Global Transitional Care

As a certified Medicare provider, Global Transitional Care (GTC) is the pioneer and leader in bridging the care gap after an inpatient discharge.

What Is Transitional Care?

Transitional Care is a NEW Medicare Benefit that provides clinical oversight and coordination to patients at home after being discharged from a hospital, skilled nursing facility or rehabilitation facility.  Clinical oversight occurs for 30 days from the date of discharge and is available to the patient and their family from GTC – 24 hours a day, 7 days a week.

What Does GTC Do?

Your personal certified Clinical Transitional Care Team, comprised of a Nurse Practitioner and Registered Nurse, overseen by a physician, meets with you and your family before or soon after your discharge date, to assess your individual post-discharge needs.

Optimally, this first visit will occur while you are still an in-patient and will require a consent form.  Your treatment plan is coordinated in conjunction with your hospital and primary care providers.  Your personal Clinical Transitional Care Nurse (TCN) will help you with everything from medical oversight, home care coordination, understanding your condition, coordination of follow-up appointments and communicates with your Provider(s) and all necessary resources needed to help you manage your health condition at home.  In addition, GTC can recommend Home Care (Caregiver) support or Home Health (Nursing Orders), if needed.

Your TCN is on call for you by telephone and e-mail.  Most importantly, your TCN communicates with your doctor(s) and any other healthcare team members to make sure everyone is up to date on your condition with real-time information and/or changes.

If there are ANY concerns or changes in your condition, your TCN alerts your physician(s).

How Can You Access GTC Transitional Care?

As a certified Medicare Provider (just like your doctor), you don’t need a referral. You can sign-up for GTC Transitional Care services directly. Transitional Care is a covered Medicare benefit. There is no cost to you other than your standard copay.

For more information, please fill out the form on this page, or contact us directly by phone at 949-679-3210.

You can also ask your doctor about GTC Transitional Care. If they do not know us yet, just let us know and we will be happy to introduce ourselves!

What To Expect

• A day or so before your discharge from the facility, your TCN will visit you to make an initial assessment.
• After you get home, your TCN will call to check on you.
• One of GTCs Nurse Practitioners will be visiting you in your home within a fews days after your discharge.
• After your initial visit, your Nurse Practitioner will determine how often you will have home visits.
• During your first 30 days at home, your TCN will be available by phone and email for any questions or concerns whenever you need them.
• Your TCN will also be communicating with your doctor and any other healthcare providers on your team, to keep them up to date.

What Do We Help You With?

• Review of discharge process and treatment regimen
• Recovery process review
• Medication reconciliation and new prescription review
• Follow up appointments, assist as needed
• Caregiver/community resource assistance as needed
• Any other patient education as needed, including symptom management and what to report
• Discuss next steps and set up nurse practitioner home visits

Is There A Cost?

Medicare Covered Patients

GTC Transitional Care is a certified Medicare Provider. Self-refer and GTC takes care of the paperwork; Transitional Care is a covered Medicare benefit. There is no cost to you other than your standard copay.

Private Pay

If you are not Medicare eligible or want to contract privately with GTC Transitional Care and Health Advocacy services, we offer our 30-day service at an affordable private pay option, which is eligible for section 125 healthcare reimbursement accounts. Medicare patients have an option to extend Transitional Care services past the 30-day period. Contact GTC for more details:

[email protected]
949-679-3210

Oncology

Cancer treatment can be challenging in many ways. Let GTC Transitional Care help you through the first 30 days of your care after inpatient hospitalization. We can help you manage every aspect of your care, any side effects from treatment and help avoid complications. We educate when needed and answer questions along the way. We keep in touch with your doctor and care team throughout our time with you, to make sure everyone is on the same page with information and alerted to any concerns or issues.

We are your health advocate so you can focus on what is most important — healing.