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Keywords

Transition, billing, operations, outpatient

Abstract

Introduction: Coordinating smooth patient transitions remains a growing area of interest among healthcare professionals in light of the addition of the Readmission Reductions Program to the Affordable Care Act, which enables CMS to penalize hospitals for 30-day readmissions due to myocardial infarction, pneumonia, heart failure, and in due time, COPD. 2 Many facilities have tested varying TOC models previously piloted at other institutions, focusing on ensuring the proper measures are in place before patients depart. However, there is a significant lack in data quantifying the rate of timely patient follow up after discharge, despite the evidence supporting the value of this visit. The purpose of this study is to analyze TOC outcomes at a local family medicine clinic to assess potential lack of billing utilization and gaps of care related to patient follow up.

Methods: The investigators were provided with emergency department discharge charts from the local hospital affiliated with the family medicine clinic; discharge dates ranged from April 2014 to August 2014. Discharge charts were analyzed to establish medical complexity. Investigators used electronic medical records to extract descriptive data to analyze patient and financial outcomes. A subgroup analysis was performed utilizing a subset of patients identified as “established” at the clinic.

Results: A total of 317 unique discharge reports were evaluated, with 104 of those in the “established” patient subgroup. During the study period, 8.8% of the total group of patients demonstrated timely follow-up. Additionally, rate of incorrect billing techniques was 79%. A consequence of the low percentage of patient follow up and improper billing is missed revenue opportunity for the clinic; financial consequences range from $3,248.60-$67,150 over the 5 month period.

Conclusion: A coordinated outpatient TOC procedure cannot be determined from this study. However, need for further analysis of outcomes at outpatient facilities has been identified.

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