Reducing Inpatient Lower Gastrointestinal (GI) Bleed Readmissions

Published 09/16/2021

This electronic Comparative Billing Report (eCBR) focuses on providers who submit claims for lower gastrointestinal (GI) bleed 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.

We are collaborating with MCG Health, a subsidiary of the Hearst Health Network, to 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 the same/similar diagnoses.

The information contained in our eCBRs and the MCG Care Guidelines will help hospitals and physicians in A/B MAC Jurisdiction M improve their readmission rates. We currently use eCBRs as educational tools to give providers insight into their billing patterns and utilization of services. eCBRs are available to our providers via the eServices provider portal where they can 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 our 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 at http://www.mcg.com.

Reducing Inpatient Lower Gastrointestinal (GI) Bleed Readmissions
For your personalized Lower Gastrointestinal (GI) Bleed MCG results Logon to eServices.

Lower Gastrointestinal (GI) Bleed MCG category code (M 182) Defined 

MCG Code

Guideline Title

MCG Service Category

MCG Guideline Category

Goal Length of Stay

M-182

Gastrointestinal Bleeding, Lower

Medical

GI

Ambulatory or 2 Days

Methods
The metrics reviewed in this CBR are the readmission rates under all diagnoses and the readmission rates under lower GI bleed 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 lower GI bleed. Additionally, a provider is considered to have a lower GI bleed specific readmission when a beneficiary is admitted to a hospital under lower GI bleed diagnoses within 30 days after discharge for lower GI bleed. The readmission rate for all-inclusive diagnoses or lower GI bleed specific diagnoses are calculated as the number of readmissions for all-inclusive diagnoses or lower GI bleed specific diagnoses, over the 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 lower GI bleed.

Example of eCBR Results from eServices 

eCBR Results from eServices for Lower GI Bleed Readmissions