Improving Care for Patients Transitioning from Hospital Acute Care to Home

Rosha L. Hamilton, DNP, MSW, BSN; Judith A. Walloch, EdD, RN; Karen Lauer, BSN, RN, MSOLQ; Thomas W. Zoch, MD, FACEP, FACP, CPE

Disclosures

Nurs Econ. 2021;39(2):59-66. 

In This Article

Abstract and Introduction

Abstract

Care management services historically have been non-billable services and often absent from the care model. Underutilizing transitional care management (TCM) reimbursement billing codes can leave financial resources on the table. implementing standard work protocols for identifying TCM discharged patients, performing medication reconciliations, implementing patient outreach phone calls, and scheduling follow-up appointments can reduce readmission rates, improve patient outcomes, and utilize TCM billing.

Introduction

Health care is changing rapidly, and financing is driving many of those changes. Health care has transitioned from a fee-for-service payment model to a value-based model payment structure (Mkanta et al., 2016). Tanenbaum (2016) describes value-based purchasing (VBP) as paying a lower cost for high-quality care based on an incentive and penalty program. With this change, care models must change, and organizations must determine how to capitalize and take advantage of revenue-generating opportunities. Organizations must implement process changes in their care delivery models to meet the quality, cost, and patient experience metrics in VBP financial structures in health care. Care management services historically have been non-billable services and often absent from the care model.

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