Reform burdensome Medicare regulations to improve end-of-life care

Research shows that more than a quarter of Americans have given little to no thought about how they want to die – or how they prefer to be cared for in their final days. As a hospice care provider for more than 32 years, sadly, this is not a surprise to me.

What too many don’t realize is that with heartfelt consideration and careful planning, death can be a profound, peaceful and personal journey. That is why it is so important that patients and their families have timely access to high-quality hospice care.

{mosads}Given how warily our culture approaches death and dying, health care services and policies surrounding the end of life are often misunderstood. At the expense of comfort, precious time and countless dollars are spent chasing an elusive cure rather than approaching an end of life illness with peace and reflection.

Hospice care provides a holistic experience that focuses on the wishes and needs of the individual. The hospice model involves an interdisciplinary, team-oriented approach to treatment that includes expert medical care and comprehensive pain management but also includes emotional and spiritual support for the patient AND their family. It’s this philosophy that drew me to this field and what I and our team at Caris continue to practice and uphold today. 

For more than 35 years, the Medicare Hospice Benefit has ensured older Americans at the end of life could access this philosophy of care. As Medicare’s original coordinated care model, hospice is a program that works.

While those in the hospice community have grown and adapted to meet the needs of those we serve these last 30-plus years, many of the regulations imposed on the Medicare Hospice Benefit are still outdated relics of the 1980s. Thankfully, members of Congress recognize the need to modernize and changes are on the horizon. We welcome updates to burdensome regulations that will improve the delivery of patient care, including the reduction of existing requirements that create needless and time-consuming administrative work for hospice programs. One positive example of this recently discussed on Capitol Hill is the Center for Medicare & Medicaid Services’ (CMS) proposed rule to give more flexibility to physician assistants to serve as the hospice attending physician – a change broadly supported by the hospice community. We applaud efforts underway in Congress – including the Ways and Means Committee’s efforts to address and cut red tape in the Medicare program.

Policymakers should also consider reforms to make palliative care more widely available and hospice care available in a more timely fashion. This means that they must ensure that any proposed payment reforms do not threaten the integrity of the Medicare Hospice Benefit and the principles on which hospice care was founded.

During my tenure, I’ve seen plenty of change, and I imagine I’ll see more, maybe even policy changes to the Medicare Hospice Benefit. What all involved must remember is that any changes must compassionately consider protecting timely access to care while making sure that regulations are less rigid, duplicative and costly. Failure to implement commonsense reforms could unintentionally disrupt or delay patients’ access to high-quality end of life hospice care. Any new policies must continue to support the basic human right of quality end of life care and protect the values of hospice, the right of patient choice and the integrity of our care philosophy.

Norman McRae is on the board of the National Hospice and Palliative Care Organization (NHPCO), chair of the Hospice Action Network (HAN) and the founder of Caris Healthcare in Knoxville, Tenn.