Years after it was first introduced, hospice leaders are calling on Congress to move forward legislation that would bolster their dwindling workforce.
The most significant bill in recent years is the Palliative Care and Hospice Education Training Act (PCHETA), which has come before Congress time and again but has not yet been passed. The bill’s most recent go around was last May, reintroduced by Sens. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (R-W.Va.).
The staffing shortage was a topic of conversation during Hospice Action Week, a lobbying event held by the National Hospice and Palliative Care Organization (NHPCO) and the Hospice Action Network. In meetings with legislators, several hospice leaders advocated for PCHETA’s resurrection.
“We have a critical worker shortage, we need help on that. We’ve got a payment update that doesn’t reflect the reality of running a hospice, and these are things that we can ask for help on,” Logan Hoover, NHPCO’s vice president of policy and government relations, told Hospice News. “There’s an opportunity for PCHETA to get added on, and to make sure that the training that physicians receive and nurses receive have at least a little bit of hospice, a little bit of palliative care awareness.”
PCHETA was first introduced in 2017. 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.
The training aspect is crucial to building the hospice and palliative care labor pool, as specialized training is often scarce.
Reimbursement rates impact labor
Hand in hand with the workforce shortage is the question of reimbursement. With wages, salaries and associated costs rising nationwide, hospices are straining under the weight.
With this in mind, a range of stakeholders in the space has indicated that the U.S. Centers for Medicare & Medicaid Services’ (CMS) proposed 2.8% base rate increase for 2024 is inadequate to support their needs. Some have called on the agency to institute a 6.5% hike that would be more in line with their costs.
“With the reimbursement rate, [CMS} needs to strongly consider giving us a better increase to match the needs, with the increases around the clinical staff salaries and the ongoing expenses that have gone up around personal protective equipment,” NHPCO’s COO and interim CEO Ben Marcantonio told Hospice News.
While labor prices aren’t the only expenses that have been going up, they are among the largest for hospices. Many providers have had to offer substantial sign-on and retention bonuses to remain competitive in the marketplace —costs that some hospice leaders have described as “astronomical.”
Labor shortage threatens patients’ access
The labor constraints have also tightened providers’ clinical capacity, threatening patients’ access to care. Referral rejection rates among hospices reached a record high of 41% last year, according to data from CarePort, a WellSky company.
While some hospice companies have reported hiring and capacity gains in recent months, often driven by bonus programs, the problem persists for many providers.
In the midst of these challenges, some lawmakers may have an appetite for PCHETA, as more recognize the potential cost savings that hospice and palliative care can generate for Medicare.
“Most places don’t even train for hospice or palliative care, so greater awareness of the challenges and getting more people into it will make them better, which will hopefully improve the delivery of services,” Rep. Joe Morelle (D-N.Y.) told Hospice News. “I don’t know that there’s enough access to hospice and palliative care services. When I look for ways to make sure that we try to drop the cost of Medicare per person, hospice and palliative care are attractive to me, because the more we utilize that, the lower costs can drop.”
Companies featured in this article:
Hospice Action Network, National Hospice and Palliative Care Organization
