Medicare's Post-Discharge Care: Does It Make a Difference?

In 2013, Medicare started paying doctors for helping patients after they leave the hospital. This is called transitional care management (TCM). We wanted to find out how this has affected patients. We studied the records of many patients and compared the care given by different groups of doctors. Some doctors used the TCM codes a lot (high-TCM), others not so much (low-TCM). We looked at the records from before (2012) and after (2015-2017) the TCM codes were introduced. We found that patients whose doctors used the TCM codes more often were less likely to be readmitted to the hospital within 30 or 90 days after being discharged. This means they didn't have to go back to the hospital as often. However, there was no big difference in how many patients died.

In 2017, there was the biggest change in how often patients were readmitted. That year, there was also a small drop in the number of deaths. The doctors who weren't part of big hospital systems, Accountable Care Organizations, or academic medical centers saw the biggest improvements. Doctors with fewer primary care physicians saw the least. So, while the TCM codes seem to help a bit, they might not make a huge difference overall. But smaller, independent practices might benefit more from this extra support for post-discharge care.

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