The increasing demand for patient advocates has created a new professional market for services provided directly to the individual patient independent of the hospital that was largely nonexistent just a decade ago.
“More and more, I think the patients that become my clients simply find it increasingly difficult to manage cancer care, health insurance bills and purchasing health insurance,” said Ruth Linden, founder of Tree of Life Health Advocates, a private patient advocacy service based in San Francisco.
More than 600 private patient advocates are working in the U.S., according to the Alliance of Professional Health Advocates, the largest professional organization for private, independent providers of those services.
In recent years, more patients have turned to private patient advocates like Linden, who play a role that was traditionally performed by family or friends. Advocates provide a range of services that include monitoring patient visits, procedures and medications for medical errors; scheduling doctor appointments; finding a healthcare provider; and helping patients purchase insurance. Other services can include negotiating hospital charges, disputing insurance claim denials, and helping patients form an advance directive that outlines their end-of-life care needs.
Like Linden, many professional advocates are former healthcare professionals, while others entered the field after going through a personal experience either as a caregiver or as a patient and realizing the need. For years, there were no qualifications needed for someone to become a professional patient advocate. No certification existed until 2018, and while training was provided at a few colleges, there was no nationally recognized accreditation process.
Certification became available last year for the first time when the Patient Advocate Certification Board began testing individuals after developing an exam to establish “ethical standards, professional competencies and best practices for professionals who work in the emerging field of patient advocacy.”
But having certification is still not a requirement to operate as a patient advocate since no state currently licenses such professionals, making the task of finding a qualified advocate difficult.
Also, private patient advocates can be expensive, costing patients between $100 to more than $400 an hour to acquire the consulting services of former clinicians.
Unlike patient advocates employed by hospitals, private advocates are paid directly by patients, which they say offers them a level of independence when working on behalf of their patients on issues such as medical decisions or hospital charges that a hospital staff member cannot offer.
Such independence would seem to raise the potential for a more adversarial relationship between private patient advocates and healthcare providers. But Linden said many hospitals recognize the benefits of working with advocates, even those not on their payroll. She said both providers and advocates share aligned interests in wanting to achieve a high level of patient satisfaction, which can mean more clients for advocates and higher Medicare reimbursement for hospitals.
“Good physicians welcome a health advocate because they know that the advocate is going to be part of the team that takes care of their patient,” Linden said.