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Empower Patients, Get Paid: Welcoming Advocates in Your Hospital

Analysis  |  By Alexandra Wilson Pecci  
   April 09, 2019

Patient and financial advocates provide an opportunity to boost patient engagement and get hospitals paid.

Editor's note: This article appears in the March/April 2019 edition of HealthLeaders magazine. This is the second installment of a two-part series on the opportunity of using patient and financial advocates at hospitals and health systems. Read part one here.

Whether they're on-staff patient counselors inside hospitals, or working independently for patients, advocates are increasingly important care team members. Advocates can guide patients through healthcare experiences, including care goals and financial responsibilities.

In-House advocates

Since patients often have complex care needs and their care is followed by multiple teams, sometimes communication among providers may be challenging, or patients may not fully understand what the care team is telling them, says Robin Lipkis-Orlando, MS, RN, NE-BC, director of the office of patient advocacy at Massachusetts General Hospital.

Other times, patients and care teams have differing opinions about the best path forward, and patient care advocates can help mediate. "What we do more and more is help to foster communication between patients and their medical teams," she says.

In addition, internal advocates can engender patient loyalty and positive experiences.

"Advocates can help make sure people return—that people get what they need and feel comfortable and come back to us again," says Stephanie Bayer, JD, senior director of patient experience at the Cleveland Clinic.

Cleveland Clinic's ombudsman's availability is advertised throughout the hospital, from the admission booklet to brochures, and is available any time patients need extra guidance.

"We'll make sure they are getting information in a language that is clear to the patient and their family to allow them to make the right decisions for them," Bayer says. "An important component of a good patient experience is making sure that we are part of that clarity of the communication."

She points out that hospital-based advocates can deliver quick results for patients because they have intimate knowledge of the system where they work; they know who and where to go to get patients' needs met.

If a patient is unsure about a treatment and wants to look for other options, internal advocates can sometimes direct the patient to other services that are provided within the system. They also work closely with other partners within the organization, like bioethics and spiritual care, meeting the holistic needs of patients.

At Mass General, the patient care advocates are also clinicians—nurses and a social worker—which means they can help translate some of the medical terminology a patient is struggling to understand or talk to a care team on the patient's behalf. They visit patients at the bedside and can accompany patients to medical appointments.

Internal patient care advocates are also helpful to doctors and nurses. If a care team is concerned that a patient needs additional guidance, they can contact the ombudsman or advocacy office right away, rather than let potential problems or miscommunications fester.

"If a doctor or nurse or another care provider feels that they're not able to connect with the patient, or the patient doesn't have that same level of understanding, they can call us, and we can come bedside and help," Bayer says.

Similarly, hospital or system-based financial advocates and counselors (the terms are often used interchangeably, depending on the organization) can help patients feel supported financially while helping the organization get paid.

For instance, the financial counselors at UCHealth in Colorado do more than set up payment plans for patients.

Its roughly 65-person financial counseling team also provides patient education about costs and payment responsibilities; state and financial assistance program screening; and financial assistance program application help, working closely with patient representatives and social workers, says Matt Kelly, UCHealth's senior director of patient access. In addition, financial case coordinators are embedded within some of its oncology and transplant departments to help patients navigate the complex and ongoing financial responsibilities that come along with cancer and organ transplants.

Plus, "many UCHealth locations provide social workers who can meet with patients and assist them with both financial concerns as well as additional services outside the hospital," he says.

Lipkis-Orlando says that the patient advocates at Massachusetts General Hospital sometimes intervene with financial matters, actually helping patients to lower, eliminate, or delay a bill in the interest of "positive patient relations."

She says the hospital's multidisciplinary Patient Revenue Advocacy Group meets monthly to review cases where patients have requested that their bills be reduced or eliminated.

If they find that a high bill was coupled with care that didn't go as planned, "we will do our best to find some way to meet patients' requests," she says.

Other times, she says the advocates will ask financial services to put a bill on hold while they investigate the quality of a patient's care.

Independent advocates can help too

While hospital-based advocates play a role in facilitating care within a particular organization, Bayer says independent advocates can have an important role regarding the "longitudinal component of care."

"I think the independent advocate probably is most helpful when a patient has a very complex situation and they're seeking care from multiple sources," she says.

Because of that independence, privately hired advocates can work with the patient across care settings, and throughout their entire journey, with whatever elements of their care they need.

Independent advocates do "whatever it takes to help the patients feel like they are driving their own healthcare decisions, getting the most out of the system, and hopefully, improve their outcomes. Even if the only outcome is the patient feels better [about their experience], that's a good outcome," says Trisha Torrey, founder and executive director of the Alliance of Professional Health Advocates, a membership support organization for independent patient and health advocates in the United States and Canada.

They can also be the patient's eyes and ears at the bedside, urging providers to double-check a medication or wash their hands upon entering the room. Such interventions shouldn't be viewed with skepticism on the part of the hospital, though, says Torrey. Instead, it's just one extra layer of safety checking that's provided at no cost to the facility.

"What does that do but cut down on errors?" Torrey asks.

Independent financial advocates can also be a boon for patients and hospitals. While hospital-based advocates can help patients navigate medical expenses from their own organization, independent financial advocates from organizations like the nonprofit Patient Advocate Foundation (PAF) can take a more holistic approach to a patient's financial needs.

Most of the patients that the PAF works with are seeking some type of financial help, says Christine Wilson, vice president for advocacy communications for the National Patient Advocate Foundation, the advocacy affiliate of the PAF.

Independent advocates can do things like organize and review bills from multiple settings; ensure bills are correct; work to get insurance claims approved; or make sure primary and secondary insurances are being used to their fullest.

Whether an organization employs its own advocates or welcomes conversations and engagement with outside advocates, it's clear that a growing number of hospitals and health systems see the value of having an extra person available to guide patients through their clinical and financial responsibilities.

"Our goal is to make sure that health outcomes are the best they can be, and having patients and families understand and collaborate with us in their care is the best way to have good health outcomes," says Lipkis-Orlando. "Sometimes you need people to help you to do that."

Alexandra Wilson Pecci is an editor for HealthLeaders.

Photo credit: Steve Debenport/


In-house advocates can bridge the communication gap between clinicians and patients.

Advocates can provide an extra set of eyes and ears at the bedside.

Independent financial advocates can tackle medical bills that might otherwise be ignored.

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