Lower Mortality, Medicare Costs Seen with Transitional-Care Management

By Anne Harding

NEW YORK (Reuters Health) - Transitional-care management (TCM) for Medicare patients after discharge to the community appears to cut mortality and costs, new findings suggest.

"The use of transitional-care-management services is associated with reductions in total health care costs and mortality in the month after the services are provided," Dr. Andrew Bindman of the University of California, San Francisco, one of the study's two authors, told Reuters Health by phone. Dr. Bindman was with the Agency for Healthcare Research and Quality at the Department of Health and Human Services (HHS) when he and Dr. Donald F. Cox did the study.

Transitioning to the community after discharge from a hospital or nursing facility is a risky time for patients, especially older patients with chronic illness, note Dr. Bindman and Dr. Cox, who is now retired from HHS, in JAMA Internal Medicine, online July 30.

Medicare began reimbursing for TCM in 2013, requiring that a patient be contacted within two days of discharge and have an office visit within seven to 14 days, depending on the complexity of the case. Providers must wait 30 days to bill for the service. Mean reimbursement is $145 for TCM, and $105 for an office visit only within 14 days of discharge.

Drs. Bindman and Cox looked at more than 18 million discharges in 2013-2015 that were eligible for TCM. Providers billed Medicare for TCM in 3.1% of the 2013 visits, 5.5% of 2014 visits and 7.0% in 2015.

Adjusted costs per patient during days 31-60 after discharge were $3,033 with TCM versus $3,358 without TCM (P<0.001). Mortality was 1.0% with TCM billing, 1.6% without these services (P<0.001), and 1.5% for non-TCM patients who had an office visit within two weeks of discharge.

"Both components are important for offering the benefits of the lower cost and improvement in mortality," Dr. Bindman said.

Among patients who were discharged from a hospital, readmission rates were 9.4% with TCM and 9.6% without TCM (P<0.001).

Workflow adjustments and appropriate information technology are needed in order to implement TCM systematically, for example to facilitate communication between discharging physicians and primary care doctors, Dr. Bindman noted.

Medicare could boost TCM uptake by increasing reimbursement and reducing administrative burdens, he added, for example allowing providers to bill for the service closer to when it's actually provided.

Dr. Peter Huckfeldt of the University of Minnesota School of Public Health, in Minneapolis, who co-authored a commentary accompanying the study, told Reuters Health by phone, "There's evidence that if the transition-care-management services are provided, you can observe reductions in hospital admissions and reduction in mortality and reduction in costs."

"The use of these services, or at least the billing of these payment codes, is quite low, so we're not fully realizing the benefit of using these services," he said.

Reimbursement for TCM is also relatively low given the amount of additional effort involved, he said. "By changing the clinical infrastructure and the way these types of services are incentivized, we could improve take-up of these services."

SOURCE: https://bit.ly/2OB4Y4D and https://bit.ly/2v8IJuN

JAMA Intern Med 2018.

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