General Inpatient Hospice Care: Better Outcomes for Patients, Better Outcomes for You

By Seasons | April 28, 2021

While understanding and acceptance of the Medicare Hospice Benefit has grown in recent years, there are still knowledge gaps about the higher levels of hospice care that Medicare allows eligible beneficiaries to receive.

General Inpatient Hospice Care: Controlling Symptoms that Can’t Be Eased Elsewhere

One of the higher levels of hospice that Medicare covers is General Inpatient (GIP) care. GIP is useful for circumstances where a patient needs “…pain control or acute or chronic symptom management, which can’t be managed in other settings.”

If patients are experiencing pain or other symptoms that meet Medicare’s requirements, and those symptoms cannot be controlled in the place they consider to be their home, GIP may be a clinically appropriate option for them on a short-term basis.

Appropriate use of General Inpatient Care Helps Patients

GIP provides 24/7 nursing and aide care, as well as access to other members of the hospice interdisciplinary team. Complex regimens and treatments needed for the control of symptoms can be provided to patients, such as compassionate extubations, advanced pain management via IV drips, or complex wound managements, among others.

GIP allows hospice professionals to work to control these symptoms in either a freestanding hospice inpatient center, a hospital-based hospice inpatient center, a skilled nursing facility under contract, or a hospital bed under contract. It provides a path for eligible dying patients a way to receive highly skilled and comforting care at one of the most vulnerable points in their life.

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Appropriate use of GIP Helps Healthcare Professionals

Use of hospice GIP for eligible patients can also help healthcare professionals along the continuum of care by easing transitions, allowing patients to stay closer to where they consider to be home, avoiding rehospitalizations, lowering costs, and honoring patient wishes.

  • For hospitals, a transfer to hospice GIP for a patient that has uncontrolled symptoms can allow for sometimes-scarce intensive or critical care resources to be reallocated. A hospice transfer to an inpatient unit or a contracted bed in your building also allows for a smooth transition. Deaths on hospice aren’t included in Care Compare mortality metrics, and hospice helps lower 30-day readmissions. Your hospice team can also handle discharges of a patient to a lower level care and facilitate transfers home, freeing up your own discharge staff.
  • For skilled nursing facilities, it may not be as commonly known that GIP can be provided in a SNF environment. Having the ability to offer GIP alongside an experienced hospice partner inside your facility can mean less burdensome transitions for your residents when these higher levels are needed for eligible patients, allowing transfers to routine hospice care when an acute episode is over without the patient ever leaving your grounds.
  • For Accountable Care Organizations, Managed Care Organizations, and Direct Contracting Entities, GIP hospice care for eligible patients serves as a bridge to care that meets the triple-aim. Hospice has been proven to lower costs and increase quality outcomes. When a patient is in crisis, GIP allows not only for aggressive symptom management, but also gently exposes patients and families to the holistic benefits of hospice. These benefits include spiritual support, music therapy, and social services. Being acclimated to these services can help families overcome misconceptions about hospice and change their mind about pursuing aggressive and potentially futile treatments that value-based care works to mitigate.
  • For primary care providers, it’s the right care at the right time. PCPs have often developed longstanding relationships with their patients and may have had multiple discussions around advance care plans with them. However, when the time comes to discontinue extreme measures, there can be reluctance by family members to honor those wishes. If a patient is in crisis and eligible for GIP, it can help to ultimately honor advance directives.

GIP is for short stays, but serves a critical purpose

Medicare doesn’t intend for General Inpatient Hospice to be used for custodial or long-term care, but rather to bring symptoms under control that can’t be managed in another setting. Discharge planning to a lower level of hospice care begins almost immediately upon enrollment, and most patients stay on GIP for hours to a few days. However, in times of crisis where a patient may unexpectedly find themselves in extreme pain or with complex medical needs, it is a critical component of how we support the dying by alleviating symptoms and providing smoother transitions.

As healthcare professionals seek to achieve better quality outcomes at lower costs to be good stewards of Medicare and Medicaid dollars, knowing when and how to partner with a hospice to provide GIP should be a critical component of their population health strategies.

 

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