Reducing Inpatient Acute Myocardial Infarction (AMI) Readmissions

Published 10/15/2020

This Electronic Comparative Billing Report (eCBR) focuses on providers that submit claims for AMI 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, a subsidiary of the Hearst Health Network focused on improving the interactions of providers and payers, to facilitate the implementation of evidence-based medicine.

The collaboration will promote the use of information contained in Palmetto GBA’s eCBRs and the MCG Care Guidelines to help hospitals and physicians in A/B MAC Jurisdiction M improve their readmission rates using evidence-based medicine. Palmetto GBA currently uses Comparative Billing Reports (CBRs) as educational tools for providers to give them insights into their billing patterns and utilization of services in comparison to their peers. 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, in this case MCG Care Guidelines.

Providers are encouraged to conduct a self-audit to compare their performance both historically and in comparison, 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.

Palmetto GBA has partnered with MCG, to proactively communicate care guidelines alongside data analysis to increase efficiency and lessen the need for readmission for same/similar diagnoses.

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 at http://www.mcg.com.  

Reducing Inpatient Acute Myocardial Infarction (AMI) Readmissions

For your personalized Acute Myocardial Infarction MCG results Logon to eServices.

Acute Myocardial Infarction (AMI) MCG Category Code (M 230) Defined

MCG Code
Guideline Title
MCG Service Category
MCG Guideline Category
Goal Length of Stay
M-230
Myocardial Infarction
MEDICAL
CARD
Ambulatory or 2 Days

Webinar:  AMI with MCG Webinar

Methods
The metrics reviewed in this CBR are the readmission rates under any diagnoses and the readmission rates under AMI diagnoses. A provider is considered to have an all-inclusive readmission when a beneficiary has been admitted to a hospital under any diagnoses within 30 days after discharge for AMI.

Meanwhile, a provider is considered to have an AMI-specific readmission when a beneficiary has been admitted to a hospital under AMI diagnoses within 30 days after discharge for AMI. The readmission rate for all-inclusive diagnoses or AMI-specific diagnoses are calculated as number of readmissions for all-inclusive diagnoses or AMI-specific diagnoses, over number of all admissions during the past six months, respectively.

For the purposes of this CBR, “peer group” is defined as other providers in the state you are in or Jurisdiction M (JM) that have billed the grouping of MCG category of AMI.

Example of eCBR

eCBR: Reducing Inpatient Acute Myocardial Infarction (AMI) Readmissions