Effectiveness of Transitional Clinic Innovations on Medicare A, B, and C Reimbursement and Cost-Saving

Abstract

Medicare A reimbursement for inpatient hospitalization (the “two-midnight” rule) is based on the prospective payment system by diagnosis-related group, which incentivizes organizations to reduce costs per each service provided. At our institution, we established a post-discharge clinic (PDC) that incorporates transitional interventions without incurring significant expenses, utilizing leadership and networking with internal stakeholders. This article presents those post-discharge interventions and their impact on reimbursement and cost-saving for healthcare facilities and patients. Our evaluation assessed the operational costs, the cumulative reduction in readmission and emergency department return visits over the past three years, and the cost savings associated with the PDC interventions. Our findings indicate that individuals who have received care at the PDC demonstrate lower readmission and emergency department return rates within the high-risk category compared with those who have not received care at the PDC.