Symposium on hospice. Establishing a Medicare-certified inpatient unit.

This article presents the experience of a community-based Medicare-certified hospice program in establishing an inpatient unit in an acute care hospital. To date, there are few Medicare-certified programs compared to the total number of hospice programs in the United States. Since the regulations are new, the total ramifications of the regulations cannot be appreciated. The most obvious concern is financial. Careful negotiation and preplanning among the persons in the power positions of the two agencies assure a smooth working relationship. Even with good planning, numerous potential problems created by the Medicare regulations can occur. These problems have been addressed and some options for solution presented. The positive aspects resulting from the establishment of the inpatient unit are nurse, patient, family, and physician satisfaction with the high quality of care delivered, community appreciation of availability of inpatient beds, good documentation, improved public relations for the hospital and hospice program, and increased census for the hospice program. Undoubtedly, there are negative aspects in establishing an inpatient unit; however, to date, none have been identified.