Some federal lawmakers are working to address workforce issues in the hospice sector, as well as bolster support for family caregivers.
In a tense political environment, palliative care policy is one area where members of both parties are finding common ground. Lawmakers have introduced a series of bipartisan bills intended to relieve workforce pressures and improve quality, according to Megan Thompson, senior policy adviser to Sen. Jacky Rosen (D-Nev.).
Several of these bills were initiated this year by the Senate Comprehensive Care Caucus, co-founded by Rosen, including the Expanding Access to Palliative Care Act, the Palliative Care Provider Training Act and the Act to improve access to transfusion care for palliative care patients.
These bills aim to increase the number of clinicians trained in hospice and palliative care amid widespread workforce shortages, Thompson said at the Coalition to Transform Advanced Care Leadership Summit ( C-TAC) and the Center for Advancing Palliative Care (CAPC) in Washington DC.
Many states face enormous challenges with providers when it comes to faculty and upward mobility. There needs to be a focus on the journeys of RN faculty, especially those who are coming into retirement and want to share those experiences with others, Thompson said at the Leadership Summit. We have not resolved this issue. There are many exciting ideas for changing the way we work with people where they are.
In addition to creating better career paths for clinicians, another important goal for lawmakers is to develop a dedicated payment model for palliative care, Thompson said. The Expanding Access to Hospice Care Act, introduced in June, would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a dedicated hospice payment demonstration.
Such a model, if adopted, would need to include additional support for unpaid caregivers and programs to improve care coordination, she said. Family caregivers often play a key role in patients’ decisions to accept or forgo hospice care, and having improved resources for caregivers can lead to better patient outcomes, according to Thompson.
[Its about] how to have a model where Medicare will pay for hospice services outside of hospice benefits, Thompson said. So, if you are diagnosed with cancer, you have access to palliative care, curative treatments and all the services you need. Patients often say it’s much better care and more compassionate to caregivers as well. This leads to better results, which is amazing and also makes a lot of sense. Thus, moving the levers of Medicare benefits aims to [hospice] is extended beyond this demonstration.
Other policymakers are taking a closer look at the Medicare Hospice Benefit itself.
Rep. Earl Blumenhauer (D-Ore.) called for a restructuring of benefits to ensure patients receive the right care at the right time. One obstacle to that is the layers of bureaucracy that take over the health care system, he said.
Part of the problem is that we need to change the system to be less emergency-focused, less bureaucratic and linked to performance so that we can begin to manage end-of-life care through through palliative care benefits and be able to provide value. moving forward while improving quality of life, Blumenhauer said at the C-TAC-CAPC Leadership Summit. It was a brutal system [with] supply chain and workforce challenges in healthcare delivery. But this is not an excuse for accepting the system and not being able to work together on reform. Its performance-based and responsible approach [care]without avoiding the most difficult questions.
One of the most difficult questions related to palliative care is how to improve program integrity as more cases of fraud in this area come to light. As regulators work to strengthen oversight of hospice care, some providers are concerned that new requirements could impact their employees in terms of changing workloads and administrative burden.
Many lawmakers are hungry to make a difference in the delivery of end-of-life care, including rethinking ways to reshape hospice delivery to allow for a better balance between oversight and quality, according to Blumenhauer. Increased audit and investigation activities at hospice centers could negatively impact providers’ ability to provide quality care, he said.
We weren’t going to solve [this] by putting more money into it or having more audits and routines or crazy hoops to jump through. We don’t have to do that, Blumenhauer said. The work we are doing in end-of-life care in terms of modernizing benefits is low-hanging fruit. No, it’s not low-hanging fruit, it’s about picking the fruit off the ground. Its ways of making a difference by providing more care, more protection and more value. This is absolutely essential. There are many opportunities for simple, common-sense initiatives.
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