New Orleans, LA—The House of Delegates of the American Medical Association (AMA) laid out guidelines for patient navigator programs during their November 2011 Interim Meeting. The aim is to ensure that patient navigators “enhance, rather than undermine, the delivery of high-quality patient care,” the resolution states. Patient navigators have become part of the oncology team in many centers, and although that development is generally viewed as positive, oncologists have concerns. One concern is that patient navigators may be overstepping clinical boundaries and functioning without sufficient direction. Another is that patients are unfairly referred to certain providers or cancer centers. The resolution adopted by the AMA addressed these and other concerns, recommending that patient navigators should:
The guidelines also suggest that navigator programs establish procedures to ensure direct communication between the navigator and the patient’s medical team. Barbara Arnold, MD, Chair of the AMA Medical Service and Practice Advocacy Committee, which brought the recommendation, addressed another issue: patient navigators are usurping roles and being paid for duties already assumed by other staffers. “We are giving language to something that has been done within our personal offices for years,” she said. “I call my billing clerk and receptionist my ‘patient care coordinators.’ What’s happening is that people outside of our offices are taking these roles, and we have legitimate concerns about whether healthcare dollars are going to pay people who are not under our supervision,” said Dr Arnold. Although Dr Arnold practices ophthalmology in Sacramento, CA, she said that the AMA leadership is going to bat for all physicians, particularly oncologists. Johannes Nunnink, MD, an oncologist at Vermont Cancer Center in Colchester, noted that the original purpose of patient navigators was to enhance access to care for underserved populations and suggested this aim is being diverted. “In my experience, some hospitals use these navigators to direct patients into a specific system. I set up a breast care center in my hospital and found that some of my patients were, under navigators, being directed to certain caregivers, even though [those pa - tients were] actively being taken care of by me. It is a critical principle that the navigator system be fair and transparent,” he said. In general, the oncologists viewed patient navigators as useful members of the team, but they recognized the need for guidelines. Charles Wilson, MD, of the AMA’s Council for Medical Services, said, “We believe this resolution gets into what the care team of the future will be. Many individuals will be on that [team] who are not employed by physicians…but physicians should be the leaders and we should never give up that position.”
