1.This Act may be cited as the
Palliative Care and Hospice Education
and Training Act
.
2.Congress makes the following
findings:
(1)Health care
providers need better education about pain management and palliative care.
Students graduating from medical school have very little, if any, training in
the core precepts of pain and symptom management, advance care planning,
communication skills, and care coordination for patients with serious,
life-threatening, or terminal illness.
(2)Palliative care is
interdisciplinary, patient- and family-centered health care for people with
serious illnesses. This type of care is focused on providing patients with
relief from the symptoms, pain, and stress of a serious illness, whatever the
diagnosis. The goal of palliative care is to relieve suffering and improve
quality of life for both patients and their families. Palliative care is
provided by a team of doctors, nurses, social workers, chaplains, and other
specialists who work with a patient’s other health care providers to provide an
extra layer of support, including assistance with difficult medical
decisionmaking and coordination of care among specialists. Palliative care is
appropriate at any age and at any stage in a serious illness, and can be
provided together with curative treatment. Palliative care is not dependent on
a life-limiting prognosis and may actually help an individual recover from
illness by relieving symptoms, such as pain, anxiety, or loss of appetite,
while undergoing sometimes difficult medical treatments or procedures, such as
surgery or chemotherapy. There were 1,623 hospitals with palliative care
programs in 2012.
(3)Hospice is
palliative care for patients in their last year of life. Considered the model
for quality compassionate care for individuals facing a life-limiting illness,
hospice provides expert medical care, pain management, and emotional and
spiritual support expressly tailored to the patient’s needs and wishes. In most
cases, care is provided in the patient’s home but may also be provided in
freestanding hospice centers, hospitals, nursing homes, and other long-term
care facilities. In 2010, an estimated 1,580,000 patients received services
from hospice or approximately 41.9 percent of all United States deaths. Hospice
is a covered benefit under the Medicare program. There were 3,509
Medicare-certified hospices in 2010.
(4)A
2005 study at Michigan State University found that the formal training of
United States doctors in palliative care is grossly inadequate
.
When the American Society of Clinical Oncology surveyed their members, 65
percent said they had received inadequate education in controlling symptoms
associated with cancer, and 81 percent felt they had inadequate mentoring in
discussing a poor prognosis with their patients and families. Training in
pediatric palliative care is also seriously lacking according to physicians,
residents, and medical students responding to a survey presented at a meeting
of American Federation for Medical Research.
(5)The American Board
of Medical Specialties (ABMS) and the Accreditation Council for Graduate
Medical Education (ACGME) provided formal subspecialty status for hospice and
palliative medicine (HPM) in 2006, and the Centers for Medicare & Medicaid
Services recognized hospice and palliative medicine as a medical subspecialty
in October of 2008.
(6)As of June 2012,
there were a total of 86 hospice and palliative medicine training programs.
Seventy-eight programs have been accredited by the Accreditation Council for
Graduate Medical Education and seven programs have been accredited by the
American Osteopathic Association. For the 2011–2012 academic year, these
programs were training 176 physicians in hospice and palliative medicine. Some
programs include an additional track in research, geriatrics, or public
health.
(7)There is a large
gap between those practicing in the palliative medicine field and the number of
physicians needed. A mid-range estimate by the American Academy of Hospice and
Palliative Medicine’s Workforce Task Force calls for 6,000 or more full-time
equivalents to serve current needs in hospice and palliative care programs. At
maximum capacity, the current system would produce roughly 4,600 new hospice
and palliative medicine certified physicians over the next 20 years, during
which time some 70,000,000 new Medicare beneficiaries will enter the Medicare
program. At the same time, there is expected to be increasing acceptance of the
hospice and palliative approach to care among the general population and health
care providers.
3.Palliative care
and hospice education and training
(a)Part D of title VII of the Public Health Service Act (42
U.S.C. 294 et seq.) is amended by adding at the end the following:
759A.Palliative
care and hospice education and training
(a)Palliative care
and hospice education centers
(1)The Secretary shall award grants or contracts under this
section to entities described in paragraph (1), (3), or (4) of section 799B,
and section 801(2), for the establishment or operation of Palliative Care and
Hospice Education Centers that meet the requirements of paragraph (2).
(2)A
Palliative Care and Hospice Education Center meets the requirements of this
paragraph if such Center—
(A)improves the
training of health professionals in palliative care, including residencies,
traineeships, or fellowships;
(B)develops and
disseminates curricula relating to the palliative treatment of the complex
health problems of individuals with serious or life-threatening
illnesses;
(C)supports the
training and retraining of faculty to provide instruction in palliative
care;
(D)supports
continuing education of health professionals who provide palliative care to
patients with serious or life-threatening illness;
(E)provides students
(including residents, trainees, and fellows) with clinical training in
palliative care in the home, long-term care facilities, home care, hospices,
chronic and acute disease hospitals, and ambulatory care centers;
(F)establishes
traineeships for individuals who are preparing for advanced education nursing
degrees in palliative care nursing, home care, hospice, in the home, long-term
care, or other nursing areas that specialize in palliative care; and
(G)does not duplicate the activities of
existing education centers funded under this section or under section 753 or
865.
(3)Expansion of
existing centersNothing in this section shall be construed
to—
(A)prevent the
Secretary from providing grants to expand existing education centers, including
geriatric education centers established under section 753 or 865, to provide
for education and training focused specifically on palliative care, including
for non-geriatric populations; or
(B)limit the number
of education centers that may be funded in a community.
(b)Palliative
medicine physician training
(1)The Secretary may make grants to, and enter into
contracts with, schools of medicine, schools of osteopathic medicine, teaching
hospitals, and graduate medical education programs, for the purpose of
providing support for projects that fund the training of physicians (including
residents, trainees, and fellows) who plan to teach palliative medicine.
(2)Each
project for which a grant or contract is made under this subsection
shall—
(A)be staffed by
full-time teaching physicians who have experience or training in palliative
medicine;
(B)be based in a
hospice and palliative medicine fellowship program accredited by the
Accreditation Council for Graduate Medical Education;
(C)provide training
in palliative medicine through a variety of service rotations, such as
consultation services, acute care services, extended care facilities,
ambulatory care and comprehensive evaluation units, hospice, home health, and
community care programs;
(D)develop specific
performance-based measures to evaluate the competency of trainees; and
(E)provide training
in palliative medicine through one or both of the training options described in
subparagraphs (A) and (B) of paragraph (3).
(3)The training options referred to in subparagraph (E) of
paragraph (2) shall be as follows:
(A)1-year retraining
programs in hospice and palliative medicine for physicians who are faculty at
schools of medicine and osteopathic medicine, or others determined appropriate
by the Secretary.
(B)1- or 2-year
training programs that shall be designed to provide training in hospice and
palliative medicine for physicians who have completed graduate medical
education programs in any medical specialty leading to board eligibility in
hospice and palliative medicine pursuant to the American Board of Medical
Specialties.
(4)For
purposes of this subsection the term graduate medical education
means a program sponsored by a school of medicine, a school of osteopathic
medicine, a hospital, or a public or private institution that—
(A)offers
postgraduate medical training in the specialties and subspecialties of
medicine; and
(B)has been
accredited by the Accreditation Council for Graduate Medical Education or the
American Osteopathic Association through its Committee on Postdoctoral
Training.
(c)Palliative
medicine and hospice academic career awards
(1)The Secretary shall establish a program to provide
awards, to be known as the Palliative Medicine and Hospice Academic
Career Awards
, to eligible individuals to promote the career
development of such individuals as academic hospice and palliative care
physicians.
(2)To be eligible to receive an award under paragraph
(1), an individual shall—
(A)be board certified
or board eligible in hospice and palliative medicine; and
(B)have a junior
(non-tenured) faculty appointment at an accredited (as determined by the
Secretary) school of medicine or osteopathic medicine.
(3)No
award under paragraph (1) may be made to an eligible individual unless the
individual—
(A)has submitted to
the Secretary an application, at such time, in such manner, and containing such
information as the Secretary may require, and the Secretary has approved such
application;
(B)provides, in such
form and manner as the Secretary may require, assurances that the individual
will meet the service requirement described in paragraph (6); and
(C)provides, in such
form and manner as the Secretary may require, assurances that the individual
has a full-time faculty appointment in a health professions institution and
documented commitment from such institution to spend a majority of the total
funded time of such individual on teaching and developing skills in
interdisciplinary education in palliative care.
(4)An eligible individual who receives an award under
paragraph (1) shall provide assurances to the Secretary that funds provided to
the eligible individual under this subsection will be used only to supplement,
not to supplant, the amount of Federal, State, and local funds otherwise
expended by the eligible individual.
(5)
(A)The
amount of an award under this subsection shall be equal to the award amount
provided for under section 753(c)(5)(A) for the fiscal year involved.
(B)The
term of an award made under this subsection shall not exceed 5 years.
(C)The Secretary shall make payments for awards under
this subsection to institutions which include schools of medicine and
osteopathic medicine.
(6)An individual who receives an award under this
subsection shall provide training in palliative care and hospice, including the
training of interdisciplinary teams of health care professionals. The provision
of such training shall constitute a majority of the total funded obligations of
such individual under the award.
(d)Palliative care
workforce development
(1)The Secretary shall award grants or contracts under this
subsection to entities that operate a Palliative Care and Hospice Education
Center pursuant to subsection (a)(1).
(2)To
be eligible for an award under paragraph (1), an entity described in such
paragraph shall submit to the Secretary an application at such time, in such
manner, and containing such information as the Secretary may require.
(3)Amounts awarded under a grant or contract under paragraph
(1) shall be used to carry out the fellowship program described in paragraph
(4).
(4)
(A)Pursuant to paragraph (3), a Palliative Care and Hospice
Education Center that receives an award under this subsection shall use such
funds to offer short-term intensive courses (referred to in this subsection as
a fellowship) that focus on palliative care that provide
supplemental training for faculty members in medical schools and other health
professions schools with programs in psychology, pharmacy, nursing, social
work, chaplaincy, or other health disciplines, as approved by the Secretary.
Such a fellowship shall be open to current faculty, and appropriately
credentialed volunteer faculty and practitioners, who do not have formal
training in palliative care, to upgrade their knowledge and clinical skills for
the care of individuals with serious or life-threatening illness and to enhance
their interdisciplinary teaching skills.
(B)A
fellowship under this paragraph shall be offered either at the Palliative Care
and Hospice Education Center that is sponsoring the course, in collaboration
with other Palliative Care and Hospice Education Centers, or at medical
schools, schools of nursing, schools of pharmacy, schools of social work,
schools of chaplaincy or pastoral care education, graduate programs in
psychology, or other health professions schools approved by the Secretary with
which the Centers are affiliated.
(C)Participation in a fellowship under this paragraph shall
be accepted with respect to complying with continuing health profession
education requirements. As a condition of such acceptance, the recipient shall
subsequently provide a minimum of 18 hours of voluntary instruction in
palliative care content (that has been approved by a palliative care and
hospice education center) to students or trainees in health-related
educational, home, hospice, or long-term care settings.
(5)A
Palliative Care and Hospice Education Center that receives an award under this
subsection shall meet targets approved by the Secretary for providing
palliative care training to a certain number of faculty or practitioners during
the term of the award, as well as other parameters established by the
Secretary.
(6)An award under this subsection shall be in an amount of
$150,000. Not more than 24 Palliative Care and Hospice Education Centers may
receive an award under this subsection.
(7)A Palliative Care and Hospice Education Center that
receives an award under this subsection shall provide assurances to the
Secretary that funds provided to the Center under the award will be used only
to supplement, not to supplant, the amount of Federal, State, and local funds
otherwise expended by such Center.
(e)Palliative care
and hospice career incentive awards
(1)The Secretary shall award grants or contracts under this
subsection to individuals described in paragraph (2) to foster greater interest
among a variety of health professionals in entering the field of palliative
care.
(2)To be eligible to receive an award under paragraph
(1), an individual shall—
(A)be an advanced
practice nurse, a clinical social worker, a pharmacist, a chaplain, or student
of psychology who is pursuing a doctorate or other advanced degree in
palliative care or related fields in an accredited health professions school;
and
(B)submit to the
Secretary an application at such time, in such manner, and containing such
information as the Secretary may require.
(3)As a condition of receiving an award under this subsection,
an individual shall agree that, following completion of the award period, the
individual will teach or practice palliative care in health-related
educational, home, hospice or long-term care settings for a minimum of 5 years
under guidelines established by the Secretary.
(4)The Secretary shall make payments for awards under
this subsection to institutions which include schools of medicine, osteopathic
medicine, nursing, social work, psychology, chaplaincy or pastoral care
education, dentistry, and pharmacy, or other allied health discipline in an
accredited health professions school that is approved by the Secretary.
(f)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this section, $44,100,000 for each of the fiscal years 2013 through
2017.
.
(b)The amendment made by this section shall be effective
beginning on the date that is 90 days after the date of enactment of this
Act.
4.Application to
advanced practice nurses
(a)Advanced
education nursing grantsSection 811(a) of the Public Health Service
Act (42 U.S.C. 296j(a)) is amended—
(1)in paragraph (1), by striking
and
at the end;
(2)by redesignating paragraph (2) as paragraph
(3); and
(3)by inserting after paragraph (1), the
following:
(2)palliative care and hospice career
incentive awards authorized under section 759A(e);
and
.
(b)Part D of title VIII of the Public Health Service Act (42
U.S.C. 296p et seq.) is amended by adding at the end the following:
832.Palliative care
and hospice education and training
(a)The Secretary shall award grants to eligible entities
to develop and implement, in coordination with programs under section 759A,
programs and initiatives to train and educate individuals in providing
palliative care in health-related educational, hospice, home, or long-term care
settings.
(b)An eligible entity that receives a grant under subsection
(a) shall use funds under such grant to—
(1)provide training
to individuals who will provide palliative care in health-related educational,
home, hospice, or long-term care settings;
(2)develop and
disseminate curricula relating to palliative care in health-related
educational, home, hospice, or long-term care settings;
(3)train faculty
members in palliative care in health-related educational, home, hospice, or
long-term care settings; or
(4)provide continuing
education to individuals who provide palliative care in health-related
educational, home, hospice, or long-term care settings.
(c)An
eligible entity desiring a grant under subsection (a) shall submit an
application to the Secretary at such time, in such manner, and containing such
information as the Secretary may reasonably require.
(d)For purposes of this section, the term eligible
entity shall include a school of nursing, a health care facility, a
program leading to certification as a certified nurse assistant, a partnership
of such a school and facility, or a partnership of such a program and
facility.
(e)Authorization of
appropriationsThere are authorized to be appropriated to carry
out this section $5,000,000 for each of fiscal years 2013 through
2017.
.