GIP is intended to be a short-term intervention (similar to the duration of an acute hospital stay). However, GIP under the Medicare hospice benefit is not equivalent to a hospital level of care under the Medicare hospital benefit. The federal regulations, at §418.302(b)(4), also state GIP is “for pain control or acute or chronic symptom management which cannot be managing in other settings.” GIP may be initiated when other efforts to control symptoms are ineffective. There is no specified disease, condition, or symptom that qualifies a patient to receive GIP. Each patient and his or her symptoms will differ; GIP may be helpful to one patient and not to another with the same disease. GIP care carries specific requirements regarding where the services may be provided, as well as types and levels of staffing.
Suggested Work Flow Transitioning to GIP Level of Care:
- Complete a Change in Level of Care form: to document that the patient transitioned from one level of care to another, this will also establish the official date in which the level of care changed. The Change in level of care form will go to internal MD for signature via the dashboard
- Update the Patient's Location information in the Contact Tab: Patient's location is no longer their home. Update the address to reflect accurately where the patient is receiving their Inpatient Care eCFR :: 42 CFR Part 418 -- Hospice Care*GIP care cannot be provided in the home, in an assisted living facility, a hospice residential facility, or in a long-term care nursing facility (NF). These environments are not equipped to provide skilled nursing and medical care to manage an acute symptom crisis
- Update the Level of Care on the Patient's Intake Screen: The patient's level of care should be immediately updated on the intake screen. ex: If the patient was a Routine Home Care, update to General Inpatient Care)
- Charting in Hospice Tools: Complete the GIP Evaluation Assessment- This document is located within the nurse chart section. Documentation to support Admission to GIPLC: Complete to indicate the specific intervention necessary, symptom changes, psychological and social problems, patient/family teaching, immanent death, and additional information text box to indicate the reason this care cannot be provided in the home.
- GIP Nurse Visit Note: Used to document scheduled or PRN visits. Comprised of a physical assessment, wound assessment, medication dashboard, care plan dashboard, & discharge planning
- Medications: Update any current or submit new medication orders using the comfort kit, single medication form, or multiple medication form s
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IDG Updates: Using the applicable discipline progress notes, nurses need to address symptom management, observations, medications initiated and changes in medications, other changes in treatment, etc. Other IDG members need to document what they see in terms of symptom management, patient and family coping, discharge planning discussions, options for returning to the routine home care or another level of care, etc. All IDG members should document to paint a complete picture of the patient, including the pain and symptoms not adequately managed and why GIP is necessary each day the patient receives this
level of care.
*Refer to the NHPCO GIP Inpatient Compliance Guide below on documentation during this specific level of care, including documentation pertaining to IDG
For more information: NHPCO General Inpatient Compliance Guide