Palliative care treats the pain and other debilitating symptoms of serious and chronic illness. By efficiently improving quality of care geared to our sickest, most vulnerable patients, it is emerging as a critical component of health reform. Since 70 percent of the Medicare budget is spent on the 10 percent of our country's sickest patients, palliative care has also become a model for high-quality, fiscally responsible care.
Policymakers can help ensure that people with serious and chronic illness have access to hospital palliative care by following the recommendations outlined below:
For Federal Policymakers
- Exempt ACGME approved Palliative Medicine fellowship training from the GME cap.
- Promote and pass legislation requiring all hospitals to offer palliative care services as a condition of Medicare and Medicaid reimbursement.
- Create loan-forgiveness programs for nurses and physicians seeking postgraduate palliative care training.
- Support congressional initiatives that increase NIH and Veteran's Health Administration funding for palliative care research.
- Promote a reimbursable code for family conferences that does not require face-to-face patient presence.
For State Policymakers
- Fund palliative care team training and technical assistance for all hospitals in your state.
- Include palliative care indicators in your state's quality programs for your state health plan and Medicaid programs.
- Ensure the development of palliative care programs in public and sole community provider hospitals, as these hospitals provide care to the underserved and most vulnerable patient populations.
- Promote and pass legislation requiring all state-supported medical schools to have affiliations with hospital palliative care programs.
- Create a statewide resource center for promotion of access to quality palliative care services (see New York Palliative Care Training Act-Public Health Law Article 28 at http://public.leginfo.state.ny.us/menuf.cgi)
- Promote and pass legislation that requires physicians take continuing medical education (CME) courses on pain management and care of the terminally ill. An example of legislation can be found at California's Business and Professions Code section 2190.5. http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2190-2196.5
Policymakers can also play a key role in promoting legislation that ensures access to high quality care that respects patients? wishes and autonomy. We recommend the following:
- Visit the American Bar Association's Commission on Law and Aging?s website for legislative updates and legal information on state health decisions and other topics that impact the quality of care received by elders. www.abanet.org/aging
- Promote the Uniform Health-Care Decisions Act (UHDA.) The UHDA provides a simple model for ensuring that patients? wishes are honored. Recommended by the National Conference of Commissioners on Uniform State Laws, this act replaces living will, health care power of attorney and family health-care consent statutes. www.nccusl.org.
- Support legislation that improves care across health care settings such as the Physician Orders for Life-Sustaining Treatment (POLST). The POLST form is designed to reflect a patient's wishes regarding treatment preferences and must be honored by all health care providers regardless of setting. www.ohsu.edu/ethics/polst. Examples of recent legislation include New York's Medical Orders for Life-Sustaining Treatment (MOLST) (http://www.compassionandsupport.org/index.php/legislation) and California's POLST legislation (http://www.finalchoices.org/ccccchcf_polst_grant%20update.htm)
For a directory of hospital palliative care programs by state, visit getpalliativecare.org
For an interactive view of the national and state-by-state report card on access to hospital palliative care, visit www.capc.org/reportcard
The Center to Advance Palliative Care (CAPC) provides health care professionals with the tools, training and technical assistance necessary to start and sustain successful palliative care programs in hospitals and other health care settings. CAPC is a national organization dedicated to increasing the availability of quality palliative care services for people facing serious illness. Direction and technical assistance is provided by Mount Sinai School of Medicine. (www.capc.org)
Center to Advance Palliative Care
1255 Fifth Avenue
Suite C-2
New York, New York 10029
212.201.2670
www.capc.org
www.getpalliativecare.org
