General Inpatient (GIP) Care is one of the four levels of care available to patients who elect the Medicare Hospice Benefit. GIP level of care is appropriate when the patient’s medical condition warrants a short-term inpatient stay for pain control or acute or chronic symptom management that cannot feasibly be provided in other settings. This care must be provided in a Medicare-participating hospital, skilled nursing facility (SNF), or hospice inpatient facility.
GIP level of care may be appropriate when:
- Pathological fractures
- Uncontrolled bleeding
- Frequent seizures
- Aggressive treatment to control pain
- Uncontrolled nausea or vomiting.
- Unmanageable respiratory distress
- Sudden deterioration requiring intensive nursing intervention.
- Delirium/anxiety/agitation related to end-stage disease process.
- Symptom management requires frequent skilled nursing observation/intervention.
GIP level of care is based on a clinical need to manage an uncontrolled symptom that cannot be managed in another setting. First Determine,
Why GIP higher level of care now and how is the GIP level of care intervention different from the current level of care?
Then continue to document clearly the ongoing need for the GIP level of care until a resolution is achieved.
1. Transfer documentation needs to include the detailed reason for the GIP level of care.
- What symptom is no longer manageable in the patient’s home setting?
- What precipitating events led up to the Interdisciplinary Group’s (IDG) decision for the GIP level of care?
- What interventions were implemented and ineffective in managing the uncontrolled symptom in the current setting?
- Is all of this clearly documented in the patient’s chart?
2. After the patient is admitted to GIP, the hospice team must document each day the continued need for the GIP level of care that identifies the specific symptoms being managed. The documentation should always reflect working towards a lower level of care with discharge planning evident from the first day of the GIP admission.
- What specific interventions were implemented? What was the patient’s response?
- How many PRN medications were required in the last 24 hours to meet symptom control goals?
Note: PRN medications that are given routinely do not support the ongoing need for GIP.
- Is there documentation of the instructions provided to the patient/family?
- Does the documentation support discharge planning?
3. Shifting to a lower level of care upon resolution of the crisis.
- Document updates to the patient plan of care.
- Document the reason for GIP level of care is resolved and the discharge plan.
- Document shifting to a lower level of care.
It is NOT appropriate to use GIP level of care when:
- Fall risk and supervision needed
- General Decline
- End-of-life care
- No available caregiver in the home
- Caregiver breakdown
All hospice providers need to make sure that audits are in place to review GIP documentation prior to billing the claim to ensure the documentation supports the level of care.
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