Transitional care management after hospital discharge was associated with more healthy days at home, lower total spending, and lower readmissions, with greater benefits in population-based APMs.
Observational
Yes
Does transitional care management (TCM) improve quality and cost outcomes in Medicare patients after hospital discharge?
Transitional care management improves post-discharge outcomes and reduces costs for Medicare patients, with synergistic benefits when combined with Alternative Payment Models.
Since 2013, Medicare has reimbursed clinicians for delivering transitional care management (TCM) services after patients' discharge from eligible medical facilities. Concurrently, Medicare has implemented population-based Alternative Payment Models (APMs) to encourage patient-centered care, care coordination, and clinician accountability. In this analysis, we used 2017-20 Medicare data to evaluate the effect of TCM on four quality and cost outcomes and the effect of population-based APM participation on the association between TCM and the four outcomes. TCM was associated with more healthy days at home and lower total spending after hospital discharge, with more pronounced differences among patients aligned with population-based APMs compared to nonaligned patients. TCM was also associated with lower readmissions but not differences in mortality; neither finding varied between patients who were versus were not aligned with population-based APMs. These findings suggest that the benefits of TCM may be even greater when patients are aligned with population-based APMs, highlighting potentially complementary effects.
Hughes et al. (Sun,) conducted a observational in Hospital discharge. Transitional care management (TCM) vs. No TCM was evaluated on Healthy days at home, total spending, readmissions, and mortality after hospital discharge. Transitional care management after hospital discharge was associated with more healthy days at home, lower total spending, and lower readmissions, with greater benefits in population-based APMs.
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