GIP physician regs

nutella, MSN, RN · Oct 8, 2016

Can anyone tell me if there is a mandatory requirement for the frequency of physician visits for GIP patients in a free standing inpatient unit? Trying to google how often physicians must physically see the pts while GIP, but I can't find anything. I thought it was required for a physician or NP to round daily, but I have recently been told that is not true. I'd love to see the requirements in some kind of official documentation, but can anyone here share with me how often the MD rounds in their free standing IPUs?

When you look at the regulations here

http://c.ymcdn.com/sites/www.hospicefed.org/resource/resmgr/hpcfm_pdf_doc/gip_report_2008_hospice_gene.pdf

it says on page 6:

"f) Standard: The Medical Director or his/her physician designee shall conduct regular onsite visits to the inpatient facility, including daily visits if necessary, to assess

patient conditions and reevaluate medical orders of unstable patients. "

other information that is interesting is here :

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

So - what does that all mean in terms of GIP?

I assume you know what GIP means - it refers to symptom severity and is not equivalent to hospital level of care. However, GIP can be done in the hospital, hospice house, or SNF as long as they meet all the criteria as outlined in medicare guidelines. Criteria for who gets admitted and how much and how long GIP is paid depends on patient's insurance and Medicare is very strict while commercial insurance may be more lenient. A patient could qualify for GIP with a commercial insurance but not under Medicare - but that is the job of people who get the pre-approval .

Although there has to be a medical director, there is no rule that the MD or designee has to physically see and assess the patient every day. They may do so if there is a requirement of if for example the 3. benefit period is coming up, the patient is on GIP and requires a F2F.

Don't confuse GIP with general hospital admission requirements where the patient needs to be seen daily by the provider.

But - as always - certain things are essential with GIP. There has to be a documented need that this level of care is required for symptom control. That includes documentation of symptoms and what has to get adjusted or needs adjustments to get the symptoms under control. If it is GIP in a hospice house, the RN confers with the hospice medical director or hospice MD daily and reviews the symptoms and documents the MD recommendations and carries them out.

If it is GIP in a hospital, the patient is usually seen by the hospital provider daily anyways BUT it is good practice that the hospice RN comes daily and discusses the case with the hospice MD to ensure that hospice is directing the plan of care and provides oversight.

GIP in nursing home - the hospice nurse comes daily and discusses with hospice MD.

As bolded above - daily visits from a MD as necessary. Necessary can mean a lot of things but it has been my experience that daily MD f2f visits under GIP are hardly ever necessary because the hospice RN facilitates the communication with the hospice MD.

I am not clear what your motivation is but if you work in a hospice house and have doubts about adherence to regulation you should bring it up to the hospice manager and ask for clarification. I am sure they will be able to explain to you.

GIP is really meant as a short term intervention to get symptoms under control.