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October 3, 2019

What hospital ombudsmen really do (and why some patients hire their own advocates instead)

Daily Briefing

    To navigate an increasingly "complicated" and at times "overwhelming" health care system, patients are turning to hospital ombudsmen and private patient advocates to navigate their care, Julie Washington reports for the Cleveland Plain Dealer.

    Infographic: Do you know if you're making the most of patient navigation?

    Hospital ombudsmen

    Hospitals have long relied on ombudsmen to investigate patient complaints and serve as a "liaison" between the patient and the hospital system, Washington writes. Often, ombudsmen help patients handle administrative and billing matters as well.

    At the Cleveland Clinic, for instance, ombudsmen focus on investigating patient complaints. The Clinic has a separate department for billing issues.

    Last year alone, the Clinic's ombudsmen department handled over 22,000 cases across the system, according to Stephanie Bayer, senior director of patient experience at the Clinic. "[Patients] come to us so confused, and when they leave they are so pleased, they send thank-you notes," Bayer said.

    Meanwhile, St. Vincent Charity Medical Center has a patient advocacy department that visits patients in their rooms and works closely with providers and the hospital's pastoral care office to address patients' needs. According to Washington, St. Vincent's patient advocates help patients with everything from legal aid to transportation to enrolling in Medicare or Medicaid.

    Anne Messer, a patient representative, noted that she doesn't wear scrubs and, as a result, "We hear more from patients than anyone in uniform ever will."

    Private advocates

    But while ombudsmen can help patients navigate their care in the hospital, their services seldom go beyond the hospital setting, Washington reports. That's why patients increasingly are hiring private patient advocates, who aren't employed by the hospital, to help them navigate doctor's visits, at-home treatments, and more.

    For instance, Ron Gecsi hired Julie Wenzinger, an RN and owner of Advocacy Healthcare Concepts, as his patient advocate, after he experienced complications from a bone marrow transplant.

    Gecsi was informed that he couldn't be discharged from the hospital until he could ensure he'd get daily infusions for hydration at home. Wenzinger helped Gecsi navigate the situation and was able to administer the at-home infusions for Gecsi.

    She also helped him coordinate his doctor visits to reduce the number of trips he had to make. "Perhaps most importantly," Washington writes, Wenzinger was able to save Gecsi's family thousands of dollars per month, by finding discounts for his cancer treatment.

    How hospital ombudsmen and private patient advocates differ

    According to Jennifer Skeels, an attorney at Hall, Render, Killian, Heath, and Lyman, a firm specializing in health care law, one advantage to private advocates is that they can focus entirely on the patient, while a hospital employee may have obligations to their employer that could interfere with how they serve the patient.

    But there is an additional cost. According to Washington, while hospital ombudsmen typically their services to patients at no charge, hiring a private patient advocate can be expensive. Some advocates charge between $75 and $400 an hour, according to Vice, and neither Medicare nor private insurance will reimburse for the cost, Washington reports.

    Private advocates are also less regulated than ombudsmen, Washington reports. For example, health systems are required by federal regulations to have an established grievance process, Bayer said.

    However, state and federal agencies do not regulate private advocates, according to Trisha Torrey, founder and director of the Alliance of Professional Advocates. There's also no official licensing system in place for patient advocates, though the Patient Advocate Certification Board implemented a certification program in 2018, which allows those who pass to become certified advocates.

    Before hiring a patient advocate, patients should be clear exactly what services the advocate will provide, Skeels said. Some advocates can prove to be cost-effective, especially if they can help get a patient out of the hospital sooner, she added (Washington, Cleveland Plain Dealer, 9/29).

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