Benefits of Transitional Care Management

 While transitional care management services is an excellent service that focuses on increasing the quality of health outcomes for patients, providers also stand to see a few benefits from providing such care.

1. Reduced Readmissions

As we mentioned earlier, the goal of TCM is to reduce the rate of readmissions and improve health outcomes for patients.

Hospital readmissions cost Medicare about $26 billion annually, with $17 billion spent on avoidable hospital trips after discharge. TCM can greatly reduce these costs to our healthcare system. Additionally, Medicare has implemented value-based penalties for excessive 30-day hospital readmission rates. In 2017, Medicare penalized over 2,500 hospitals at a cost of more than $564 million for such excessive readmission rates.

By reducing readmissions, providers can reduce costs for themselves, Medicare, and their patients.

2. Higher Quality of Care

More and more, readmission rates are being used as a quality of care indicator.

Both commercial payers and consumers (patients) are using these rates to judge the quality of the provider.A perceived lower value by patients can affect the bottom line of a practice.

3. Financial Reimbursement

As shown above, the national average for moderately complex care is $176.50 per patient per month, while the rate for high complexity is $236.77.The financial incentives of transitional care management are clear.

When combined with the reduction in associated costs with readmissions and fewer hospital and office visits, providers stand to improve their bottom lines.

As an example, providing moderately complex TCM services for 10 patients in a month can net your practice an additional $1,765 per month, or more than $21,180 per year.

4. Chronic Care Management (CCM) Is Billable With TCM

Previously, Medicare would not reimburse for both Chronic Care Management and transitional care management services in the same month. Now, it does. 

This change allows for dual reimbursement for the same patient when “reasonable and necessary."

Use Software to Offer Transitional Care Management

When you combine TCM’s financial incentives for providers with the health benefits for the patients, implementing a TCM program becomes an easy decision. Assisting with a seamless transition from a hospital, nursing facility, or other qualifying healthcare setting is rewarding for both the patient and the primary care physician. Knowing these benefits, the decision to implement a TCM program becomes easier.

The transitional care management system from HealthArc guarantees patient care while lowering hospital admissions. New regulations for Medicare transitional care management services have been released by CMS.