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Hospital and Hospice Partnerships

Next Reply: Re:Hospital criteria to convert inpatients to GIP
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Post Hospital criteria to convert inpatients to GIP
Author: MicheleRN
Date: May 12, 2009 3:21 pm
I am a Palliative Care nurse at a 150 bed hospital in a city with no inpatient hospice facility. I have been tasked with writing a hospital policy and list of criteria for inpatient eligibility to convert to GIP. My prior experience as a hospice nurse in other hospitals was that if our recommendation was to keep the patient GIP, the hospital was accepting as we were the ones having to justify to Medicare that the pt met the GIP criteria and the hospital would receive payment per our contract even if we were later denied (never saw this happen). If the patient condition stabilized or symptoms were manageable at home, then our social worker assisted with discharge home or to nursing home. In spite of this, I am told, "we don't want the family to think they can live here." (Although our avg LOS for GIP is about 2-3 days) Does anyone out there have such a policy for their hospital? Any feedback is much appreciated.
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Re:Hospital criteria to convert inpatients to GIP (by AmberBJones on 05/13/2009)
Since general inpatient services (GIP) are a designated level of care for Medicare-certified hospices, eligibility criteria for this level of care is spelled out by the federal language describing the Medicare Hospice Benefit (MHB). Given this, any language you or your hospital develop should be consistent with MHB requirements.

In order for the hospice to provide GIP in your hospital, there must be a written contract between the two entities (the hospice and the hospital). While it is not possible to anticipate all patient conditions and associated lengths of stay, the federal language makes it clear that the intent of GIP is for stays of short duration. To enforce this expecation, Medicare requires that each hospice provide at least 80% of its patients days as home care days. It may also be helpful to share with your management that NHPCO statistics reveal that more than 95% of hospice patient care days in 2007 were at the routine home care level and just over 3% of hospice patient care days were at the GIP level of care.

There is a sample hospital-hospice contract on the CAPC website that may be useful to you: go to www.capc.org and then insert 'hospital-hospice contract' in the search bar. Since each State has its own regulations governing health care providers, you will want to have the contract reviewed by a health attorney familiar with local rules.

Amber B. Jones
CAPC Hospice Liaison Consultant
+ Re:Hospital criteria to convert inpatients to GIP (by algardner on 01/19/2010)
Within the past year our hospice, which is an extension of our local hospital, has started to do inpatient hospice. While I am not well versed in all of the infinite legal details that are involved with this transition yet, I can tell you a few things that we do. Upon recieving the referral from the hospital, we send a nurse and a social worker to do the initial referral. If the patient is unstable, symptoms are out of control (pain, SOB, etc), they are actively dying/changing and the family desires our services, then we can consider inpatient admission, upon our medical director's permission and a following physician. We change the patient's payer source from GIP to inpatient hospice. Admitting has to discharge the patient from the system and readmit them under a new account number. The nurse on the unit then completes an abbreviated admission that is called "discharge to another level of care" and then they follow our orders for hospice. The only catch is, we have to make sure everyday to document something that shows the patient still qualifies for inpatient care. If after 3-5 days, sometimes up to 7 days, they are not declining or showing that death is imminent, then we have to have a plan B for placement. I hope this helps you a little!

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