little as possible on that patient. It’s not that they don’t want the patient to find solutions, but it’s absolutely true that the patients’ solution is secondary to the institution’s needs. Thus, an insurance company advocate begins with an inherent conflict of interest.

Back to my frustration with the press this week: Yet another article about patient advocacy or navigation as a new career. It talks about the educational organizations providing training and then…. ? Rarely do these articles mention anything about whether JOBS are available. So when readers get all excited about the possibilities and begin to look into it, they realize the huge disconnects that exist. That’s when they write to me, and I tell them:

1. Little, if any, EMPLOYMENT exists for advocates or navigators unless they are within hospitals or insurance companies, and those jobs often require previous clinical training or years of experience within a healthcare setting. They aren’t a possibility for most of these folks at all.

2. Many (most?) of the educational organizations providing training are doing so without regard to job possibilities afterwards. Students are paying some big bucks to take these certification courses (certified only by those institutions because no national certification exists yet) believing there will be a job for them at the other end – but there will not. Most will need to be SELF-EMPLOYED.

3. That if they want to become a patient advocate who can truly help patients, for the most part they must be self-employed. They must start their own practices, then market themselves directly to patients, or to other advocates who might be able to hire them (as independent contractors.). (That’s where APHA comes in, of course.)

And so – my army of truth-tellers…. I leave this message in your good and capable hands.

1. If you are interviewed by the press – please be sure to make this distinction between employed vs self-employed (institutional vs private) advocates and navigators. Cite institution vs private and conflicts of interest.

2. If you are contacted by a potential client – then make doubly sure you make this point.

3. If someone says to you, “The hospital has an advocate I can contact, so why should I pay you?” – then begin to herald the Allegiance Factor loud and clear!

4. Use the Allegiance Factor in your marketing: What’s the difference between a hospital advocate and a private advocate? Be clear!

I’m only one voice and – obviously – by myself I am not loud enough. (If I were, this blog post would be unnecessary!) But together, we can be an army of voices that will begin to make a dent in the misconceptions so that – yes – even the press will begin to get it right.

> Learn more about The Allegiance Factor

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8 thoughts on “The VITAL Piece of Information the Press – and Many Patients AND Advocates – Are Missing”

  1. Your point is real and well taken, but you did not mention the many Patient Advocates who are volunteers. I am one of them, and I work very hard at what I do. This doesn’t make me a hero, it makes me just one of the many across the country who advocate for patients who are not paid one dime by them, or anyone else! Family members are unrecognized unpaid patient advocates as well, and some of them are downright heroic.

  2. Kathy,

    You make an excellent point about volunteers and for most volunteer advocates, I’m not even sure the adjective “hero” is strong enough!

    My intention, of course, was not to leave out volunteers. Recently there have been many articles published that cite patient advocacy and navigation as a new and upcoming career – but none of them have been realistic about the realities of employment, or the lack of employment, and the conflicts of interest that arise through advocacy employment. That’s what this article addresses.

    Advocacy volunteers are a subject for a whole ‘nuther post – so I thank you for raising the point.


  3. Kathy, thank you for you dedication as a volunteer Patient Advocate. I’ve been a nurse over 40 years and have just applied for a position as a patient advocate for a hospital. I agree with Trisha that working for a hospital in this position versus self employed does present a conflict of interest. I hope my years of experience and my desire to see situations and scenario’s objectively will help me if I am so chosen. However, this is not to say that I have not sat on the fence before between the client and the institutions in other positions in my nursing career and have generally been able to benefit the client by presenting evidenced based information to those who make the real decision. It will be interesting to see if I am hired for this position; I am told the other candidate has worked for the company over 15 years and is just graduating as an RN. I worked for the same company over 21 years before I retired. I am sure our prespective on situations that arise will be different. Only time will tell if the company will chose her or me. Thanks for the blog. Kathy

    1. Hello Kathy! I admire you for seeking out that job with a Hospital. I am also an RN, and I know that nurses are advocates first, in almost all situations. I wish you luck on your application and position if you are hired. Your experience and dedication to nursing for 40 years will be a great foundation for patient advocacy.

  4. I am an independent Patient Navigator & sometimes it is the insurance company, or a TPA paying for our services. We have no problem guiding these patients to the appropriate provider even if he/she may not be in the carriers network. In this case, my job is to influence the insurance company to take my recommendation for their client. If it is a matter of cost, then I have several options, among them.. ask the provider to take the rates an ‘in” network provider would get; create a case rate the insurance will honor just for this particular case; ask the patient to pay up front, and get a commitment form the ins carrier that they will be reimbursed a certain percentage. We are a liaison between the patient, physician, medical center and health insurance company & have no problem speaking up, across or down to make things happen for the patient ~ who is ultimately who we serve.

  5. Margaret Cook

    I am a patient advocate employed by a hospital. My department is not in Risk Management, but is under the Vice President for Mission. Our primary goal is to obtain the best outcome for the patient. I find that we exist in a space of ambiguity because, as representatives for the patients, we are often called upon to go against the Hospital, its staff and its policies in order to best serve the patient. Many of our patients don’t have the resources to help themselves in today’s complex medical environment and our job is to connect them with the resources that the Hospital has to offer to assist them.

  6. Margaret – thanks for sharing your perspective from your vantage as a hospital patient advocate.

    And kudos to your hospital for looking at your work from a different perspective than most. It’s unusual – but certainly appreciated, and definitely needed.

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