Transitional Care Management Services Lower Costs, Mortality Rates Among Medicare Patients

Transitioning back into the community following discharge from the hospital or nursing facility often poses vulnerable situations for Medicare beneficiaries, with potential lapses in quality of care and adverse events. Presenting a potential solution to the problem, researchers have found that transitional care management (TCM) services are associated with reductions in mortality and total Medicare costs in the month after their implementation.

The researchers’ findings also showed that despite these observed benefits for Medicare beneficiaries, use of these services has remained low since the adoption of TCM payment codes in 2013.

Medicare implemented these TCM payment codes with the hopes of improving patient outcomes after hospital discharge. In order for a care team member to receive reimbursement, they must provide outreach to the beneficiary or caregiver within 2 days following discharge and the clinician must provide an office visit within 14 days.

Researchers of the study analyzed claims data on all Medicare beneficiaries from January 1, 2013, to December 31, 2015. Of the nearly 19 million discharges identified, 975,169 (5.2%) were linked to billing for TCM services.

Costs for beneficiaries who received TCM services amounted to $3022 in the month after receiving the services, accounting for $336 in savings when compared with beneficiaries who did not receive TCM services. Mortality rates among beneficiaries who received TCM services were 1.1%, while rates were 1.6% for those who did not receive TCM services.

Among those who did not receive TCM services, those who visited their clinician within 14 days after discharge had a significantly lower mortality rate than those who did not. However, this rate was still higher compared with that of those who received TCM services.

“We observed a stepwise benefit in mortality with the provision of an office visit within 14 days of an eligible discharge, which was enhanced when an office visit also included TCM services,” wrote the researchers. “This observation suggests that clinician contact with a patient within 2 business days after an eligible discharge offers a health benefit beyond what is achieved with the office visit within 14 days.”

They noted that despite the benefits observed with these services, utilization remains low and is growing slowly. In 2015—2 years after the implementation of the payment codes—TCM was billed in 7% of eligible discharges, just 4% higher than in 2013.

According to the authors, clinicians are well positioned to provide TCM services, but they may not have the systems needed to perform some of the time-sensitive steps. In order to bill for TCM services, the clinician must know that an eligible discharge is occurring, have the capacity to contact the patient within 2 business days following discharge, and be able to bill for the service 30 days after discharge.

Reference

Bindman A, Cox D. Changes in health care costs and mortality associated with transitional care management services after a discharge among Medicare beneficiaries [published online July 30, 2018]. JAMA Intern Med. doi: 10.1001/jamainternmed.2018.2572.