Stakeholder Support Grows for Hospice Patient Transfusions Legislation

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Stakeholders are closely eying the legislative journey of a bill designed to improve access to blood transfusion services among hospice patients. If enacted, it could affect hospices’ ability to measure quality.

Providing terminally ill patients with greater blood transfusion access could result in improved outcomes and hospice utilization, according to Dr. John Armitage, CEO of the Oklahoma Our Blood Institute (OBI). Armitage also serves as president of the Global Blood Fund. Transfusion services are not sufficiently covered under current hospice reimbursement, hindering providers’ in terms of care delivery and patient reach, Armitage stated.


Having greater payment options for blood transfusions could vastly improve quality outcomes and access, he indicated. Greater transfusion support could translate into smoother care transitions in the home among hospice patients, according to Armitage.

“The current amount of money hospice gets per day isn’t enough to cover costs of at-home blood transfusions,” Armitage told local news. “Transfusions are given for comfort and relief. People who are short of breath aren’t as labored in their breathing when they have red cells, so it’s all about the comfort aspects. And, it’s all about these patients being able to opt into hospice care rather than having to stay in the hospital, or keep going back and forth to clinics to get these transfusions.”

Introduced last summer with bipartisan support from Sens. Jacky Rosen (D-Nev.), John Barrasso (R-Wyoming) and Tammy Baldwin (D-Wisc.), the Improving Access to Transfusion Care for Hospice Patients Act of 2023 is currently in Senate review.


If enacted, the legislature would require the Center for Medicare and Medicaid Innovation (CMMI) to design a payment demonstration model that would include coverage of blood transfusion services within the Medicare Hospice Benefit. It proposes to allow hospice providers to bill Medicare separately for transfusion services in addition to daily per diem.

Patients with blood-related conditions historically have low rates of hospice utilization, according to research published in the Journal of Pain and Symptom Management.

More than half (54.9%) of 113 hospices polled nationwide in a 2022 survey indicated that they “never offer” transfusion services. A meager 2.7% indicated that they “always offer” these services, compared to 40.7% who stated transfusions are provided occasionally.

The findings highlight the significance of blood transfusion access as a main barrier to increasing hospice utilization, the researchers wrote. The data suggest that hospice providers face a “critical need” for innovative payment models that improve end-of-life care among patients with blood cancers, they stated.

The proposed legislation could give insight into quality metrics related to hospital utilization and length of hospice stay before the end of life.

Hospice enrollment rates and length of stay are often lower among those with blood-related conditions. Another study published in 2024 in the Journal of Pain and Symptom Management found that transfusion-dependent patients had 51% shorter hospice stays compared to others, with an average enrollment period of 6 days versus 11 days, respectively.

“I am proud to join my Comprehensive Care Caucus colleagues in introducing legislation to reduce the financial barriers for hospice patients and ensure no person has to choose between getting the lifesaving transfusions they need to live or receiving comprehensive hospice care,” Baldwin said previously in a statement. “Having served as my grandmother’s primary caregiver, I have seen firsthand the challenges that patients face when trying to access palliative care.”

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