Patient Navigation

 

Louisiana Patient Navigation Network Program    |    PN Resources    |    PN Policy    |


Patient Navigation Policies and Standards:

Patient Navigator Outreach and Chronic Disease Prevention Act was signed into law by President George Bush in 2005.  http://beta.congress.gov/bill/109th/house-bill/1812 .  Although section 3510 of the Patients Protection and Affordable Care Act extends the 2005 law until 2015, it remains unfunded.  Additionally, there is no mechanism for billing Medicaid or private insurance for patient navigation services.

The Institute of Medicine’s (IOM) recommendations shape the national policy agenda on cancer.  Its most recent publication, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis concluded that the cancer care delivery system is in crisis due to a growing demand for cancer care, increasing complexity of treatment, a shrinking workforce, and rising costs. Changes across the board are urgently needed to improve the quality of cancer care. All stakeholders – including cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industries – must reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality cancer care delivery system. Working toward the recommendations outlined in this report, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.  Click here to access the full report ( http://www.iom.edu/Reports/2013/Delivering-High-Quality-Cancer-Care-Charting-a-New-Course-for-a-System-in-Crisis.aspx )  

 The American College of Surgeons (ACOS) is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment.  The standards set by ACOS via the Commission on Cancer shape the way quality cancer care is provided as well as the provision of navigation.  To view their website click here  http://www.facs.org/cancer/ .  For the Complete Commission on Cancer 2012 Program Standards, click http://www.facs.org/cancer/coc/programstandards2012.pdf

Commission on Cancer as stated in the 2012 Program Standards: 

Standard 3.1 Patient navigation Process

A patient navigation process, driven by a community needs assessment, is established to address health care disparities and barriers to care for patients. Resources to address identified barriers may be provided either on-site or by referral to community-based or national organizations. The navigation process is evaluated, documented, and reported to the cancer committee annually. The patient navigation process is modified or enhanced each year to address additional barriers identified by the community needs assessment.

 CoC Program Standards for 2012 (pgs. 76-77: The CoC 2012 Standards require access to patient-centered services such as psychosocial distress screening and navigation.  Major Standard Changes: Performance Standards and Patient-Centered Programs must fulfill the following criteria:

1.     Conduct a community needs assessment at least once during the three-year survey cycle to address health care disparities and barriers to care for patients.

2.     Establish a patient navigation process and identify resources to address barriers that are provided either on site or by referral to community-based or national organizations.

3.     Each year, barriers to care are assessed and the navigation process is evaluated, documented, and the findings are reported to the cancer committee.

4.     Each year, the patient navigation process is modified or enhanced to address additional barriers identified by the community needs assessment.

The evaluation of the patient navigation program must include the following:  The evaluation and report includes, but is not limited to, the following:

1.     Health disparities identified

2.     Description of the navigation process

3.     Population(s) served and barriers identified by the community needs assessment

4.     Documentation of activities and metrics (outcomes/outputs)

5.     Areas for QI, enhancement, and future directions

Standard 3.3 Survivorship Care Plan (Pg. 78)

The cancer committee develops and implements a process to disseminate a comprehensive care summary and follow-up plan to patients with cancer who are completing cancer treatment. The process is monitored, evaluated, and presented at least annually to the cancer committee and documented in minutes. 

The IOM and National Research Council 2005 report, From Cancer Patient to Cancer Survivor: Lost in

Transition (http://www.iom.edu/Reports/2005/From-Cancer-Patient-to-Cancer-Survivor-Lost-in-Transition.aspx), recommends that patients with cancer who are completing the first of course treatment be “provided with a comprehensive care summary and follow-up plan that is clearly and effectively explained.” The recommendation suggested that these plans would help cancer survivors who may otherwise get “lost” in the transitions from the care they received during treatment through the phases of their life or stages of their disease course.

The Process Requirements for the CoC are as follows:

1.     A survivorship care plan is prepared by the principal provider(s) who coordinated the oncology treatment for the patient with input from the patient’s other care providers.

2.    The survivorship care plan is given to the patient on completion of treatment.