Rural patients: Doctor or Hospice?

Kavin Cartmell

For those of us lucky enough to reside here, our community offers a picturesque home – full of history, culture, and fun. As a native to Maysville, our community has offered me endless opportunity. Now, on the brink of retirement, I’m very grateful for my fulfilling career as a hospice nurse.

But drive down U.S. 68 in Kentucky or over the bridge into a Southern Ohio town such as Manchester or Higginsport and you’ll find our rural neighbors don’t have access to the same opportunities or services – especially when it comes to health and hospice care.

For many individuals living in rural communities, access to a doctor and other basic services is only available through Rural Health Clinics and Federally Qualified Health Centers. These centers often serve as a “safety net” for individuals with limited care options with an estimated 27 million Americans relying on an RHC or FQHC to receive primary care services. Across Kentucky, there are currently 250 RHCs tending to the needs of our state’s rural communities, which makes up a quarter of the Commonwealth’s population.

I know how important these centers are because I receive my primary care from providers that work at the FQHC in Maysville.

As a registered nurse in a freestanding hospice program – serving about 175 patients a day in as many as 12 area counties – I witness the challenges rural communities face when seeking healthcare services. For our hospice program, more than 75 percent of the areas we serve are rural communities. Our patients are overwhelmingly (over 90 percent) Medicare beneficiaries who have elected hospice care to manage their healthcare and personal needs and provide comfort at the end of life.

Despite the incredible value of RHCs, FQHCs and hospice programs, the current Medicare payment system creates obstacles for patients at the intersection of receiving care at a rural health center and entering hospice. Clinic doctors experience a payment limitation when providing care to patients on hospice services. Quite frequently these physicians often pass their patients to our program’s hospice physician, and sometimes patients lose access to their known primary physician.

This can be very disorienting to the patients who have come to love and trust their primary care doctor. This “payment limitation” is a flawed policy that even deters some patients from entering hospice – which can provide unique and invaluable person-focused services. –.

Not only is this unfair for hospice patients, it is a limitation that exists nowhere else in the current Medicare program. In fact, a similar restriction was lifted for RHC and FQHC physicians providing care in skilled nursing facilities. No patient should ever be forced to make this difficult choice.

Luckily, there is an easy fix.

The bipartisan Rural Access to Hospice Act – introduced in both the House and Senate – would remove this barrier to care for rural beneficiaries. If passed, Medicare would allow RHC and FQHC physicians to receive payment for providing hospice services. Better yet, patients wouldn’t lose the connection to their trusted primary care physicians when electing hospice care, therefore expanding access to hospice for America’s rural seniors.

I strongly urge our lawmakers in Congress – including Senate Majority Leader Mitch McConnell (R-KY) and Senator Rob Portman (R-OH) – to prioritize this bill. On behalf of your rural constituents, supporting passage of this bill would be the right thing to do for Kentuckians and Ohioans who deserve high quality of care and quality of life that hospice programs like mine are honored to ensure.

Kavin Cartmell is a registered nurse with more than 40 years’ experience working in hospital, physician office, and hospice settings. She currently is the Executive Director at Hospice of Hope, which has been in operation for 30 years, serving 12 counties in Northern Kentucky and Southern Ohio.

Kavin Cartmell