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Johnathan Keyserling, Vice president of public policy, NHPCO

The National Pain Care Policy Act of 2005, an initiative developed by the American Pain Care Coalition, is snaking its way through Congress.

If the bill becomes law, it would help raise awareness of pain as a national health issue through the creation of a White House Conference on Pain Care, establishment of a National Center for Pain and Palliative Care Research, and promotion of education, training and outreach efforts on treating pain.

H.R. 1020 was drafted in 2001 but was not introduced into Congress until 2003. Republican Rep. Mike Rogers of Michigan introduced the bill to the 109th Congress on March 1, 2005. Now with 32 cosponsors, it has been referred to the Committee on Energy and Commerce, Committee on Ways and Means, Armed Services, and Veterans' Affairs, where it now sits in the subcommittee on health.

The proposed legislation would also require healthcare organizations offering Medicare Advantage to "provide appropriate care for the treatment of patients in pain." Medicare Advantage organizations would not be allowed to increase deductibles, co-payments or premiums for recipients who opt to go out-of-network.

Partners for Understanding Pain, a consortium of nearly 80 organizations including the American Society of Pain Educators and others with interests in pain management issues, endorses the proposed legislation.

"By supporting this bill, our government can make a difference in the lives of millions," said Penney Cowan, executive director of the American Chronic Pain Association, who pointed out several facts about pain in America:

· Pain is the leading cause of adult disability in the United States, affecting 100 million Americans.

· Employers pay an estimated $100 billion annually in lost workdays, medical expenses, and other benefit costs; and reduced productivity costs our economy an estimated $61.2 billion a year.

· In spite of pain's pervasiveness, few physicians receive more than a few hours of formal training in pain management.

· Unmanaged pain causes people to withdraw from family and friends and leaves them unable to care for children, hold steady jobs, and at times even face the future.



Lobbying for Increased Medicare Hospice Benefits

As predicted, MedPAC (Medicare Payment Advisory Commission) has introduced a chapter on hospice in its June report to Congress, outlining the growth and change in Medicare's hospice benefit, consideration of payment system refinements, and Medicare hospice payment directives for further investigation. The findings of MedPAC's recent study include reemphasizing the need for more detailed data from Medicare-certified hospices.

"As a relatively 'young' provider group under Medicare, the hospice community is adjusting to the evolving data requirements of the various interested parties," said Jonathan Keyserling, vice president of public policy for the National Hospice and Palliative Care Organization (NHPCO). "The Government Accountability Office, the Medicare Payment Advisory Commission and Centers for Medicare and Medicaid Services (CMS) itself have ongoing needs for accurate and reliable data from the hospice community. At the same time, however, the need for data shouldn't replace care at the bedside, so we have to balance the detailed and specific data needs against what is rational and reasonable in the field given a limited amount of resources.

"But make no mistake about it: data collection and analysis is critically important. As the hospice community, as well as healthcare in general, moves to more electronic patient records, we ought to see an increase in both the amount and depth of data that is available for government agencies, as well as the research community."

MedPAC discovered that adding diagnosis and other patient characteristics did not improve the ability of the number of days in the current per diem payment categories to predict variation in labor costs. The commission also found that the first and last days of stays have more visits and higher visit costs than intervening days.

The study also pointed out that Medicare spent $6.7 billion on hospice care in 2004, and the CMS Office of the Actuary estimates that Medicare will spend $9.8 billion for beneficiaries in 2006. Hospice services expenditures are predicted to increase at an average rate of nine percent annually from 2004 to 2015, a rate that outpaces the growth in spending projected for hospitals, physicians, skilled nursing facilities and home health care. During the same 11-year period, the number of Medicare beneficiaries is estimated to grow at an average annual rate of 2 percent annually.

"As the patient population continues to age and as the baby boomers become a larger part of our patient base, the pattern of more acute patient presentations and late referrals put an ever increasing strain on the resources that a hospice has available for patient care," said Keyserling.

For example, hospice care is intended for delivery in the patient's home, and that entails getting professional staff members and volunteers to the patient's residence, he explained.

"We all know about the ever increasing gas prices, and hospice workers are no exception to these costs," he said. "When you factor in the rapidly escalating costs of drugs and other materials, the per diem payment is under more and more pressure."

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