Oncology Patient Success With Reimbursement, Sustainability, and Job Roles

That’s a wrap for a banner year in oncology patient navigation for 2023!

December 2023 Vol 14, No 12
Sharon S. Gentry, MSN, RN, HON-ONN-CG, AOCN, CBCN
Program Director, AONN+

On November 2, 2023, the Centers for Medicare & Medicaid Services issued the Calendar Year 2024 Medicare Physician Fee Schedule Final Rule, which included payment for principal illness navigation services to help patients and their families navigate cancer treatment and treatment for other serious illnesses. The initial rule supported professional, nonclinical (not having clinical training but performing under the direction of a physician or other practitioner) patient navigation services for patients with a high-risk condition like cancer. On November 9, the American Medical Association released the Current Procedural Terminology codes to describe principal illness navigation services. Also recognized were clinical navigation services, which focus on clinical care, clinical coordination, and clinical education and are provided by licensed clinical staff, such as registered nurses or licensed clinical social workers.1 For the first time, there will be reliable reimbursement pathways to support the professional patient navigation workforce, and this supports the Biden-Harris Administration’s Cancer Moonshot mission to accelerate the fight against cancer.

The Patient Navigation Sustainability Assessment Tool proposed by the National Navigation Roundtable (NNRT) and adopted by the Academy of Oncology Nurse & Patient Navigators (AONN+) in 2023 demonstrated continued collaboration to support the professionalization of oncology navigation. Funding is important, but it takes engaged staff/leadership, organizational context, an engaged community, workflow integration, communication implementation, evaluation, and outcomes effectiveness to achieve sustainability.2

The NNRT Workforce Development Task Group, which includes AONN+ members, released their table clarifying how patient navigators’ job roles vary based on level of expertise—entry-, intermediate-, and advanced-level cancer patient navigators.3 More to come in 2024!

It was a busy and productive year with anticipation for more professional support to come.

Happy 2024 to all!

References

  1. American Medical Association. Reporting CPT codes for oncology navigation services: The Cancer Moonshot. www.ama-assn.org/practice-management/cpt/reporting-cpt-codes-oncology-navigation-services-cancer-moonshot
  2. Dwyer A, Weltzien E, Harty N. Patient Navigation Sustainability Assessment Tool for Preventive Cancer Screening. Colorado School of Public Health and University of Colorado Cancer Center, Aurora, CO. 2019.
  3. American Cancer Society. Patient Navigation Job Roles By Levels Of Experience: Workforce Development Task Group, American Cancer Society National Navigation Roundtable (ACS NNRT) 2023. https://navigationroundtable.org/resource/https-navigationroundtable-org-wp-content-uploads-workforce-development-job-performance-behaviors-pdf/
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Last modified: December 19, 2023

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