Patient Navigator Improves Outcomes, Incomes

Chapman notes that patient navigation has been moving from just having a navigator at the point of screening and getting people to treatment: Now, emphasis is being placed on survivorship, as well—basically "trying to make sure that people are following up as doctors recommended after their treatment," Chapman says.

And while patient navigators are helpful for the patient, they also have a very practical—and economical—purpose as well, as was discovered by the 1,100-bed Mt. Sinai Medical Center in New York City.

The facility used a colonoscopy patient navigator program not only to eliminate barriers to care and improve patients' understanding of colonoscopy, but also to reduce "no-show" patients. This translated into a healthier patient population and a healthier bottom line for the medical center, according to Steven Itzkowitz, MD, a professor of medicine and associate director of the Dr. Henry D. Janowitz Division of Gastroenterology at Mount Sinai.

"Think about it: If you have somebody booked for a colonoscopy and they don't show up, you just can't fill that slot because another patient would have to be prepped. A no-show is a money loser for the hospital," Itzkowitz says. "And if a patient shows up poorly prepped, that's a money loser, too."

Instead, by working with a patient navigator, no-show rates dropped from 40% to 15% and quality improved, as rates of inadequate or poor prep dropped from 12% to just under 5%, according to Itzkowitz.

The impact of the patient navigator—such as by reminding the patient to show up or assisting with transportation issues—meant an additional 33 cases were being treated per week. At $700 per case, this created approximately $1.1 million in additional yearly income to the facility. "When doing the math, patient navigators pay for themselves very easily because all you have to do is cut down on the no-show rate," he says.

And there's the matter of catching a condition at an earlier, more treatable stage. People present so late for many reasons, says Elizabeth Marcus, MD, chair of the division of breast oncology at 464-licensed-bed John H. Stroger Jr. Hospital of Cook County, a large public facility in Chicago.

This lack of access is more than just about insurance—roughly half of the patients in her program do not have insurance: Instead it involves logistical barriers, such as being able to get to the doctor, getting time off work, finding childcare, or even knowledge or belief issues. "Frankly, that small lump is really not just the worst problem they have now," she says. "Once diagnosed with cancer, the same obstacles that prevented someone from coming in at an earlier stage are the same things that may prevent them from receiving appropriate treatment."

The two-year-old patient navigation program, staffed by two social workers, can be helpful for anyone who has gotten a diagnosis of cancer. "Patient navigators are there to help lower barriers, remove obstacles, and help people get what they need," she says.