I come from eight generations of Oregonians, many of whom have worked in the medical field, so choosing a career as a nurse here in Burns was an easy decision. While being a nurse has created some of my fondest memories, it has also opened my eyes to the difficult decisions that many rural residents face in order to access high-quality, compassionate end-of-life care.

As one of the first coordinated models of care, hospice is an example of how person-centered care can and should work. Expert medical care and pain management is combined with emotional and spiritual support to address the unique end-of-life needs of patients and their families. Unfortunately, due to our aging population, shrinking resources, and a stretched-thin workforce, hospice providers face growing difficulties meeting the care needs of our community. These problems are only further aggravated by Medicare reimbursement policies, which stifle access to hospice care for Oregonians living in rural and underserved areas.

Our small hospice agency serves the largest county in Oregon. Caring for those at the end of life who are spread across over 10,000 square miles is a challenge, but what makes this difficult situation worse is a current Medicare reimbursement policy that prevents doctors at rural health clinics from serving as a hospice patient’s attending physician.

Rural health clinics (RHCs), much like federally qualified health centers, serve as an essential healthcare safety net for an estimated 675,000 rural Oregon residents and 27 million rural Americans nationwide. Similar to other rural communities where healthcare treatment options are limited, many Eastern Oregon residents rely on RHCs for their primary care. But a statutory oversight in the Medicare program restricts physicians or nurse practitioners who work in these clinics from providing compensated hospice care. As a result, rural patients who have come to know and trust their doctor at the local health clinic are incapable of keeping that physician as their end-of-life care provider.

Needless to say, given the already severe healthcare obstacles rural patients face, this unnecessary barrier to care must end. And while I have seen caregivers at RHCs go above and beyond to provide uncompensated hospice care to patients and families in need, this should not be the norm. We should not penalize those who are willing to sacrifice their own well-being to care for the dying. We also should not penalize patients by blocking them from accessing their trusted physician at the most vulnerable point of life.

Fortunately, U.S. lawmakers from both sides of the political aisle have recognized this problem and introduced a simple legislative fix. The Rural Access to Hospice Act was introduced in both the House and Senate earlier this year to allow physicians employed in RHCs and FQHCs to receive equitable reimbursement for providing person-centered hospice services when acting as the attending hospice physician for rural patients.

This bipartisan bill represents a practical, common sense legislative fix that is long overdue.

Here in Oregon, we need our members of Congress, including Sen. Ron Wyden, to step up as a champion for our state’s rural population and the amazing hospice professionals who care for them.

Patients deserve the best care for their end-of-life journey, regardless of where they live. That means protecting patients from the impossible decision of keeping their doctor or electing hospice. I call on Oregon’s delegation to support the Rural Access to Hospice Act so that patients across our state can access the quality end-of-life-services they need and deserve.


Jodi McLean is executive director of Harney County Home Health and Hospice.

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