GIP regulations

[CapeCodMermaid, RN]

I'm hoping one of you hospice experts can answer this for me:

What qualifies a hospice patient to be on GIP?

I was always told it was symptom management that required the skill of a hospice nurse even if the resident lives in a skilled nursing facility.

Any information would be helpful.

[Spidey's mom, ADN, BSN, RN]

Ok, gonna be honest here and say I don't know what GIP means. I googled it and found: Gastric inhibitory polypeptide or "an act of cheating; a swindle".

We have hospice patients mostly in their homes but we also can admit to local LTC. We are responsible for hospice meds like the CADD Pumps with Morphine or Dilaudid. But the LTC nurses can give the other meds.

So . . . please enlighten this dumbfounded nurse.

[toomuchbaloney]

GIP= General Inpatient level of care for hospice beneficiaries.

It is one of the 4 levels of care that can be billed under the hospice guidelines.

The vast majority of time the GIP level of care is initiated because the patient is experiencing a noxious symptom that is not successfully palliated in a routine level of care at the patient's current location. Most often the patient is then admitted either to a hospice inpatient facility, to a local SNF partnered with the hospice to provide the required RN supervision and hourly nursing care, or sometimes in an acute care facility if no other options are available and the hospital has agreed to accept that care and reimbursement. The acute care hospital setting is pretty rare, in my experience, but I have cared for GIP level patients in the acute hospital setting. It is often closely related to a healthy inpatient palliative care program within the hospital that coordinates the transition to hospice while the patient remains hospitalized and "unstable". These are sometimes the hospice patients who receive "terminal sedation" or are quickly sent home from the ICU setting for a terminal extubation.

The billing is different and this level of care has the highest reimbursement as well as the highest cost of delivery for the hospice provider. Often the vast majority of the reimbursement is paid to the facility where the care is occuring.

The GIP level of care is expected to be brief with short term goals directed at palliating the cause of GIP status and the return of the patient to the preferred environment for death. In my experience the expectation is that most patients can achieve symptom relief and return to home within 72 hours.

The following link provides a good explanation.

http://www.nhpco.org/sites/default/files/public/regulatory/GIP_Tip_GIP_Sheet.pdf

[Spidey's mom, ADN, BSN, RN]

Duh.

Thanks. Great explanation.

[ShesanRN]

We can take move our GIP patients to a snf we are contracted with for that purpose, but most of ours are cared for in the hospital. We either get the referral from the hospital for one of their patients who needs palliation, or one of our current patients who needs moved in to a different setting to manage symptoms, most often pain, dyspnea, nausea/vomiting, etc.

This level of care requires a daily RN visit, and our hospice reimburses the facility at 100%. In my area, it's a great way to give families hospice care within the hospital setting.

[Caffeine_IV]

What I can recall from working in hospice

GIP is meant to be short term and for uncontrolled symptoms such as uncontrolled pain, intractable N/V, seizures, severe agitation/delirium, respiratory distress and other varied symptoms.

Once the patient has their symptoms managed, they are changed to routine and should go home, LTC or even assisted living.