Transitional care management services reduce mortality, Medicare costs

Significant reductions in mortality and Medicare costs occurred in the month after transitional care management services were provided, according to research published in JAMA Internal Medicine.

“Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities,” Andrew B. Bindman, MD, from the Agency for Healthcare Research and Quality at HHS, and Donald F. Cox, PhD, retired from the Office of the Assistant Secretary for Planning and Evaluation at HHS, wrote.

“To bill for the 30-day service, a care team member must communicate with the beneficiary or the caregiver within 2 business days after the discharge and the clinician must provide an office visit within 14 days,” they added.

Bindman and Cox analyzed all Medicare fee-for-service claims from 2013 to 2015 for 18,756,707 beneficiaries (43.9% men; mean age, 72.5 years) eligible for TCM services to determine the association between receiving services and subsequent health care costs and mortality in the 31 to 60 days after discharge.

The researchers found that TCM services were billed in 3.1% of cases in 2013, 5.5% in 2014 and 7% in 2015 after eligible discharges. Beneficiaries who did not receive TCM services had higher total Medicare costs ($3,358 vs. $3,033) and mortality (1.6% vs. 1%) than those who did receive TCM services after adjusting for beneficiary age, sex, risk score, dual eligibility for Medicare and Medicaid, type of eligible discharge and year of discharge.

“We found that TCM is a promising delivery model innovation that has the potential to improve health outcomes and costs among Medicare beneficiaries discharged to the community from medical facilities,” Bindman and Cox concluded.

“An assessment should be made regarding a reduction in the administrative burden associated with billing for TCM services, such as allowing clinicians to bill for TCM services at the time of an office visit rather than waiting 30 days following an eligible discharge,” they added. “Future consideration should also be given to the amount paid for TCM services and whether it provides an adequate incentive to change community-based practice.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.