Action at the federal and state levels is critical to ensure that palliative care is accessible to all individuals facing serious illnesses, along with their families and caregivers. Expanding this vital support system necessitates a multi-faceted approach, addressing workforce development, financial frameworks, quality standards, clinical training, and public awareness.
At the federal level, the Palliative Care and Hospice Education and Training Act (PCHETA, S. 2243 in the 118th Congress) continues to be a crucial legislative instrument. PCHETA aims to bolster the specialized palliative care workforce and equip all clinicians—not just palliative care specialists—with essential skills in communication, pain management, and symptom control. Furthermore, it seeks to advance palliative care research and improve public understanding of palliative care’s benefits. For detailed information on advocacy efforts, the Patient Quality of Life Coalition’s (PQLC) Advocacy page offers valuable resources.
States also have a significant role to play in expanding palliative care access. The Center to Advance Palliative Care (CAPC) encourages state policymakers and advocates to consider actions in several key areas. These include strategies to identify individuals who could benefit from palliative care through effective palliative care screening tools, although the focus extends beyond just screening to encompass comprehensive system improvements.
Building a Robust Palliative Care Workforce
A significant barrier to palliative care access is the shortage of specialized professionals. To address this, states can prioritize workforce expansion through targeted initiatives:
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Loan Forgiveness Programs: Implementing or expanding loan forgiveness programs for clinicians who specialize in palliative care and practice within the state can incentivize professionals to enter and remain in this critical field. This is especially important in attracting talent to areas with the greatest need.
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Telehealth and Remote Consultation Grants: Providing grants and support for palliative care teams to offer remote consultations to rural hospitals and Federally Qualified Health Centers (FQHCs) can bridge geographical gaps in access. Telehealth solutions are vital for reaching underserved populations and addressing disparities in palliative care availability.
Improving Payment Structures and Financial Incentives
Sustainable and equitable access to palliative care requires sound financial models. States should explore payment reforms to incentivize palliative care integration:
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Medicaid Program Integration: Incorporating palliative care components into Medicaid programs, such as Health Homes, Managed Long-term Care Plans, or Home and Community Based Services, is crucial. This can involve refining enrollee assessments to better capture functional impairment, symptom burden, and caregiver stress. Furthermore, integrating communication training mandates for care managers and other clinicians within these programs can enhance the overall quality of care.
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Stakeholder Collaboration for Reimbursement Models: Establishing a collaborative process involving various stakeholders, in partnership with the state department of health, is essential for developing effective Medicaid reimbursement and quality control measures for interdisciplinary, community-based palliative care. This ensures that payment models are both financially sustainable and promote high-quality, patient-centered care.
Enhancing Quality and Establishing Standards
Accountability for delivering high-quality palliative care is paramount. States can leverage policies and regulations to drive quality improvements:
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Defining Palliative Care Services and Standards: State policies and regulations should clearly define palliative care services and establish quality standards. This provides a framework for ensuring consistent and high-quality care delivery across different settings and providers.
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Utilizing BRFSS for Consumer Feedback: Incorporating a palliative care module into the state Behavioral Risk Factor Surveillance System (BRFSS) questionnaire can provide valuable insights into palliative care delivery from the patient and family perspective. This data can inform quality improvement efforts and ensure that services are meeting the needs of those receiving care.
Strengthening Clinical Skill-Building
Expanding the skills of all clinicians in essential palliative care competencies is vital for widespread access:
- Mandatory Training in Licensure and Continuing Education: Revising state health professional licensure and continuing education requirements to include mandatory instruction in pain and symptom management, serious illness communication, and caregiver support is essential. Special emphasis should be placed on best practices in equitable care, including addressing implicit bias in healthcare delivery. Several states are already leading the way by requiring implicit bias training for physicians, setting a precedent for others to follow.
Raising Public and Clinician Awareness
Improving knowledge and understanding of palliative care is crucial for increasing utilization and reducing misconceptions:
- Public Awareness Campaigns: State-level initiatives to educate the public and healthcare professionals about the benefits of palliative care can significantly increase appropriate referrals and utilization. These campaigns should focus on clarifying what palliative care is, who can benefit, and how it differs from hospice care.
For state-specific strategies and more tailored recommendations, consulting with palliative care leaders within each state is highly recommended before implementing new initiatives. Resources such as CAPC’s State Policy Toolkit and the National Academy for State Health Policy (NASHP) Palliative Care Resource Center offer further guidance and information.
Alt text: Infographic titled “PCHETA Reintroduced” highlighting key aspects of the Palliative Care and Hospice Education and Training Act, including workforce expansion, research advancement and public awareness.
