Reducing Inpatient Acute Diverticulitis Readmissions

This electronic Comparative Billing Report (eCBR) focuses on providers that submit claims for acute diverticulitis and experience unplanned hospital readmissions. eCBR information is one of the many tools used by Palmetto GBA to assist individual providers in identifying variation and improving performance. Palmetto GBA is collaborating with MCG Health, a subsidiary of the Hearst Health Network. Our focus is on improving the interactions of providers and payers, and facilitating the implementation of evidence-based medicine. The goal is to proactively communicate care guidelines alongside data analysis to increase efficiency and lessen the need for readmission for same or similar diagnoses.

The information contained in Palmetto GBA’s eCBRs and the MCG Care Guidelines will help hospitals and physicians in A/B MAC Jurisdiction M improve their readmission rates. Palmetto GBA currently uses eCBRs as educational tools to give providers insight into their billing patterns and utilization of services. eCBRs are available to Palmetto GBA providers via the eServices provider portal where they have the ability to view and download their individual eCBRs. The eCBR displayed includes links to additional education material, including MCG Care Guidelines. 

Providers are encouraged to conduct self-audits to compare their performance to others in their respective states and A/B MAC Jurisdictions. The collaboration with MCG will enhance the educational information available to both hospitals and physicians and establish a common language via the eCBR platform. Based on Palmetto GBA’s experience working with both physicians and institutional providers, this level of communication among physicians, hospitals and payers will be required to sustainably improve the performance of our healthcare system.

MCG’s Inpatient and Surgical Care guidelines provide evidence-based criteria and other tools for efficient review of utilization and documentation of medical necessity, making it a valuable resource for proactive care management and assessment of patients facing hospitalization or surgery. The guidelines are designed to be used in conjunction with a provider’s clinical judgment. Please visit MCG’s website for additional information.

For your personalized Acute Diverticulitis MCG results log on to eServices.

Acute Diverticulitis MCG Category Code (M-150) Defined 

Methods
The metrics reviewed in this CBR are the readmission rates under any diagnoses and the readmission rates under acute diverticulitis diagnoses. A provider is considered to have an all-inclusive readmission when a beneficiary is admitted to a hospital under any diagnoses within 30 days after discharge for acute diverticulitis. A provider is considered to have an acute diverticulitis-specific readmission when a beneficiary is admitted to a hospital under acute diverticulitis diagnoses within 30 days after discharge for acute diverticulitis. The readmission rate for all-inclusive diagnoses or acute diverticulitis-specific diagnoses are calculated as the number of readmissions for all-inclusive diagnoses or acute diverticulitis-specific diagnoses, over number of all admissions during the past six months, respectively. For this CBR, “peer group” is defined as other providers in your state or Jurisdiction M (JM) that have billed the grouping of MCG category of acute diverticulitis.

Example of eCBR