A series of bicameral and bipartisan actions in Congress in recent weeks has signalled strong support for the expansion and strengthening of palliative care in the United States.
As the population ages and more people live longer with greater disability and disease, policymakers are increasingly motivated to build out the palliative care infrastructure so that more patients and families can access these vital services that address the stress and symptoms of serious illness. The COVID-19 pandemic and the suffering it has caused have also spotlighted how the status quo system falls short when it comes to addressing what matters most to very sick patients and families, and have bolstered the interest and argument for more and better palliative care across settings.
Provider Training in Palliative Care Act
On September 29, Senators Jacky Rosen (D-NV) and Lisa Murkowski (R-AK) reintroduced the Provider Training in Palliative Care Act (S.2890), which would make changes to the Health Resources and Services Administration’s (HRSA) National Health Service Corp (NHSC) program to make it easier for participating providers to pursue additional fellowship training in palliative care. The NHSC provides scholarships and loan repayment to healthcare professionals practicing at approved sites located in/or serving Health Professional Shortage Areas (HPSAs) throughout the United States. NAHC is a strong supporter of this bill, recognizing the critical need to bolster the palliative skills of the health care workforce.
“NAHC applauds Senators Rosen and Murkowski for reintroducing the Provider Training in Palliative Care Act. Home-based providers of every kind, including those that deliver high-quality palliative care to people with serious illness, are facing unprecedented workforce challenges,” said Bill Dombi, President of the National Association for Homecare and Hospice. “We need creative solutions to expand training opportunities in the kind of holistic, person-and-family centered services that palliative care can provide. By making it easier for National Health Service Corp providers to pursue palliative care education, the bill would increase access to this much-needed care in some of the country’s most underserved communities.”
On October 5, Senator Jeff Merkley joined Rosen and Murkowski in co-sponsoring the legislation.
Palliative Care and Hospice Education and Training Act
Keeping with the drumbeat around supporting the palliative care frontlines, Senator Tammy Baldwin (D-WI) and Representative Yvette Clarke (D-NY-9) recently wrote to congressional Democratic leaders to request that the massive and still-developing reconciliation package include policies to boost and better prepare the serious illness workforce to meet the demands of the future. In a letter, the policymakers urged leadership to use the Palliative Care and Hospice Education and Training Act (PCHETA) as the foundational legislation for these negotiations.
PCHETA would promote education and research in palliative care and hospice, increase the number of palliative care professionals, and implement an awareness campaign to educate the public on its benefits. Passing PCHETA has long been a NAHC policy priority, and we strongly support the inclusion of the bill, or parts of it, in a broader social spending reconciliation package.
Community-Based Palliative Care Demonstration
In addition to these actions focusing on existing workforce challenges, a group of ten U.S. House members from the powerful Ways & Means committee recently penned a letter to CMS Administrator Chiquita Brooks-LaSure, calling for the agency to launch a community-based palliative care (CBPC) demonstration pilot run out of the Center for Medicare and Medicaid Innovation (CMMI). NAHC and other stakeholders in the hospice and palliative care community have been advocating for such a demonstration, and we are grateful for these House leaders’ efforts to encourage CMS to finally bring it to fruition. The letter cites research showing how CBPC not only improves the quality of life for patients and families, but also can reduce unnecessary and unwanted utilization that drives up costs for people with serious illness. As a matter of process, the members write that CMS could either create a new standalone CBPC model, or build upon the success of the existing Medicare Care Choices Model (MCCM). MCCM has been operating for 5 years, and is testing the quality and cost impacts of allowing hospice patients to receive hospice-like palliative care services without having to give up disease-focused “curative” treatments.
A recent MCCM evaluation found that demo has reduced Medicare expenditures by $26 million while maintaining a high-quality of care and increasing the likelihood of participating beneficiaries electing the hospice benefit.