Few studies have evaluated barriers to hospice from a hospice provider perspective. We assessed such views via a postal survey to all licensed hospices in Alabama (N = 193)-response = 55.4%. Most providers considered physicians and health care professionals to be somewhat knowledgeable of hospice, but also indicated a lack of knowledge constituted the barrier with the most impact in their communities. Respondents also cited physician difficulties with discussing end of life with patients and prognosticating death within 6 months as leading barriers. Providers also described Medicare reimbursement cap issues that have resulted in barriers to hospice. Our findings were similar to previous investigations assessing provider perceptions. Future studies should explore how reimbursement cap issues affect the receipt and delivery of hospice care. © The Author(s) 2011.