With high school graduation season in full swing, many seniors are turning their attention to college. While most college freshman successfully make the transition, nearly a third don’t—many of those return home and create a sometimes stressful and financially burdensome situation for the family. Those students who fail to make the leap to college often underestimate the transition or don’t receive the right support to get there.
Making the Transition
Transitioning from high school to college is not unlike medical transitions of care. When patients are discharged from the hospital or other institutional setting, many handle the transition to self-care just fine. But one in five underestimate the transition and are readmitted within 30 days of discharge. For them, making the change from an environment where medications and meals are administered on schedule and visiting hours are structured around rest and recovery proves too difficult. Medication errors, missed follow-up appointments and gaps in self-care are all major contributors to readmission and higher costs.
Improved Transition Care Management
Readmission rates highlight the opportunity to improve the quality and effectiveness of Transition Care Management and reduce the cost of avoidable readmissions. One way to do that is to simply do more patient outreach after discharge. But that is not always easy, and only fairly recently has there been a financial incentive to do so. In October,2012, Medicare introduced “the stick” by levying hospital readmission penalties. Then, in January, 2013, Medicare applied “the carrot” by offering reimbursements to providers for eligible Transition Care Management services (in the range of $172.66 to $243.60) billed under CPT codes 99495 and 99496. And still, relatively few provider organizations are capitalizing on it.
Many practices lack the resources to perform even the most rudimentary transitional care activities. But over the last 24 months, companies like West have recognized the need in the market and are working hard to deliver solutions that combine patient engagement technology with the human touch to enable providers and their networks to quickly and cost-effectively deliver more robust transitional care services.
Incentives to Improve
With CMS expected to spend well over $1 billion annually on Transitional Care Management payments, the potential up-side incentive for providers working to improve transitional care is significant. But the downside for those who do not is also very real. CMS is ratcheting up readmission penalties to 3% of payments this year and organizations are finding it increasingly difficult to ignore the call.
If you’re the parent of a graduating senior attending college this fall, best of luck in this exciting time of transition! If you’re also responsible for the successful transition of patients from one setting to another, you have your hands full, but perhaps there’s more help out there than you thought. Click here to learn more about West Engagement Center solutions which are focused on patient engagement and activation.