Study Questions Effectiveness of Medicare’s Transitional Care Program

Reliable research is hard to come by

Reducing excessive medical costs associated with high hospital readmission rates is a pillar of health care reform. From 2007 to 2011, as many as 19% of patients in the U.S. returned to hospitals less than a month after discharge, accounting for an estimated $15 million in preventable hospitalization costs.

In an effort to prevent adverse outcomes for chronically ill and aging patients and to reduce the burden of cost on the government, Medicare providers have implemented transitional care management (TCM) programs as a bundled component of Medicare payment plans. TCM programs comprise services and interventions designed to ease the transition from a hospital to community-based care and to prevent the recurrence of hospital admission for patients with complex medical needs. Beginning in 2013, patients became eligible for Medicare reimbursement for TCM services, such as outpatient visits and adherence to treatment assessments.

A review conducted by researchers at the University of Kentucky found that most TCM programs were ineffective in meeting the criteria for serving the needs of the patients intended to receive transitional services. The investigators culled peer-reviewed journal articles reporting the readmission rates of adults receiving the TCM bundle of services that were published between 2004 and 2015. The purpose of the study was to assess the state of research monitoring the effectiveness of fully reimbursable TCM visits in reducing hospital readmission rates.

The researchers identified 969 studies reporting readmission rates for TCM service recipients, but only three articles incorporated all required elements of TCM service. Although two of the three TCM studies were improvement designs and none was a randomized controlled study, each reported success in reducing readmission rates, contributing limited evidence that TCMs are effective in reducing hospital readmission. Based on these results, the researchers called for additional studies examining the implementation of TCMs.

“The few identified studies through our systematic review show promising efficacy data on the impact of TCM visits on hospital readmission rates. However, it also highlights that effectiveness studies are needed to further understand its impact in real-world settings and what attributes of the TCM process cause this impact,” said senior investigator Dr. Roberto Cardarelli.

The study results were published in the January issue of the American Journal of Medical Quality.

Source: Medical Xpress; January 15, 2016.