Hospices Have High Hopes for PCHETA, But Is It Enough?

Stakeholders in the hospice space are optimistic that Congress will pass the recently reintroduced Palliative Care and Hospice Education Training Act (PCHETA). While some see the bill as a beacon of hope, sustainable change will likely require more than a single piece of legislation.

The legislation has percolated for the past five years without passing, but COVID may have opened lawmakers’ eyes to the value of hospice and palliative care, as well as a “huge gap” between demand for this care and supply of qualified staff to provide it, according to Davis Baird, director of hospice government affairs at the National Association of Home Care & Hospice (NAHC).

“[PCHETA] was desperately needed when it was first introduced, and it is needed even more now. The excess death, serious illness and related suffering wrought by COVID has been a stark reminder that the country needs hospice and palliative care expertise woven into all aspects of our health care system,” Baird told Hospice News in an email. “PCHETA would go a long way towards achieving that goal through its focus on building and training the next generation of leaders in this vital field.”

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If enacted, PCHETA would authorize $100 million over the course of five years to support programs designed to bolster clinical education in hospice and palliative care, along with related interdisciplinary professions such as chaplaincy, pharmacy and social work.

The legislation would establish fellowships through new palliative care and hospice education centers to provide short-term, intensive training, as well as incentivized award programs across all the relevant disciplines. Additionally, it would support programs to develop career paths within the field.

Third time’s a charm?

PCHETA was first introduced in 2017 and again in 2019. The U.S. House of Representatives approved the bill both times, only to stall in the Senate — despite the support of nearly 300 bipartisan cosponsors on the second attempt.

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Sens. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (R-W.Va.) revived PCHETA last week, and the bill has since picked up eight additional cosponsors.

The bill also received endorsements from upwards of 50 industry organizations. These include NAHC, as well as the National Hospice and Palliative Care Organization (NHPCO), Hospice Action Network, Hospice and Palliative Nurses Association and the American Academy of Hospice and Palliative Medicine, among others.

Supporters are taking a look at every “nook and cranny” to move PCHETA forward, according to Logan Hoover, NHPCO’s director of legislative affairs.

“Legislating takes time, and it can be frustrating at times. But the intention is that when things do move slowly, it’s to ensure that we do them right,” Hoover told Hospice News. “The language in PCHETA has been modified and perfected over time. Every time we bring it back, we get one step closer. I’m optimistic this time that we’re going to get more support and strong momentum in the Senate.”

Timing also makes a difference.

The last attempt to push the bill forward coincided with the onset of the pandemic. While the bill had garnered bipartisan support, legislators’ attention had to shift towards COVID response, Hoover indicated.

A long, winding road through Congress

In today’s Congress, PCHETA will need additional cosponsors from both sides of the aisle, along with support of influential stakeholder organizations representing patients, families, clinicians, payers and others key constituencies, according to Baird.

“Advocates need to keep up the drumbeat on PCHETA’s importance in order to keep it on congressional leadership’s radar,” he continued.

Even with that support, legislators may need to include its language in separate, larger and possibly “must-pass” legislative vehicle later in the year, such as an end-of-year tax and health extender package, said Baird.

“Congress is producing few and few bills over time, and it takes a larger vehicle to move things like this along,” said Hoover. “We have broad-based support, we just need the car to put it in. With the political winds that we have right now, we’re going to have a handful of lame-duck members just trying to get a couple last victories put together in a larger package, and that’s ultimately one of our best opportunities for something like PCHETA to fit into.”

Also important to bear in mind, getting the bill passed and signed is not the end of its journey. Even if PCHETA is enacted, lawmakers would later have to appropriate the funds to implement it.

The bill’s current language would authorize a maximum of $100 million, but that does not guarantee that the federal budget would include that total amount.

A drop in the bucket

PCHETA represents an important and historic investment in shoring up the workforce, but will not be sufficient to close all the gaps, according to Baird.

“We need a sustainable and ongoing funding stream to keep building out the pipeline of hospice and palliative care clinicians,” Baird said. “Especially as the unprecedented worker shortage and burnout crisis we find ourselves in now continues to hamper organizations’ capacity to serve those who need high-quality serious and end-of-life care.”

These labor pressures are a longstanding problem made much worse by the pandemic.

Roughly 18% of health care workers have left their jobs during the pandemic, while 31% have considered leaving the field, according to a nationwide 2021 Morning Consult poll.

A large contingent of those, or 79%, indicated that widespread staffing shortages played a role in their decisions, while burnout, poor wages and the pandemic itself were also leading reasons.

NHPCO President and CEO Edo Banach indicated in a statement that PCHETA would be a “down payment” towards improvement, and that a comprehensive plan is needed to address ongoing shortages.

“PCHETA and providing for more education and more money is going to help address the problem going forward,” Banach said at the Hospice News Palliative Care Conference in Chicago. “But it’s going to take a lot more than that.”

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