Do You Need to Learn Hospice GIP Documentation? [Expert Tips]

As a hospice nurse, there are many skills that you must master. One of these skills is understanding and completing hospice GIP documentation. In this article, we’ll explore why you need to learn General Inpatient (GIP) documentation and explore patient scenarios where GIP might be necessary.

Plus, I’ll explain when GIP care is appropriate and when it’s not.

I know I say this a lot, but hospice documentation is not just about meeting regulatory compliance guidelines, it’s also about ensuring the BEST outcome for the patient.

If you’re seeking clarity on GIP-level care and hospice GIP documentation, you’ve come to the right place.

What is Hospice GIP Care?

First, if you are a hospice nurse, you probably already know about the four levels of hospice care. So, I won’t bore you with all the details.

However, you might not know that Medicare requires Medicare Certified Hospice Agencies to provide or offer GIP-level care.

Secondly, to ensure your patient gets the right level of care, you need to understand GIP.

Medicare Regulatory Requirement for Hospice GIP Documentation:

According to Medicare regulations (42 CFR § 418.302), hospice GIP level care is provided to patients whose symptoms cannot be effectively managed in other settings, such as the patient’s home, and require short-term, intensive inpatient care for pain control or acute symptom management.

GIP care must be provided in a Medicare-certified hospice inpatient facility or a hospital.

Additionally, the hospice agency must have a contract with the facility that is providing GIP care.

Also, the patient’s attending doctor must certify the need for GIP care based on their clinical condition and care needs.

When is GIP Care Appropriate?

Determining when GIP care is appropriate requires collaboration from the hospice IDG.

Also, it should include discussions between the RN case manager and the IDG.

These are a few of the factors to consider when trying to determine if GIP makes sense for your patient:

• Symptom Management: Sometimes, you’re throwing every medication and every trick you have at the patient and nothing seems to work. For instance, your patient may have nausea and vomiting that require an IV drip. As a rule, GIP care is suitable when a patient’s symptoms cannot be effectively managed in other settings, such as at home or in a nursing facility. Symptoms may include severe pain, uncontrolled nausea or vomiting, dyspnea, or other distressing symptoms that require close monitoring and intervention.

• Caregiver Not Skilled to Provide Care: GIP care may be necessary when caregivers cannot adequately meet the patient’s needs. Respite care is not the same as GIP. What this means is that the patient’s condition has become more complex and managing the patient’s needs requires specialized medication attention and knowledge.

• Medical Crisis: GIP care is appropriate during medical crises, such as sudden deterioration in health or acute exacerbations of a chronic condition, where immediate medical intervention is necessary to stabilize the patient’s condition.

• End-of-Life Care: GIP is NOT used for a patient who is imminently dying and can be managed at home. This is reserved for patients who require around-the-clock care from a multidisciplinary team, including physicians, nurses, social workers, and spiritual care providers. At times, this can cause hospital physicians some frustration because they may not understand the complexity of the GIP rules.

RECOMMENDED ARTICLE: The Secret is Out: Hospice Recertification Made Easy!

When is GIP Level of Care Not Appropriate?

Another reason you need to understand GIP care is to ensure that you are not changing the level of care to GIP when the patient is not appropriate. Sometimes, you might be asked to admit someone GIP and if they do not require GIP-level care, Medicare can deny the claim and your agency won’t get paid.

I tend to think about all the work that the nurse has completed that does not get covered by Medicare. Your skills are invaluable, and you should be compensated for that care.

While GIP care is vital in hospice services, it may not always be the most appropriate option. Consider the following scenarios where GIP-level care may not be necessary:

• Stable Symptom Management: If the patient’s symptoms can be controlled at home, then they are not appropriate for hospice.

• Patient Preference: For instance, if the patient’s home living situation is not safe. This does not satisfy the GIP requirement.

• Resource Availability: Given the limited availability of GIP beds, healthcare providers must prioritize patients who need the services most.

• Caregiver Relief: GIP is NOT respite care.

Understanding the Importance of GIP Hospice Documentation:

Following Medicare Rules: Medicare, the main payer for hospice services in the U.S., has specific requirements for GIP care. Knowing the rules and documenting GIP admissions, assessments, and treatments accurately is essential for getting paid and following the law.

Providing Quality Care: Good documentation helps the hospice team work together better, which means better care for patients. It lets nurses track how patients are doing, see if treatments are working, and change the care plan if needed.

Protecting Nurses and Patients: Good records protect nurses and their employers if there’s a legal problem. They show that nurses did their job well, followed the rules, and put patients first.

Communicating with Other Health Workers: Clear records help nurses talk to other healthcare providers, like doctors and hospital staff. This makes it easier to make good decisions and keep patients safe when they move between places like home and the hospital.

This case study is for informational purposes only. Always consult with your IDG before making level-of-care changes.

GIP Hospice Documentation Tips

(Before level of care change)

The first, and most important, thing to document is what led up to the decision to transfer to a higher level of care. Similar to the admission, you want to be clear about what the patient’s symptom management needs are and what has already been done to support the patient.

Your documentation should include:

Describe the problem: Include a detailed account of what pain or symptoms occurred

Document interventions: Chart everything you did to manage the patient in their current setting. Include both pharmacy and non-pharmacy interventions

Document patient needs: For instance, what will they need from the inpatient team? An example could be that the patient will need frequent medication adjustments and will require MD assessment or frequent titration. Also, you will want to highlight that home efforts have been unsuccessful.

Notify IDG: This might seem like a no-brainer, but it’s critical to include documentation that shows communication with the hospice IDG. This is a condition of participation and a necessary component of transitioning the patient to GIP.

GIP Documentation Tips

(During GIP Admission)

Once your patient has been admitted to hospice, someone from the hospice GIP should visit the patient at least once per day.

In my prior agency, the nurse was required to visit daily and other members from the IDG also made visits.

Outline the patient’s needs in your plan of care.

It was always drilled into my brain, that EACH DAY of hospice GIP documentation should be able to stand alone. Furthermore, it should include information that showed what was being done to stabilize the patient so that they could be transferred to a lower level of care.

Important things to document:

• Medications– what was given, and any required adjustments
• Responses-how has the patient responded to the interventions
• Treatments-for instance, if the patient has required dressing changes or breathing treatment
• Skilled Care-what skilled care has been provided
• Plan of Care-this includes the reason for the transition of care

Better Words to Chart

Instead of

“no complaints”– Document that the intervention is effective and detail the patient’s response to the intervention

“GIP for symptom management”– Change to GIP for uncontrolled or intractable (symptom)

“patient is nonverbal”– Patient requires frequent assessment for nonverbal signs of pain

“education provided”– explained changes in medications, expected side effects, and outcomes

“patient stable”- (symptom) managed effectively using (intervention) ongoing monitoring is required

GIP Case Study

52 y.o. female with metastatic pancreatic cancer was admitted to hospice three weeks ago. She has experienced pain that has been well controlled with fentanyl patch and oxycodone PRN. She has experienced intermittent nausea that has been controlled with Zofran. In the last 48 hours, she has c/o increased nausea and vomiting and is no longer able to tolerate her PO medications. Her abdominal pain has increased in the last 24 hours and she is restless. She has required and PRN visit in addition to her PRN visit.

Is this patient appropriate for GIP?

What would you admit her for, and what would you want to document?

Based on your assessment and discussion with the hospice attending. You decide to admit the patient to GIP for symptom management. Dx; Intractable N/V.

CONCLUSION

In hospice care, learning to document GIP care well isn’t just a rule; it’s a way to give patients the best possible care. Hospice nurses play a big part in this by keeping good records, communicating well with the IDG, and ensuring patients get the right care at the right time. By understanding why GIP documentation matters and doing it right, you can make a real difference in the lives of your patients.

Want More Hospice Tips?

Hospice IDG: Top Time Wasters and How to Avoid Them

End-of-Life Care: Your Patient Has Died, Now What?