Robin Zon, MD
Not too many years ago, it took only a rudimentary search for financial counselors at Michiana Hematology Oncology’s Advanced Centers for Cancer Care in Indiana to find financial aid for the few patients, primarily those without insurance, who needed it. Since then, higher insurance premiums, deductibles, and co-pays, along with the increased cost of cancer care, have made it more complicated to find aid. Approximately 40% of insured patients at the practice now need financial assistance. Moreover, sources of assistance, such as foundations, have not been able to keep up. Their funds become depleted rapidly, often requiring practices to widen their searches and work more hours.
“The foundations and drug manufacturers are doing their best to try to keep up, but the demand has gotten out of hand” said Robin Zon, MD, medical oncologist practicing at Michiana Hematology Oncology in Elkhart and Mishawaka, Indiana.
Because of the rising volume of patients who need financial help, many practices such as Zon’s are turning to software tools developed over the past decade. These include automated online applications, electronic health record (EHR) notifications about patient assistance programs, and cloud-based tools that can search for oncology assistance programs and enroll patients.
Physicians and financial counselors interviewed for this story added that increasingly specific drug indications and eligibility rules for many assistance programs have made it more challenging to deliver affordable care to patients and maintain financially sustainable community practices.
Automated Search and Application Increases Efficiency
Cicely Wang, patient advocate at Broome Oncology in Binghamton, NY, a six-physician practice, stated that she spends approximately five hours per day searching for financial assistance for patients. “One of the first things I do in the morning is to go on the computer and see which funds I can access and whether I need to look further,” she said. Online applications now possible for most of the third-party foundations that provide patient assistance have helped cut the approval time from weeks to minutes; however, the fund depletion rate can be equally fast.
Wang has found this out the hard way when funding sources have been exhausted during the several minutes it took her to fill out the application. She attributed the rapid depletion in part to the fact that many foundations are not receiving as much money as before from major sources, such as pharmaceutical companies. “Foundation funds are drying up for big diagnoses,” said Wang. “We’re having to look further into smaller sources, and patients continue to come in needing assistance.”
Wang also said that patients often need additional expensive agents to counteract the side effects of chemotherapy, making it necessary to fill out multiple applications. “If I could do just one application and get all the funds at once, that would be huge,” she said.
With this increasing workload, many financial counselors are using new products designed to save time. These products have many advantages, but they do require a transition period for training and implementation that many busy practices are hesitant to initiate, and they have other limitations that are described below.
To aid in the search process, Shelly Rentsch, administrator of Gabrail Cancer Center in Canton, Ohio, uses Clinical Decisions Gateways (CDG), a program developed by Altos (currently Flatiron) that identifies drug-specific financial assistance and support programs and enables enrollment directly through the electronic medical record (EMR). “CDG identifies patients with a certain diagnosis and on a certain medication, and if there’s a [financial assistance] program that is associated with that drug, the system alerts us,” said Rentsch. However, she must still perform additional research for patients, such as those on Medicare, who do not qualify for patient assistance programs sponsored by pharmaceutical companies.