Janice Finder, RN, MSN; Cathleen Hernandez Vita, BSN, RN; Ashlyn Florack, BS; Denise Sanchez, MHA, MBA; Morgan Nestingen, PhD, RN, AGCNS-BC, NEA-BC, OCN, ONN-CG
Department of askMDAnderson, Patient Navigation Program, Division of Patient Experience, MD Anderson Cancer Center, Houston, TX
Background: In 2023, MD Anderson launched the Pre- Intake Navigation (PIN) team to facilitate timely access to care by educating and empowering new patients. Previously 53% of newly referred patients experienced delays due to financial barriers (eg, insurance restrictions, intricate authorization processes, and inadequate coverage), causing heightened distress and delayed care.
Objective: Design and implement a program to address financial and insurance-related barriers to accessing timely cancer care.
Methods: Using our Change Enablement model, we hired 16 additional health information specialists and provided extensive training in financial navigation, patient experience, and difficult conversations. This specialized PIN team delivered 1:1 support to newly referred patients within 48 hours (including weekends and after hours), assisting patients to directly resolve financial barriers, providing patient education, and empowering patients to access covered care. Staff closely collaborated with the Financial Clearance Center and Patient Access to ensure timely financial clearance and scheduling whenever possible. If the team was unable to resolve a patient’s financial barriers, they provided individualized education on the patient’s coverage and care options, empowering them to seek care, and providing follow-up to ensure the patient was scheduled at a covered facility. The PIN team was deployed within a larger, established call center, and success was measured using call center metrics, timeliness of care, patient satisfaction, and return on investment (ROI) metrics.
Results: Between September 2023 and May 2024, the PIN team assisted over 11,000 prospective patients through more than 39,200 calls and 32,721 emails, maintaining an average call handling time of 8 minutes and an abandonment rate of just 1%. The team’s expertise led to the resolution of insurance restrictions and timely scheduling for 16 patients, resulting in an estimated annualized ROI of $1.4M. The team expanded eligibility criteria in December 2023 to April 2024, covering over 600 additional genitourinary referrals, reducing days to financial clearance time by 38%, reflecting enhanced patient support and decreased wait times for care. In March 2024, new tracking mechanisms were added to aid in identifying PIN-assisted patients who accessed covered care. With this enhanced reporting, we identified 364 patients who successfully secured appointments at insurance-approved facilities, demonstrating improved access to timely cancer care.
Conclusion: The PIN program takes a proactive approach to managing the financial burden accompanying cancer care. PIN aids in bridging the patient to care pathways by providing crucial education, support, and resources to ensure access to essential care. Long call handling times (versus industry benchmarks) reflect the complexity of financial barriers addressed, ultimately saving time for other teams. New initiatives are continuously being rolled out across other sites and subpopulations, broadening the reach and impact of the program. The overall concept of PIN represents a novel and cost-effective approach, offering comprehensive support for patients facing complex financial barriers to care.
Jacqueline Miller, MSN, RN, OCN
Jefferson Health, Philadelphia, PA
Background: Measuring the impact of an oncology navigation program is challenging but critical for sustainability. The Sidney Kimmel Cancer Center (SKCC) – Jefferson Health is part of an 18-hospital academic health system spanning 2 states, with the largest in the Philadelphia region. Within this expansive enterprise, 35 oncology navigators support over 7000 patients annually. To evaluate the impact of this service, the AONN+ domains for certification were referenced, and patient experience/patient satisfaction survey results/month was selected as a baseline metric across the enterprise. To measure navigation’s impact on the patient experience, we created a navigation patient satisfaction survey.
Objective: To develop a standard metric across a large enterprise to evaluate oncology navigation’s impact on the patient experience.
Methods: Working with our Press Ganey team, we developed a navigation patient satisfaction survey. The patient selects the site of service and navigator who supported them, then a 10-question survey opens where patients can reflect on their experience and add comments.
In January 2023, phase 1 distribution included a QR code that each navigator provided to the patients. After 100 surveys were successfully distributed and completed, we began phase 2, in which all surveys are electronically distributed when a third encounter is linked to an open navigation case in the documentation system (Epic Healthy Planet). Surveys are distributed via the patient portal, email, and text message.
Results: Over 900 surveys have been completed as of December 15, 2023. Positive feedback includes patients who would recommend navigation services (90%), support services met (95%), and overall experience (95%). Opportunities for improvement include navigation services would have been beneficial earlier in the cancer journey (30%). Services the navigator assisted with include coordination of services (80%), communication concerns with medical personnel (53%), counseling and support services (42%), and learning and education resources (40%). The comment section has been a wonderful mechanism to recognize navigators for the excellent care they are providing.
Conclusion: The navigation patient satisfaction survey has provided a standard metric to gather patient feedback across our enterprise. Survey results and feedback are shared with every division’s leadership team. Measuring the impact of oncology navigation on the patient experience supports sustainability and growth of our program.
This abstract was presented as an oral podium session at the 2024 Oncology Nursing Society Congress.
Academy of Oncology Nurse & Patient Navigators. Standardized Metrics Source Document. 2016. www.aonnonline.org/metrics-source-document
Strusowski T, Stapp J. Patient navigation metrics: measuring the impact of your patient navigation services. Oncology Issues. 2016;31(1):62-69.
Kelley Moultry, MPH, CHES; Mandi L. Pratt-Chapman, PhD, MA, OPN-CG; Samantha Scott, MPH; Alyncia Mason, MPH; Janet Okamoto, PhD; Julie McMahon, MPH
Susan G. Komen, Dallas, TX
Background: In January 2024, the Centers for Medicare & Medicaid Services (CMS) introduced billing codes for patient navigation services, which include training requirements. Komen’s Patient Navigation (PN) Training Program aligns with these requirements for the 2024 CMS Physician Fee Schedule for Principal Illness Navigation (PIN).1
Objectives: To evaluate the impact of Komen’s PN Training Program to support navigators in providing high-quality services meeting professional standards, specifically addressing the unique needs of underserved communities, and to understand training and implementation needs surrounding the 2024 CMS Physician Fee Schedule for PIN.2,3
Methods: Komen’s training includes a learning pathway of 9 required courses, which accounts for approximately 10 hours of learning, and which is aligned with the 2024 CMS Physician Fee Schedule for PIN required core competencies. Training content includes content licensed from George Washington University’s foundational, competency- based training curriculum for patient navigators and additional specialized content created by Komen. Learners have access to a catalog of over 40 other trainings beyond the required training elements. Participants in Komen’s training register in a learning management system in which demographic information and pre- and postprogram evaluation surveys are collected, using a Likert scale to assess content, method of content delivery, and intent to apply content. A supplemental multiple- choice question was administered to those who completed the CMS-aligned learning pathway to gather understanding about implementation of PIN billing codes.
Results: From January to April 2024, 80 learners completed CMS training requirements through Komen. Participant race/ethnicities: 25% Black/African American/African; 52.5% White; and 17.5% Hispanic/Latino/Latina. Years of experience averaged 3.5 (range, 0-22). Most common professional roles were patient navigator (27%), other health professional (17%), and nurse practitioner or nurse (11%), with the majority at healthcare facilities. Nine participants reported prior training or certification. Participants reported high levels of satisfaction with the program (92%), content (98.7%), presentation of information (97.4%), online platform (98.8%), and networking opportunities (93.6%). Respondents reported improvement in ability to navigate (98.7%), ability to address racism (98.9%), and intent to apply to practice (98.7%). Regarding plans to implement use of billing codes for navigation services, 44.1% were unsure, 32.4% intend to implement in the next year, 11.8% did not plan to implement, 8.8% were unfamiliar with the codes, and 2.9% (1 participant) reported they had implemented the codes.
Conclusion: Data show Komen’s training successfully equips navigators from diverse populations and professional backgrounds to meet the needs of underserved populations. Despite completing training requirements to support billing implementation, most learners did not know about the billing opportunities or reported being in the planning stages of implementation. More awareness is needed about opportunities to build sustainability of navigation services using billing codes. Komen’s PN Training Program will continue to meet evolving workforce training needs by supporting awareness about PN sustainability, billing codes, and aligning with the Professional Oncology Navigation Standards,4 including delivering training customizable to varying levels of proficiency.
Catherine Oplinger, MSN, RN, OCN, AMB-BC; Margaret Wight, BA, ODS-C
Sidney Kimmel Cancer Center at Jefferson Health, NJ
Background: In July 2023, the Commission on Cancer released new guidelines regarding length of time from definitive surgical intervention to the start of radiation for patients with breast cancer undergoing breast-conserving surgery. This updated quality measure prompted an improvement process within our cancer center to meet the requirement.1 Discussion with the radiation oncologist and director of Oncology Data Services revealed that our tracking methods were not adequate to assure timely treatment to meet the requirement; data and cases were being reviewed too late to impact the start of treatment prior to the 60-day window for start of treatment.
Objective: Development of a process for proactive referral of patients who are undergoing breast-conserving surgery without having had systemic treatment to the radiation oncology department to allow for timely start of care within the 60-day window for initiation of radiation treatment.
Methods: Tracking is managed with a spreadsheet that is updated regularly and color-coded for ease of use. Because the 60-day window applies to start of treatment regardless of the location of care, coordination with outside health systems due to location or patient preference may also be needed.
Results: Data demonstrate improvement with a performance rate of 78% in 2022, 81% in 2023, and 87% thus far in 2024 meeting the 60-day goal. Data from 2024 (February 1, 2024, to August 15, 2024) with the improved referral/ tracking system indicate that those who fell outside the time goal were due to radiation not being indicated, treatment being declined by the patient, development of seroma/healing issues, or an unrelated surgery.
Conclusion: As a surgical nurse navigator within the breast center, I saw an opportunity to impact care for our patients and improve statistics regarding start of radiation for patients who had undergone breast-conserving surgery without prior systemic therapy. This process change resulted in improvement in timeliness to treatment for patients and increased coordination of scheduling for the radiation team. Remaining within the appropriate time parameters for treatment provides benefit not only to the care continuum for patients but also streamlines data collection for various accreditation processes for the cancer center.
Jennifer West, BSN, RN, CCRC, ONN-CG
University of Florida, Gainesville, FL
Background: The University of Florida Health Cancer Center initiated the role of the clinical trial nurse navigator in 2022. The purpose was to improve access to clinical trials, increase screening for potential patients, providing crucial education and support to patients through the complex screening process, and ultimately increase trial enrollment.
Objectives: To show the impact on trial access, screening, and enrollment volume when a clinical trial nurse navigator is actively involved in clinical trial–based care.
Methods: Data were collected from the University of Florida Cancer Center from ONCORE for 2021 (prior to implementing the clinical trial navigator role), 2022, and 2023 to compare (a) the number of trials open, (b) the number of patients screened, and (c) the number of patients accrued to studies.
Results:
Over the 3-year study period, even though the number of open studies decreased slightly, patient accrual more than doubled. When comparing the data from 2021 to 2022, while the number of open studies decreased by 17%, the number of patients screened increased by 36% and enrollment increased by 239%. Comparing the data from 2022 to 2023 shows a 16% increase in open studies, a decrease in patients screened by 48%, and a decrease in total patient accruals of 30%. While these figures reflect decreases from 2022, they demonstrate a year-over-year improvement in the screened to accrual rate of 25%.
Conclusion: Analysis is ongoing to measure the longer- term impacts clinical trial nurse navigators have on patient screening, accrual, and retention. Preliminary data from the 2 years after role introduction show a significant positive impact on accrual rate and total patient enrollment. Initiating the clinical trial nurse navigator role, and specifically having a research navigator screen potential patients ahead of their clinic visit to address barriers to participation, greatly improves the patient experience and their understanding of clinical trial–based care. Based on the 239% overall increase in the number of patients enrolled, the position introduction has been successful.
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