Does Medicare's Transitional Care Management Program Help Everyone?

Managing the transition from a hospital or nursing home to home can be challenging for patients, as they try to juggle multiple follow-up appointments, new medication regimens, and rehabilitation programs, all while recovering from illness. To help recenlty discharged patients with this transition, Medicare introduced increased payments for Transitional Care Management (TCM) in 2013.

TCM financially incentivizes doctors to provide extra support to patients during this critical time. Clinicians receive increased compensation of approximately 130% to 150% compared with typical office visits if they contact the patient within 2 business days of discharge and conduct an office visit within 14 days of discharge, in addition to conducting a medication reconciliation and coordinating care with specialists.

Medicare spending on TCM services between 2013 and 2018 reached nearly $1 billion, and some evidence shows that patients who received TCM services after discharge saw reduced costs and mortality compared with patients who did not receive TCM. However, other studies have shown that TCM services are delivered to fewer than 10% of eligible patients and highly concentrated among a small number of practices.

A recent study in JAMA coauthored by Professor of Health Care Policy, Bruce Landon investigates the overall impact of the TCM program across patient demographic characteristics, in attempt to answer questions regarding TCM's overall influence: Does it truly increase the number of follow-up appointments, and is access to TCM equal for everyone, or are certain groups left behind?

The cross-sectional interrupted time-series study assessed quarterly post discharge visit rates before and after TCM implementation of Medicare fee-for-service beneficiaries. The authors tracked the follow-up appointments for those discharged to the community after a hospital or skilled nursing facility stay between 2010-2019. They also analyzed subgroups based on race/ethnicity, Medicaid dual eligibility, and location. 

Findings revealed that TCM led to an increase in timely follow-up appointments after hospital discharge. However, Black patients, Hispanic patients, and those with Medicaid dual eligibility were less likely to receive timely follow-up compared to White patients and those without Medicaid. They also found that patients in urban areas had better access to follow-up care compared to those in rural areas.

While TCM shows promise in improving post-discharge care, most patients did not benefit from a timely follow-up, even when clinicians were financially incentivized. The study highlights the need for further improvements and research surrounding disparities in access, ensuring all patients receive the appropriate follow-up care.