Developing a specialty transition clinic: Inaugural clinical and financial operations.

Purpose: Few examples of hospital-wide transition programs have been presented in the literature and to date, we have no data on the clinical and financial operations of such services. Design and methods: A transition clinic, guided by Got Transition's Six Core Elements, was created for youth with moderate-to-high medical and psychosocial complexity (per Bob's Levels of Social Support scale). The clinic visit and transition readiness assessment (UNC TR Results: In Year 1, the clinic completed 115 appointments (113 unique patients). Most patients were older adolescents/young adults (M = 19.7 ± 1.8 years) and nearly half were Latinx. Patients presented with several complex medical needs including coordination of care across multiple subspecialties, high health care utilization, decision-making determinations, behavioral and mental health concerns, and resource needs. Implementation of the Six Core elements was high (range 99.1%-100%). The average billed per patient was $498 (in 2021-2022 USD). Considering paid and unpaid office visits, we collected an average of 31.6 cents on the dollar. Almost 80% of office visit claims and 21.9-33.3% of transition readiness assessments were paid by insurers. Patient/parent satisfaction was high, with over 90% of families reporting that they learned something, knew one thing they could do to improve transition readiness, and were able to get their questions asked and answered. Conclusions: Transition clinics may never be fully self-sustainable given low collection rates and inability to capture extra charge codes related to chronic care management and transitional care. However, our collection rate was on-par with the collection rate for our hospital's subspecialty clinics and we show it is possible to receive some funding from insurers.