Objectives: A reimbursement model for a multidisciplinary young adult diabetes clinic supporting pediatric to adult transition of care was examined.
Method: In approximately one year (Dec 2017-Oct 2018), 31 patients with type 1 diabetes (T1D; ages 17-25; 56% males, Hemoglobin A1C ranged from 6.0 to >14.0 (M=9.44, SD=2.07) were billed for attending a Young Adult Diabetes Clinic. Data were extracted via electronic medical record. Reimbursement rates, as noted by Got Transition and American Academy of Pediatrics for Medicare 2018, were used to assess financial sustainability.
Results: Services billed included a 45-minute behavioral health group intervention (96153), emotional/behavioral (96127) and substance use questionnaires (96160). This was followed by a 25 minute diabetes education visit (G0108), a 10 minute warm hand off and a 25 minute medical provider visit (99203). Medical CPT Codes (99213, 99205, and 99204) were reimbursed 76% of the time, producing wRVUs of approximately 50. Behavioral health CPT codes (96150, 96152, and 96127) were reimbursed 46% of the time and produced wRVUs of approximately 14. Approximately $8300 was billed for the half-day clinic over the course of 11 months. Approximately $5700 was returned (68% return rate) and wRVUs were around 70. More than 50% of the patients who agreed to attend the clinic also established ongoing clinical services. The clinic model also supported only 10% of patients being lost to follow-up compared to higher rates previously predicted in the literature.
Conclusions: The half-day, once a month, multidisciplinary transition clinic designed to support transition-age youth with T1D yielded additional funds and increased youth engagement. While not highly lucrative, this may be due to antiquated billing infrastructure and a small sample size. Future studies are needed to assess the link between outpatient engagement, billing, and reduced health crises, hospitalizations and related costs.
F. Joarder: None. H. Nagra: None. L. Andreas: None. L. Rocha: None. K. Kraus: None.