Rural access to hospice matters

Categories: Featured and Policy.

Just 45 minutes out of Tucson (Arizona) in the tri-community area, our small towns are quiet, and our pace of life is just a little slower. Many of our seniors, be they lifelong Arizonans or recent retirees, love the idyllic lifestyle that the desert offers and choose to live out their golden years here. And as the sun sets on their lives, many choose to take advantage of hospice care.

Since becoming law in 1982, the Medicare hospice benefit has provided coordinated, comprehensive and professional care to millions of Americans and their families — nearly 1.5 million beneficiaries in 2017 alone. Generations of Americans enrolled in Medicare have chosen to receive hospice care for their end-of-life journey because it addresses each patient’s unique physical, spiritual and emotional needs.

Yet current policy limits patient access to hospice — especially in underserved areas like the tri-community. Our seniors are concerned, legitimately so, that choosing hospice means they are no longer able to see the doctor they’ve come to know and trust.

Most hospice care happens in the comfort and safety of the patient’s home; but wherever patients choose to enter hospice, an entire team of caregivers is coordinated to honor the patient and help their family prepare for the end of life. The care team includes physicians and nurses, physical and occupational therapists, speech-language pathologists, hospice aides, grief counselors, social workers, chaplains, volunteers — whatever and whoever is needed to meet the patient’s needs. Recognizing the numerous benefits, over 35,000 Arizonans, including members of our local tribal communities, opt to utilize the Medicare Hospice Benefit each year, and 59% of all Medicare deaths in Arizona occur in hospice care.

Patients in rural and tribal communities, however, face unnecessary barriers when it comes to choosing hospice care.

Medicare beneficiaries who are eligible for hospice must select a physician or nurse practitioner to be their attending physician for hospice care. Most Americans choose their primary care doctors with whom they have built a strong, trusting relationship. But the physicians who serve at the Rural Health Centers (RHC) and Federal Qualified Health Centers (FQHC) in the tri-community area cannot serve as attending physicians for hospice unless they volunteer their time to provide unreimbursed care. Some do — but far more often, patients must either choose a doctor they may not know to be their attending physician on their end-of-life journeys or forgo the benefits and team of care that hospice offers.

This statutory barrier to hospice care is harmful to rural patients, both here in Arizona and across the United States. To address this sad situation, Congress recently introduced the bipartisan Rural Access to Hospice Act (S. 1190/H.R. 2594). This bill, which is supported by Democrats and Republicans, including Senator Kyrsten Sinema and Congressman Tom O’Halleran, would remove this barrier to hospice care by providing payment for certain RHC and FQHC services to hospice patients under the Medicare program. By reimbursing RHC- and FQRC-based doctors for the hospice care they offer, rural patients will be able to keep their primary care physicians when choosing to use the Medicare hospice benefit.

The end-of-life journey is one of the most precious and vulnerable times in a person’s life. We must allow patients to maintain a strong relationship with their doctor of choice when entering hospice.

To make terminally ill patients and their families feel even more comfortable and respected, Congress must quickly pass the Rural Access to Hospice Act.