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Hospice

As a hospice CEO and longtime Montana resident, I see daily the difficulties our most vulnerable neighbors face as they traverse our complex healthcare system. It is not an understatement to say that navigating care is complicated for nearly anyone who juggles doctors, prescriptions, insurance and more — but managing it all is especially tricky for our frail, elderly and seriously ill populations who face increased barriers to accessing quality care.

Hospice is a philosophy of care that involves an interdisciplinary team of doctors, nurses, social workers, and chaplains who work with a patient and their family to face the end of life with dignity. Thankfully, hospice is a Medicare benefit available to all Americans. Unfortunately, due to a limitation in current law, this benefit is difficult to access for too many rural Americans.

Those living in traditionally underserved and rural areas often receive their healthcare through Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC). FQHCs and RHCs form an important part of the healthcare “safety net” and provide primary care to more than 27 million Americans. For many, FQHCs and RHCs are the only source for primary care in their area.

Here in Montana, we have 61 RHCs and 51 FQHCs that, under current law, cannot be paid for providing hospice services. This means that just as a patient is reaching a very difficult and tenuous time they must leave their trusted healthcare network in order to find a provider who can serve as their hospice attending physician. For many this means traveling hours for a new doctor. This is a terrible burden to place on rural patients facing the end of life.

In no other part of the healthcare system is a patient required to leave their current physician to enter hospice. In fact, the Medicare Hospice Benefit guarantees patients the hospice attending physician of their choice. Why are patients at RHCs and FQHC denied this right?

Fortunately, there is a bill before Congress that would fix this issue. The bipartisan Rural Access to Hospice Act was recently introduced by Sens. Shelley Moore Capito (R-WV) and Jeanne Shaheen (D-NH) and Congressman Ron Kind (D-WI) and Congresswoman Jackie Walorski (R-IN). If passed, it would allow RHCs and FQHCs to be paid for hospice services, thus expanding access to hospice care to Americans in rural areas.

Congress has a record of fixing issues like this before. In 2003, Congress passed legislation that allowed RHC and FQHC physicians to bill Medicare separately for their services in a skilled nursing facility. The Rural Access to Hospice Act would provide a similar technical fix and would promote the use of hospice care among rural, hospice-eligible beneficiaries.

I hope that our Montana congressional delegation (Sen. Jon Tester, Sen. Steve Daines, and Congressman Greg Gianforte) will see the importance of this bipartisan, common-sense legislation for their constituents’ access to quality care. I urge them to sign on as cosponsors and push for passage of this legislation. As a friend, neighbor and caregiver to Montanans faced with serious illness, I am speaking up to ensure they have access to the quality, compassionate end-of-life care all Americans deserve.

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Dianne Hansen is chief executive officer of Partners in Home Care Inc. 

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