The weeks after a hospital stay matter.
Major hospital systems have asked Synergy Health 360 to help manage their patients, using transitional care management (TCM) and wellness services with the goal of avoiding hospital and ER admissions.
What transitional care management includes
- Contact with you or your caregiver within two business days of discharge, by phone, electronically or in person
- An office visit within 7 or 14 days of discharge, depending on the complexity of your care
- A review of your medications, completed on or before that visit
- A review of your discharge records, plus follow-up on tests and treatments
- Coordination with your other providers, referrals and community resources
- Education and support for you and the people caring for you
Care that continues after the first 30 days
Transitional care covers the 30 days after discharge. From there, primary care, chronic-condition management and wellness services keep your care connected in one practice.
Coverage
Medicare may cover transitional care management for eligible patients. Call the practice to confirm your coverage and any visit costs.
Hospitals, ERs and rehabs
See how we work with hospital systems, ERs and rehabs, or call 480-553-6168.
For a medical emergency, call 911.