PAs Given Access to Hospice Care Await Final Rule

For nearly a decade, America’s physician assistants (PAs) have been lobbying Congress to give them access to hospice care for Medicare patients. Their diligence has finally paid off. Legislators have passed the Medicare Patient Access to Hospice Act, giving PAs the authority to manage and provide hospice care beginning 2019.

Though the final rule has not yet been written, all indications point to PAs having the same kind of role in hospice as nurse practitioners (NPs). Giving PAs this greater role should open more access to hospice care and to alleviate some of the pressure on doctors who are continually being asked to do more with less.

The legislation will apply to PAs working with Medicare patients whose physicians have already certified they have six months or less to live. Those patients must have already agreed to receive palliative care, and they will be required to sign a statement indicating they have elected hospice care.

The Role of the Physician Assistant

Prior to the legislation, PAs were all but barred from being involved in hospice care. Now they will be able to contribute to the hospice environment. For starters, they will be able to act as attending physicians in a hospice facility while working alongside nurse practitioners and hospice directors.

Second, they will be able to manage hospice care even if they do not spend the majority of their time in a hospice facility. Some will undoubtedly choose to both manage and provide care at the same time; others will practice elsewhere but still manage hospice care for their patients.

Finally, PAs will be able to conduct the necessary face-to-face evaluations mandated by law when a patient survives the initial certification period. The PA will work as part of a hospice team that may include an NP, one or more RNs, and hospice directors.

It is expected that hospice directors will still need to sign off on both certification and recertification of patients after talking things over with the entire hospice team. But who knows? Rule makers could surprise us by giving both PAs and NPs the same authority.

Improved Hospice in Rural Areas

Among the biggest beneficiaries of the legislation are Medicare patients living in rural areas. Such areas are desperately short of medical professionals of all stripes, and they often receive healthcare services by way of locums who are only in town on a temporary basis.

Where hospice itself is concerned, there are rural communities that have no hospice facilities nearby. There just isn’t enough staff available. That could change as a result of this legislation. Making hospice accessible to PAs may convince more of them to set up practices in rural communities where they can specialize in palliative care.

At the very least, the legislation may encourage healthcare groups to open hospice facilities in rural areas with the knowledge that they now have access to PAs for managing and providing care. We might even see a more aggressive attempt to recruit PAs as a result of the legislation. We will have to wait and see.

A Win for Patients

The ultimate winners of the Medicare Patient Access to Hospice Act are the patients themselves. Those who wish to access hospice care will have greater opportunity to do so. Congress did the right thing in passing this legislation.

While we wait to see what the final rule looks like, it is expected that PAs will begin gearing up to offer hospice care next year. It will be interesting to see if they approach it any differently than physicians and NPs.