Hospices need ‘huge catapult’ to replenish workforce

By enacting, the recently reintroduced Hospice Palliative Care and Education Training Act (PCHETA) could make a dent in the recruitment barriers that hospices continue to hit. But clinical training will need a much bigger boost to ensure a sustainable workforce, many providers say.

The issue of training is a serious barrier to recruitment into palliative care, as very few students in any clinical discipline are exposed to palliative or palliative care concepts. Most clinicians also train in hospitals, and many are inclined to stay in this familiar setting early in their careers.

According to Eunju Lee, palliative care social worker at Memorial Sloan Kettering Cancer Center, palliative care and palliative care need greater recognition across disciplines at all levels beyond medicine and nursing.

“[Hospice] must be part of the training of medical students, nurses and social workers in general,” Lee told Hospice News. “In fact, for anyone who gets into healthcare and becomes a thread of discussion when things like healthcare proxies and advanced directives are discussed.”

The lack of exposure not only complicates the ability of healthcare professionals to deliver the care, but also floods potential referral organizations with clinicians who do not understand the nature or benefits of these services.

This may cause patients to come to hospice later in their illness, according to Lee, who also sits on the board of the Social Work Hospice & Palliative Care Network (SWHPN).

A late referral often means that the patient will not receive the full benefits of palliative care. Some providers have had patients who died within a day or two of admission, or in some cases within hours.

About 10% of hospice patients were only enrolled for two days or less in 2019, according to the National Hospice and Palliative Care Organization. Nearly half of all hospice patients were enrolled for less than 18 days and 25% received care for five days or less.

Part of the problem is that medical and nursing school instructors are “cutting time” when it comes to hospice and palliative care content, according to SWHPN Treasurer Tanisha Bowman, palliative care social worker at Butler Memorial Hospital.

“Providers become providers without having a real understanding of the job, which makes our job more difficult,” Bowman told Hospice News.

This follows the available data. According to a 2018 study, most students in clinical disciplines feel unprepared to provide end-of-life family care.

Resuscitate PCHETA

With PCHETA back on the table, hospices are hoping the needle will start to move.

If passed, the bill would authorize $100 million over five years to support programs designed to strengthen clinical training in hospice and palliative care, as well as related interdisciplinary professions such as chaplaincy, pharmacy and social work. It would also support programs to develop career paths in the field and publicize these services.

Two previous versions of the bill passed the House but twice stalled in the Senate, the last in 2019, despite its nearly 300 bipartisan co-sponsors.

More than 50 industry organizations have endorsed the legislation. These include providers such as Amedisys (NASDAQ:AMED) subsidiary Contessa, Compassus, Chemed Corp (NYSE:CHE) subsidiary VITAS Healthcare and Trinity Health, among others.

Other mentions came from SWHPN, as well as NHPCO, Hospice Action Network, Hospice and Palliative Nurses Association, National Association for Home Care & Hospice (NAHC), and American Academy of Hospice and Palliative Medicine (AAHPM).

The professional fields of hospice and palliative care need a “catapult” to grow and meet growing demands for care, and PCHETA is a good start toward improvement, said Joe Rotella, MD, MD. -head of the AAHPM, to Hospice News in an email.

It is time for lawmakers to act, he continued. The longer time passes without legislative action, the slower vendors fill their ranks, Rotella said.

Those sentiments were echoed by Tara Friedman, MD, president and vice president of the AAHPM and national medical director of Aspire Health.

Aspire is a subsidiary of Anthem (NYSE: ANTM) and is the nation’s largest palliative care provider.

“PCHETA really focuses us on the fact that to have really high quality palliative care, we need a huge catapult for our skilled interprofessional workforce,” Friedman told Hospice News. “We have a really big labor shortage right now. It will probably even get a little worse before it gets better.

To pass, the bill will likely need more co-sponsors on both sides of the aisle, as well as advocacy from influential stakeholder organizations representing patients, families and payers, according to Davis Baird, director of NAHC Hospice Government Affairs.

To expedite clearance, lawmakers may need to include its language in a separate, larger, and possibly “mandatory” legislative vehicle later in the year, such as a set of end-of-life tax and health extenders. year, Baird told Hospice News.

If adopted and fully funded, PCHETA could meet a growing need for more trained hospice and hospice care professionals, as well as help Medicare beneficiaries and their families understand the value of hospice and hospice care. palliatives, Compassus CEO David Grams told Hospice News in an email.

In recent years, Compassus has developed partnerships with responsible care organizations (ACOs), physician groups, health systems, and Medicare Advantage plans to accelerate understanding of the value of palliative care for advanced care management and people with serious illnesses.

Educating lawmakers on the success of partnerships like these could garner more support for legislation that could benefit the industry, like PCHETA, according to Grams.

“The single best catalyst for generating support for the bill is the commercial success of these partnerships, which provide Medicare beneficiaries with the pain and symptom management and intensive communication and care coordination needed to manage the severe and chronic complex diseases,” he said.

Staffing constraints limit growth

Labor shortages are by far the biggest headwind in the industry.

Providers also face a fiercely competitive labor market in which hospices face larger providers like health systems, which may be better placed to absorb the costs of rising wages.

This presents a challenge for hospices, as rampant inflation pushes many clinicians to accept jobs that can offer them higher pay.

Aveanna Healthcare Holdings (NASDAQ: AVAH) recently conducted an analysis of workforce trends that suggested higher compensation may be the most important consideration for potential employees, especially in light of the rise inflation, said the company’s CEO, Tony Strange, at the RBC Capital Markets Global Healthcare Conference. .

Providers argue that a second review of the reimbursement rates offered by palliative care would help them increase their workforce.

The US Centers for Medicare & Medicaid Services (CMS) released a proposed rule calling for a 2.7% salary increase for palliative care in fiscal year 2023, a number that a number of stakeholders found it disappointing.

Currently, hospices face a “thin mix” of funding that limits their ability to grow and provide sustainable training, Friedmand told Hospice News.

Many providers pay for training and education programs with donations or philanthropic grants. More innovative support mechanisms are needed to provide funding for special education, she continued.

Solving the labor issue will likely require coordinated, multi-faceted responses designed with input from government, suppliers and industry groups, among others.

There will be no miracle solution.

“There is no ‘silver bullet’ to meet the staffing needs of health care providers at all levels. It will take the collaboration of all parties to ensure our workforce is supported,” said VITAS President and CEO Nick Westfall. “Palliative and palliative care has been proven time and time again to improve patient outcomes and reduce healthcare costs. We must do all we can to support essential care teams who work with patients and families to ensure the best quality of life. »

Michael A. Bynum