Academic journal article The Hastings Center Report

VI. Approaching Just Access: Recommendations

Academic journal article The Hastings Center Report

VI. Approaching Just Access: Recommendations

Article excerpt

The following recommendations are the result of five Hospice Access and Values Project Task Force meetings (involving segregated and mixed stakeholder discussions as well as solicited papers), and responses to thirteen foundational queries on the Access and Values website from September 1999 through August 2001. The recommendations identify a realistic but challenging course for the future of hospice in America. They will require patience, political leadership, broad debate, a willingness to compromise, and an openness to new ideas. They also require further research and increased understanding of why the health care system behaves as it does and of how various new practices may affect the needs and well-being of dying patients and their families.

Some recommendations have been shared in whole or in part with various stakeholders and constituencies: Congress, hospice providers, invested consumers, and other stakeholder representatives. Other recommendations, such as Hospice/PACE programming, have already resulted in preliminary discussions among Access and Values participants and national association leaders, for they outline reasonable demonstration projects worthy of federal funding support.

A. Recommendations Concerning Policy and Regulatory Barriers to Access

Recommendation 1: Healthcare leaders, policymakers, and key stakeholder groups must come to consensus on the definition of palliative care and develop a framework for greater accountability in palliative care delivery in concert with financing mechanisms.

1) As was done by the Kellogg Foundation with the emerging hospice movement in the early '80s, we recommend that a national field survey of services calling themselves "palliative care" be conducted. The survey will:

* determine what elements these services have in common and how they qualitatively differ;

* use the exhaustive NHPCO Standards of Hospice Care/Robert Wood Johnson Foundation Precepts of Palliative Care Crosswalk as a foundation for the survey;

* document the scope of palliative care services in U.S. hospitals in order to assess the integration of this service within the practice activity of the hospital and determine the relationship, if any, of palliative care consultation to hospice admissions; and

* identify specific savings realized from improved end of life care practices, such as patient cost avoidances and lower health care utilization by family caregivers who are relieved of the intensity of their caregiving burden.

2) We recommend that a national forum be convened to bring together key constituencies, including provider and consumer groups, to establish a definition for palliative care to provide the framework for service delivery models, standards of care delivery, and reimbursement models.

3) We recommend that a position paper be developed in conjunction with the national study and forum that will elucidate current and proposed distinctions between palliative medicine, palliative care, and the care available through hospices of various types.

4) We recommend that this position paper and a record of the deliberations and conclusions of the study and forum be presented to members of Congress, executive branch officials, and other policymakers at the federal and state level. These materials should inform the discussions and recommendations proposed for Medicare beneficiaries in acute hospitals, rehabilitation programs, and long-term care centers as well as ambulatory, home care, and hospice programs.

Recommendation 2: Public policy should expand the scope of hospice services.

We recommend that Congress approve a series of demonstration projects to Advance Hospice Access (AHA). The goals of the AHA Projects would be twofold. One goal would be to advance hospice access for persons who do not yet qualify for traditional hospice due to extended or uncertain prognosis and/or their preference for therapies directed toward cure or prolongation of life. …

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