[Congressional Record Volume 158, Number 109 (Thursday, July 19, 2012)]
[Senate]
[Pages S5214-S5216]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. WYDEN:
  S. 3407. A bill to amend the Public Health Service Act to increase 
the number of permanent faculty in palliative care at accredited 
allopathic and osteopathic medical schools, nursing schools, and other 
programs, to promote education in palliative care and hospice, and to 
support the development of faculty careers in academic palliative 
medicine; to the Committee on Health, Education, Labor, and Pensions.
  Mr. WYDEN. Mr. President, I rise today to discuss the critical need 
in today's health care workforce for additional training related to 
palliative care. Palliative care is an interdisciplinary model of care 
focused on relieving the pain, stress and other debilitating symptoms 
of serious illness, such as cancer, cardiac disease, respiratory 
disease, kidney failure, Alzheimer's, AIDS, ALS, and MS. Its goal is to 
relieve suffering and provide the best possible quality of life for 
patients and their families.
  Many people mistakenly believe that palliative care is only 
beneficial when a cure is not possible. Actually, palliative care is 
not dependent on a life-limiting prognosis and may actually help 
individuals recover by relieving symptoms--such as pain, anxiety or 
loss of appetite--while they are undergoing sometimes difficult medical 
treatments or procedures, such as surgery or chemotherapy. Palliative 
care is provided by a team of doctors, nurses, social workers, 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 decision-making and coordination of care among 
specialists. Palliative care is appropriate for people of any age and 
at any stage in an illness, whether that illness is curable, chronic or 
life-threatening.
  There is a specific type of palliative care, called hospice, for 
people for whom a cure is no longer possible and who likely have 6 
months or less to live. Hospice care can be provided at one's home, a 
hospice facility, a hospital or a nursing home. Hospice care is about 
giving patients control, dignity and comfort so they have the best 
possible quality of life during the time they have. Hospice care also 
provides support and grief therapy for loved ones whose struggles are 
often cast aside or forgotten during treatment.
  A growing evidence base has demonstrated that palliative care, 
including hospice, improves quality, controls cost and enhances patient 
and family satisfaction for the rapidly expanding population of 
individuals with serious or life-threatening illness. Palliative care 
may also prolong the lives of some seriously ill patients.
  Over the last 10 years, the number of hospital-based palliative care 
programs has more than doubled due to the increasing number of 
Americans living with serious, complex and chronic illnesses and the 
realities of the care responsibilities faced by their families. Studies 
suggest that in states with more hospital-based palliative care 
programs, patients are less likely to die in the hospital, are likely 
to spend fewer days in the ICU, have better pain management and higher 
satisfaction with their health care.
  As usual, Oregon is ahead of the curve and I am proud to say that in 
a 2011 report ranking states on their citizens' access to hospital-
based palliative care programs, Oregon was among the seven states who 
earned an ``A'' rating, with 88 percent of Oregon hospitals offering 
palliative care.
  Unfortunately, many seriously ill patients and their families lack 
the access available to Oregonians. Palliative care is a relatively new 
medical specialty and more must be done to ensure an adequate, well-
trained palliative care workforce is available to provide comprehensive 
symptom management, intensive communication and a level of care 
coordination that addresses the episodic and long-term nature of 
serious, chronic illness. I believe that, with Federal support, we can 
help address the workforce gap between those currently practicing in 
palliative care and hospice and the number of health care professionals 
required to care for this expanding patient population That is why 
today I am introducing the Palliative Care and Hospice Education and 
Training Act or PCHETA. This authorizing legislation focuses on three 
key areas to grow the palliative care and hospice workforce.
  Education centers to expand interdisciplinary training in palliative 
and hospice care.
  Training of physicians who plan to teach palliative medicine and 
fellowships to encourage re-training for mid-career physicians, and 
academic career awards and career incentive awards to support 
physicians and other health care providers who provide palliative and 
hospice care training.
  With this legislation, patients and families who are facing serious 
or life-threatening illness will have access to the high-quality 
palliative care and hospice services that can maximize their quality of 
life. I urge my colleagues to join me in this effort.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

[[Page S5215]]

                                S. 3407

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Palliative Care and Hospice 
     Education and Training Act''.

     SEC. 2. FINDINGS.

       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.

     SEC. 3. PALLIATIVE CARE AND HOSPICE EDUCATION AND TRAINING.

       (a) In General.--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:

     ``SEC. 759A. PALLIATIVE CARE AND HOSPICE EDUCATION AND 
                   TRAINING.

       ``(a) Palliative Care and Hospice Education Centers.--
       ``(1) In general.--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) Requirements.--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 centers.--Nothing 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) In general.--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) Requirements.--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) Training options.--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) Definitions.--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) Establishment of program.--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) Eligible individuals.--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.

[[Page S5216]]

       ``(3) Limitations.--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) Maintenance of effort.--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) Amount and term.--
       ``(A) Amount.--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) Term.--The term of an award made under this 
     subsection shall not exceed 5 years.
       ``(C) Payment to institution.--The Secretary shall make 
     payments for awards under this subsection to institutions 
     which include schools of medicine and osteopathic medicine.
       ``(6) Service requirement.--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) In general.--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) Application.--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) Use of funds.--Amounts awarded under a grant or 
     contract under paragraph (1) shall be used to carry out the 
     fellowship program described in paragraph (4).
       ``(4) Fellowship program.--
       ``(A) In general.--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) Location.--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) CME credit.--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) Targets.--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) Amount of award.--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) Maintenance of effort.--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) In general.--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) Eligible individuals.--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) Conditions of award.--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) Payment to institution.--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 Appropriations.--There are 
     authorized to be appropriated to carry out this section, 
     $44,100,000 for each of the fiscal years 2013 through 
     2017.''.
       (b) Effective Date.--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.

     SEC. 4. APPLICATION TO ADVANCED PRACTICE NURSES.

       (a) Advanced Education Nursing Grants.--Section 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) In General.--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:

     ``SEC. 832. PALLIATIVE CARE AND HOSPICE EDUCATION AND 
                   TRAINING.

       ``(a) Program Authorized.--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) Use of Funds.--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) Application.--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) Eligible Entity.--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 Appropriations.--There are 
     authorized to be appropriated to carry out this section 
     $5,000,000 for each of fiscal years 2013 through 2017.''.
                                 ______