Keeping Hospice from Defining and Directing U.S. Palliative Care: Letter to Senator Loeffler

Senator Kelly Loeffler
3625 Cumberland Blvd
Suite 970
Atlanta, GA 30339

RE: PCHETA Palliative Care & Hospice Education Training Act HR647/S2080; Hospice Care Improvement Act; Helping Our Senior Population in Comfort Environments (Hospice) Act HR5821; Hospice Care Improvement Act S2807; U.S. Department of Health and Human Services, Office of Inspector General July 2019 Report on Hospice Deficiencies

Dear Senator Loeffler:

As my new Senator I am writing to you regarding the defeat of the PCHETA HR647/S2080 legislation in the Senate. Discouraging the synonymous use of terms and definition between palliative and hospice care – since these are uniquely different areas of healthcare delivery and clinical practice.

Given the findings by the US Dept of HHS, OIG on Hospice deficiencies posing risk for Medicare patients, released July, 2019 and subsequent 2 bills introduced in the House and Senate protecting the vulnerability of fragile patients nearing the end-of-life (HR5821; S2807) these should be important considerations to not pass PCHETA (HR647/SS2080) in the Senate. I caution the synonymous use of palliative care with hospice care.

This letter is meant to bring your attention to several national/international initiatives to support the premise of palliative care – or aggressive symptom management used and implemented in the optimal management of MCCs. American’s with MCCs represent the largest, fastest growing and costliest patient populations.

Currently, the Agency for Healthcare Research and Quality (AHRQ), embarked on a systematic review of the literature, exploring the implementation of palliative care in the management of chronic conditions in ambulatory primary care. A recent publication (February 2020) in the American Journal of Managed Care, evaluated Medicaid data on the effectiveness of complex care management on the spending and utilization of high-need, high cost Medicaid patients – showing reduction in costs of care and utilization.

The Centers for Medicare and Medicaid Services (CMS), enacted the Chronic Care Management incentive for primary care providers managing patients living with and dying from MCCs in 2015. This coordinated comprehensive care model is a perfect example on the use and implementation of palliative care in the primary care setting – preventing symptoms, reducing hospital admission and maintain patient quality of life and physical functioning.

I have been invited this summer to lecture at the 31st International Nursing Research Congress in Abu Dhabi on the use and implementation of palliative care in the management of MCCs. I have provided you a copy of my award-winning textbook: Integration of Palliative Care in Chronic Conditions and currently working with Emory University School of Nursing to promote this clinical application in their nurse practitioner programs to meet the complex care needs of America’s largest patient populations.

Please consider sponsoring legislation that highlights the current practices used in the U.S. to demonstrate and define the effective use of palliative care in persons with complex advanced MCCs (e.g., Chronic Care Management, Complex Care Management [Medicaid, Accountable Care Organizations] etc.,). Palliative care must be separated from Hospice care and used in the primary care setting long before a patient is considered terminally ill and dying.

Your attention to this area of healthcare is important, yet, more efforts are required to help direct the appropriate care, education and clinical practice for the costliest and complex U.S. patient populations.

Dr. Kim Kuebler DNP, APRN, ANP-BC