Current Practices for Screening and Management of Financial Distress at NCCN Member Institutions

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  • 1 Mayo Clinic Alix School of Medicine, Phoenix, Arizona;
  • 2 National Comprehensive Cancer Network, Plymouth Meeting, Pennsylvania;
  • 3 Fred Hutchinson Cancer Research Center, University of Washington Children’s Hospital, Seattle, Washington;
  • 4 Mayo Clinic, Rochester, Minnesota; and
  • 5 Duke University Medical Center, Durham, North Carolina.
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Background: Financial distress from medical treatment is an increasing concern. Healthcare organizations may have different levels of organizational commitment, existing programs, and expected outcomes of screening and management of patient financial distress. Patients and Methods: In November 2018, representatives from 17 (63%) of the 27 existing NCCN Member Institutions completed an online survey. The survey focused on screening and management practices for patient financial distress, perceived barriers in implementation, and leadership attitudes about such practices. Due to the lack of a validated questionnaire in this area, survey questions were generated after a comprehensive literature search and discussions among the study team, including NCCN Best Practices Committee representatives. Results: Responses showed that 76% of centers routinely screened for financial distress, mostly with social worker assessment (94%), and that 56% screened patients multiple times. All centers offered programs to help with drug costs, meal or gas vouchers, and payment plans. Charity care was provided by 100% of the large centers (≥10,000 unique annual patients) but none of the small centers that responded (<10,000 unique annual patients; P=.008). Metrics to evaluate the impact of financial advocacy services included number of patients assisted, bad debt/charity write-offs, or patient satisfaction surveys. The effectiveness of institutional practices for screening and management of financial distress was reported as poor/very poor by 6% of respondents. Inadequate staffing and resources, limited budget, and lack of reimbursement were potential barriers in the provision of these services. A total of 94% agreed with the need for better integration of financial advocacy into oncology practice. Conclusions: Three-fourths of NCCN Member Institutions reported screening and management programs for financial distress, although the actual practices and range of services vary. Information from this study can help centers benchmark their performance relative to similar programs and identify best practices in this area.

Submitted August 13, 2019; accepted for publication January 15, 2020.

Author contributions: Study and survey design: Khera, Sugalski, Griffin, Zafar, Lee. Literature search and drafting of manuscript: Khera. Survey administration and results compilation: Sugalski, Krause. Statistical analyses: Butterfield, Zhang. Interpretation of findings, critical review, and final approval of manuscript: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article. Ms. Sugalski, Ms. Krause, and Dr. Carlson are employed by NCCN.

Correspondence: Nandita Khera, MD, MPH, Mayo Clinic Alix School of Medicine, 5777 East Mayo Boulevard, Phoenix, AZ 85054. Email: khera.nandita@mayo.edu

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