303 - Transitional Care Management in Complex Care: A Quality Improvement Pilot Study

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 303
Publication Number: 303.204

Nicola Brodie, Children's National Health System, Washington, DC, United States; Kathryn Detwiler, Children's National Health System, Washington, DC, United States; Heidi Clark, Children's National Health System, Washington, DC, DC, United States; Sarah Kimball, Children's National Health System, Washington, DC, United States

Presenting Author(s)

Nicola Brodie, MD (she/her/hers)

Pediatrician
Children's National Health System
Washington, District of Columbia, United States

Background: Children with medical complexity (CMC) comprise a rapidly growing proportion of the pediatric population and have unique care needs related to frequent hospitalizations. The transition from hospital to home is a time of extreme vulnerability for CMC and their families. The Complex Care Program at Children’s National Hospital serves as an outpatient Patient and Family Centered Medical Home for over 600 CMC and their siblings; our patients experience frequent hospitalizations. Transitional Care Management (TCM) is a billable specific current procedural terminology (CPT) code that can be utilized to capture the work required to transition a child safely and effectively from the hospital back to the outpatient medical home and community under specific documentation parameters.

Objective: We undertook a pilot quality improvement study (March 1 – August 31, 2022) to determine the financial feasibility of TCM within our program to improve the quality and safety of our care management of children who were hospitalized at Children’s National Hospital for greater than four days and were being discharged to the community setting.

Design/Methods:

A nurse from our program provided outreach to patient families within two business days of discharge to assess for any urgent transitional needs (equipment, medication, or unanswered questions) and to schedule a post-hospitalization visit with the patient’s primary care provider within 14 days of discharge. After the visit with the provider, the TCM CPT code was used to capture the bundle of transitional care services provided (Figure 1). Reimbursement data from our payors was obtained.

Results:

During our six-month pilot period, a total of 185 discrete encounters were identified as eligible for the TCM process; of these, 93 successfully completed the process with all required elements (50%); monthly data is shown in Figure 2. 75% of visits were conducted via telemedicine. Reasons for failure to complete TCM are shown in Table 1. Regarding payment, of the successfully completed encounters, only six claims were denied by insurance payors and the remaining 94% (n=87) were reimbursed at a rate in keeping with other charges within our practice.

Conclusion(s):

Management of the critical time of transition from hospital to home is an essential function of Complex Care Programs. TCM CPT codes can be leveraged to ensure the financial viability of this time intensive process; telemedicine is a viable platform for these visits. Future studies will look at the effectiveness of our TCM program in preventing readmissions and in family self-efficacy and satisfaction.