FutureFocus August 8, 2018

Lisa Remington

In this week’s FutureFocus, palliative care and hospice are in the spotlight. A bill called the Palliative Care & Hospice Education Training Act passed the House at the end of July. It establishes greater palliative care workforce training programs for doctors, nurses and other health professionals. In another story, the OIG is taking a closer look at hospice and finding vulnerabilities. We provide the report that has some eye-opening findings. 

Lisa Remington, President, Remington Health Strategy Group

By: Ronald M. Schwartz, Contributing Writer, The Remington Report

One of the most significant measures directed at addressing the future manpower needs of hospice care in the United States since creation of the Medicare benefit in the 1980s passed the House July 23—the Palliative Care & Hospice Education and Training Act (PCHETA, HR1676).

Chances are good for the Senate to pass a similar measure (S693), where like the House there is strong bipartisan support. It means, if there is time in this Congress, the bill could become law in 2018.

In sum, HR1676 directs the Department of Health and Human Services to award grants to improve the training of health professionals in palliative care. It would also increase education and awareness about the benefits and services of palliative care, and enhance research on palliative care through leveraging existing authorities and funds at the National Institutes of Health (NIH).

"PCHETA also would launch a national palliative care education and awareness campaign to: inform patients, families, and health professionals about the benefits of palliative care."

Among the provisions, PCHETA would establish palliative care workforce training programs for doctors, nurses, and other health professionals, such as:

  • Provide grants to medical schools and teaching hospitals to train physicians to teach palliative medicine. Create career development awards for hospice and palliative medicine faculty.
  • Establish workforce development fellowships in palliative medicine for doctors, nurses, social workers, chaplains and other allied health professionals.
  • Provide career incentive awards for nurses, clinical social workers, and pharmacists who agree to teach or practice palliative medicine for a period of five years.
  • Create special preferences in existing nurse education law for hospice and palliative nursing, in education, practice and quality grants, workforce development, and nurse retention projects.

PCHETA also would launch a national palliative care education and awareness campaign to: inform patients, families, and health professionals about the benefits of palliative care; and, create and disseminate information about available palliative care services. And, PCHETA would enhance research by directing NIH to use existing authorities and funds to develop a research strategy in palliative care, pain management, and symptom management.

Minus Federal Action, Future Manpower Falls Far Short of Need

Research indicates that the current rates of educating and training medical professionals in palliative care will be insufficient to ensure future access to quality palliative care. A 2017 study by the George Washington University Healthcare Institute, as cited by the National Hospice and Palliative Care Organization (NHPCO), estimates that there will be no more than 1 percent growth in the palliative care and hospice physician workforce in the next 20 years, while the number of people eligible for palliative care will increase by over 20 percent.

Without a boost for palliative care education and training, as provided in PCHETA, there will be only one palliative physician for every 26,000 seriously ill patients by 2030, NHPCO notes.

“This predicted shortage of care providers would gravely impact access to quality hospice and palliative care and services for individuals facing serious, advanced or life-limiting illness.  We’re calling on Senate leaders to follow the House’s example and rise to meet this challenge,” said NHPCO President and CEO Edo Banach. “Passing this legislation is something Congress can do right now that will directly help their constituents in need of the patient-centered and coordinated care so many prefer.”

In the Senate, S693 is currently co-sponsored by 31 bipartisan Senators. In addition to NHPCO, organized support comes from more than 40 national organizations including the American Cancer Society Cancer Action Network, the Alzheimer’s Association, and the American Heart Association. The Congressional Budget Office still needs to “score” or estimate the cost of the legislation.