Timely Follow-Up (TFU) is one of four ACO REACH quality measures. Pearl’s TFU alerts help practices prioritize patients recently discharged from the hospital who are most likely to count toward this measure.
How TFU alerts work today
TFU alerts identify patients who need a follow-up visit within 7–14 days after a hospital discharge.
These alerts appear in the Prioritized Patient List and Daily Do Now email.
Following the alert guidance helps practices improve continuity of care, reduce readmissions, and strengthen quality performance.
What’s different with expanded TFU alerts
Broader coverage: In the past, some discharges couldn’t be classified as TFU because ADT feeds were missing diagnosis details. Pearl now uses claims history and predictive modeling to identify when these discharges are likely TFU-eligible.
Reclassification, not more work: The overall number of discharge alerts stays the same. More of those discharges now appear as TFU alerts instead of standard Discharge alerts.
Same workflow: No new steps are required. Continue reviewing the discharge summary, contacting patients within 2 days, and scheduling follow-ups within 7–14 days.
Why this matters
More opportunities to support quality performance: With expanded TFU coverage, practices have more chances to complete follow-ups that count toward the CMS Timely Follow-Up measure.
Better outcomes for patients: Timely follow-up reduces complications and avoidable readmissions, helping patients stay healthier at home.
Key takeaway
Expanded Timely Follow Up (TFU) alerts ensure more discharges are captured under the Timely Follow-Up quality measure, without creating additional work. Use these alerts as prompts to deliver timely care and support both patient outcomes and quality performance.
FAQs
Does this mean I’ll see more alerts overall?
No. The total number of discharge alerts stays the same. More of those discharges are now classified as TFU instead of standard Discharge.
Do I need to change my workflow?
No. The workflow remains the same: review the discharge summary, contact patients within 2 days, and schedule follow-ups within 7–14 days.
Does this affect payments or capitation?
No. This enhancement only affects how alerts are classified. The impact is on quality performance and preventing readmissions, not on capitation payments.
Why are more TFU alerts important?
TFU is one of four ACO REACH quality measures. More TFU alerts mean more opportunities to complete follow-ups that count toward this measure, which supports quality scores and shared savings potential.
Do patients notice any changes?
No. Patients don’t see the alerts. What they may experience is better continuity of care through timely outreach and follow-up visits.