Medicare's “Transitional Care Management” Might Be Beneficial

Smooth transitions from hospital to outpatient care are critical, especially for elders with severe chronic conditions. To encourage a more-structured approach to transitional care management (TCM), Medicare implemented special TCM billing codes in 2013; practices can use these codes (which offer higher reimbursement) if patients are contacted within 2 business days of discharge and are seen by a clinician within 14 days. Investigators used Medicare records for 2013 through 2015 to identify more than 18 million patients who potentially were eligible for TCM; only 5.2% actually were billed at the TCM rate during the study period.

Mean reimbursement for the first office visit after discharge was US$145 for TCM recipients, compared with $105 fo…