Developing a specialty transition clinic: Inaugural clinical and financial operations

Few examples of hospital-wide transition programs have been presented in the literature and to date, we have no data on the clinical and financial operations of such services.

A transition clinic, guided by Got Transition's Six Core Elements, was created for youth with moderate-to-high medical and psychosocial complexity (per Bob's Levels of Social Support scale). The clinic visit and transition readiness assessment (UNC TR_xANSITION Index) were billed fee-for-service or under a bundled payment managed care model. We present data on patient characteristics, clinic operations, finances, and patient/parent satisfaction (online survey) in the clinic's first year of operation (March 2021-February 2022).

In Year 1, the clinic completed 115 appointments (113 unique patients). Most patients were older adolescents/young adults (M = 19.7 ± 1.8 years) and nearly half were Latinx. Patients presented with several complex medical needs including coordination of care across multiple subspecialties, high health care utilization, decision-making determinations, behavioral and mental health concerns, and resource needs. Implementation of the Six Core elements was high (range 99.1%-100%). The average billed per patient was $498 (in 2021-2022 USD). Considering paid and unpaid office visits, we collected an average of 31.6 cents on the dollar. Almost 80% of office visit claims and 21.9-33.3% of transition readiness assessments were paid by insurers. Patient/parent satisfaction was high, with over 90% of families reporting that they learned something, knew one thing they could do to improve transition readiness, and were able to get their questions asked and answered.

Transition clinics may never be fully self-sustainable given low collection rates and inability to capture extra charge codes related to chronic care management and transitional care. However, our collection rate was on-par with the collection rate for our hospital's subspecialty clinics and we show it is possible to receive some funding from insurers.