💡 What is Transitional Care Management?

Transitional Care Management is a Medicare-supported service that provides ongoing medical guidance and support during the 30 days after you’re discharged from a hospital, rehab, or skilled nursing facility.

This service is led by your healthcare provider and care team, who work closely with you to:

• Review your discharge plan and medications
• Coordinate follow-up appointments and referrals
• Monitor symptoms and address any complications
• Help prevent unnecessary ER visits or readmissions
• Ensure your recovery stays on track

👩‍⚕️ Who Is TCM For?

You may qualify for TCM if you were recently discharged from:

• A hospital (inpatient or observation stay)
• A skilled nursing facility or rehabilitation center
• A psychiatric or long-term acute care hospital

This service is ideal if you have chronic conditions, recent surgery, or need additional care coordination to stay safe and supported at home.

🛠️ What’s Included in Our TCM Program?

✔️ A follow-up phone call within 48 hours of discharge
✔️ A face-to-face or telehealth visit within 7–14 days
✔️ Personalized medication review and reconciliation
✔️ Coordination with specialists, home health, pharmacies, and family
✔️ Education about warning signs and when to seek help

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🗓 Ready to Enroll or Have Questions?

If you’ve recently been discharged from the hospital or care facility, you may be eligible for TCM services through our clinic.

📞 Contact us today to get started with Transitional Care Management.
We’ll help ensure your next chapter in care is smooth, safe, and successful.