Lawmakers Take Bipartisan Approach to Hospice, Palliative Care Policy

Some federal legislators are working to address workforce issues in the hospice space, as well as bolstering support for family caregivers.

In a fractious political environment, hospice and palliative care policy is one area in which members of both parties find common ground. Lawmakers have introduced a series of bipartisan bills designed to relieve workforce pressures and improve quality, according to Megan Thompson, senior policy advisor for Senator Jacky Rosen (D-Nev.).

Several of these bills have rolled out this year from the Senate Comprehensive Care Caucus, which Rosen co-founded, including Expanding Access to Palliative Care Act, the Provider Training in Palliative Care Act and Improving Access to Transfusion Care for Hospice Patients Act.


These bills aim to increase the number of clinicians trained in palliative and hospice care amid widespread labor shortages, Thompson said at the Coalition to Transform Advanced Care (C-TAC) and the Center to Advance Palliative Care (CAPC) Leadership Summit in Washington D.C.

“Many states face huge challenges with providers when it comes to faculty and upward mobility. It’s making sure we’re focusing on pathways for RN faculty, especially those that are reaching retirement and want to share those experiences with others,” Thompson said at the Leadership Summit. “We have not solved this problem. There are a lot of great ideas in changing the way we work with people where they’re at.”

Aside from building better career pathways for clinicians, another “big picture” focus for legislators is to develop a payment model dedicated to palliative care, Thompson stated. The Expanding Access to Palliative Care Act, introduced in June, would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a dedicated palliative care payment demonstration.


Such a model, if enacted, would need to include additional support for unpaid caregivers and programs to improve care coordination, she said. Family caregivers are often a key part of patients’ decisions to accept or forgo hospice care, and having improved resources for caregivers can lead to better patient outcomes, according to Thompson.

“[It’s about] how to have a model where Medicare will pay for palliative care services outside of the hospice benefit,” Thompson said. “So, if you’re diagnosed with cancer, you have access to palliative care, to curative treatments, to whatever services you need. Patients often say this is so much better and more compassionate care to caregivers also. Doing that leads to better outcomes, which is incredible and also makes a lot of sense. So moving levers in the Medicare benefit is with a goal that [hospice] is expanded beyond this demonstration.”

Other policymakers are taking a closer look at the Medicare Hospice Benefit itself.

Rep. Earl Blumenhauer (D-Ore.) has called for a restructuring of the benefit to ensure patients receive the right care at the right time. One of the obstacles to this is the layers of bureaucracy that pervade the health care system, he said.

“Part of the problem is we need to change the system to be less emergency-centered, less bureaucratic, and have it performance-related so we can start dealing with end-of-life care through the hospice benefit, and being able to provide value going forward while we improve the quality of life,” Blumenhauer said at the C-TAC-CAPC Leadership Summit. “It’s been a brutal system [with] the challenges for delivery of health care in supply chain issues and workforce issues. But that’s no excuse for us to accept the system and not be able to work together on reform. It’s performance-based, accountable [care], not ducking the harder questions.”

Among the “harder questions” related to hospice is how to improve program integrity as more instances of fraud in the space come to light. As regulators work to strengthen hospice oversight, some providers have been concerned that new requirements could impact their employees in terms of changing workloads and administrative burden.

Many legislators are “hungry to make a difference” in end-of-life care delivery, including looking at ways to reshape the hospice benefit that allows for a better balance between oversight and quality, according to Blumenhauer. Increased hospice auditing and survey activity may be having adverse effects on providers’ ability to deliver quality care, he said.

“We’re not going to solve [this] by throwing more money at it or having more audits and senseless routines or hoops to jump through. We don’t have to do that,” Blumenhauer said. “The work that we’re doing on end-of-life care in terms of modernizing the benefit – this is low hanging fruit. No, it’s not low hanging fruit, it’s picking the fruit up off the ground. It’s ways to make a difference in providing more care, more protection, more value. This is absolutely essential. There is so much opportunity in terms of simple, common sense initiatives.”

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