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Transitions of Care – Inpatient Notification

Advantage MD Provider Specialty: PCP, OCP. Members age 18 years and older.

The percentage of acute and non-acute discharges, on or between January 1 and December 1 of the Measurement Year, for members 18 years of age and older. Inpatient Notification is one of the four rates reported for the TRC Measure. Requires documentation of receipt of notification of inpatient admission on the day of admission through 2 days after the admission (3 days total).

Administrative reporting is not available for this indicator.

Best Practice and Measure Tips

Documentation sent to the member's PCP or OCP must include dated evidence of receipt of notification of inpatient admission of the day of admission through 2 days after admission from one of the following sources:

  • Communication between inpatient providers or staff and the member's PCP or ongoing care provider (e.g., phone call, email, fax).
  • Communication about admission between emergency department and the member's PCP or ongoing care provider (e.g., phone call, email, fax).
  • Communication about admission to the member's PCP or ongoing care provider through a health information exchange; an automated admission or discharge and transfer (ADT) alert system.
  • Communication about admission with the member's PCP or ongoing care provider through a shared electronic medical record (EMR) system. Received date is not required in a shared EMR system. File date, date "in basket," or date information was accessible to PCP/OCP can be used.
  • Communication about admission to the member's PCP or ongoing care provider from the member's health plan. The member's PCP or ongoing care provider admitted the member to the hospital. Specialist admitted the member to the hospital and notified the member's PCP or ongoing care provider.
  • The PCP or ongoing care provider placed orders for tests and treatments any time during the member's inpatient stay.
  • Documentation that the PCP or ongoing care provider performed a preadmission exam or received communication about a planned inpatient admission.
  • May be performed/received prior to admission and must be clearly related to the inpatient admission stay.

Not Acceptable:

  • Provider sending the member to the ED.
  • Documentation that the member or member's family notified the member's PCP or OCP of admission.

Note: Admission is defined as the date of the inpatient admission or the date of admission when an observation stay turns into an inpatient admission.

Measure Exclusions

Required Exclusion: Hospice

Measure Codes

Administrative reporting is not available for this indicator.