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CAPC Palliative Care Discussion Forum
Hospital and Hospice Partnerships

In Reply To: Changing hospice inpatients to "Routine Level"
Next Reply: Re:Re:Changing hospice inpatients to "Routine Level"
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Post Re:Changing hospice inpatients to "Routine Level"
Author: DOVENM
Date: Nov 11, 2010 1:36 pm
our hospice-hospital partnership is exploring this same question, after learning more details about GIP criteria from Medicare University online. Have you had any other responses, or learned more about your question?
does your hospice also use GIP for pt's already hospitalized, as their entry point for hospice, if they are not safe to go home?
if a patient is already in the hospital, has never been on hospice, and does NOT meet GIP criteria, have any of you used the routine level of hospice care (stay in same bed, technically "discharge" from hospital,admit to hospice medicare benefit, "routine" as opposed to GIP level) while the pt. remains hospitalized?
Replies: order by [Date] [Author] [Subject]
+ Re:Re:Changing hospice inpatients to "Routine Level" (by kkeosaian on 11/11/2010)
I may be misunderstanding this question...we admit patients GIP in the Hospital setting OFTEN. We begin discharge planning right away, if applicable. We then move the patient home, Hospice House as GIP or routine based on LOC needed. Our Hospice Houses have residential care, crisis care or GIP. We bill routine and then room amd board based on sliding fee scale for those patients that are routine.
Many of our patients go from GIP in our Houses to routine in the same stay.
+ Re:Re:Changing hospice inpatients to "Routine Level" (by AmberBJones on 12/04/2010)
As long as the patient meets criteria, makes the hospice election, and the hospice and hospital have a written contract, a patient may receive hospice care in the inpatient setting.

When a patient elects hospice care while in the hospital, that patient is paper-discharged from the hospital and admitted to hospice.

A patient who does not qualify for GIP is not suitable for a continued hospitalization. Regulatory requirements, reimbursement considerations and patient preferences mitigate against keeping a hospice patient in the hospital unless clinical circumstances dictate the need for an inpatient level of care. In the unlikely event that the GIP level of care is inappropriate but the patient remains in the hospital, it is incumbent on the hospice to help find community placement alternatives that better serve the needs (and usually the preferences) of the patient.

It is important to note that if a patient does not qualify for the GIP level of care during a hospital stay, reimbursement would be at the routine home care rate with no consideration for the costs incurred by the hospital. Even if the hospice were to pass through the entire daily rate, this amount would be significantly less than the hospital costs incurred and could conceivably become a barrier to continuation of the hospital - hospice contract.

If the hospice has dedicated beds or a dedicated unit, it has greater latitude about bed utilization although regulatory, contractual and cost considerations still apply.

Amber B. Jones
CAPC Hospice Consultamt

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