Impact of an EMR-integrated, screening-based oncology financial counseling program.

Abstract

350 Background: Financial hardship (FH) is highly prevalent in oncology, adversely impacting quality of life and clinical outcomes. While FH screening is increasing, translating positive screens into actionable financial navigation remains a critical care gap. This study aims to evaluate the implementation and impact of the Oncology Financial Counseling Program (OFCP), an initiative connecting cancer patients with financial navigation to mitigate hospital bills and secure external funding. Methods: Patients in oncology clinics across 9 campuses of an urban hospital system were prompted in the electronic patient portal at 6-month intervals to complete a validated 2-item FH survey (adapted from the COST tool, assessing financial worry and savings confidence). Positive screens triggered an automated electronic medical record (EMR) referral to the OFCP. Manual referrals (via EMR, email, or calls) were also accepted from the care team or patient. Encounters with 6 financial counselors were tracked in Epic Compass Rose. An automated 3-month follow-up survey assessed service value, suitability, and accessibility. Process measures included referral volume, source distribution, and contact success. Outcome measures included services rendered, grant dollars awarded, billing adjustments, and payments recovered. Results: Between 3/2025 and 6/2026, 4,583 patients were referred to the OFCP. Drivers were automated EMR screening (n=2,987; 65%), counselor self-referrals for outstanding balances >$300 (1,035; 23%), provider EMR orders (273; 6.0%), staff communications (241; 5.3%), and patient self-referrals (47; 1.0%). The OFCP contacted 3,044 (66%) of referred patients. While 879 (29% of contacted patients) completed a comprehensive financial counseling session, targeted assistance was provided broadly across the contacted cohort, resulting in 2,446 discrete services rendered. Interventions included referrals for health-related social needs counseling (n=630; 26%), hospital financial aid referrals (453; 19%), copay assistance program enrollment (394; 16%), grant program enrollment (346; 14%), insurance benefit reviews (332; 14%), and insurance marketplace enrollment/connection (291; 12%). Financially, the OFCP secured $1.51 million in external patient grants. Patients avoided $521,887 in debt via billing corrections ($398,555) and financial aid write-offs ($123,332). The hospital recovered $234,650 in patient payments, primarily from grant funds, leaving $1.275M available for patients' future medical expenses. Conclusions: In 15 months, the OFCP engaged 3,044 patients, delivered 2,446 targeted financial interventions, and generated substantial financial relief for both patients ($1.51M in grants, 522K in debt adjustments) and the institution ($235K). Future QI cycles will integrate patient feedback to prioritize high-impact services and optimize multidisciplinary integration.