Medicare Transitional Care Management Program and Changes in Timely Postdischarge Follow-Up.

Area of Science:

• Health Services Research
• Health Policy
• Ambulatory Care

Background:

• Medicare introduced Transitional Care Management (TCM) payments in 2013 to incentivize post-discharge ambulatory care.
• This policy aimed to improve patient outcomes by ensuring timely follow-up after hospital or skilled nursing facility stays.

Purpose of the Study:

• To evaluate the impact of TCM payments on the rate of timely post-discharge follow-up visits.
• To determine if TCM implementation affected disparities in healthcare access.

Main Methods:

• A cross-sectional, interrupted time-series study analyzed Medicare fee-for-service data from 2010-2019.
• The study included over 79 million discharges, comparing follow-up visit rates before and after TCM payment implementation.

Main Results:

• Timely primary care follow-up increased by 7.3% (from 31.5% to 38.8%) post-TCM implementation.
• While overall follow-up improved, disparities persisted and widened for Black and Medicaid dual-eligible patients.
• Only 11.3% of eligible patients received TCM services by 2019.

Conclusions:

• Medicare's TCM payments were associated with increased timely post-discharge primary care.
• The policy did not reduce, and in some cases widened, existing demographic and socioeconomic disparities in care.
• A significant proportion of beneficiaries still lacked timely post-discharge follow-up.