Reducing Inpatient Atrial Fibrillation (A-fib) Readmissions

Published 08/27/2021

This electronic Comparative Billing Report (eCBR) focuses on providers who submit claims for atrial fibrillation (A-fib) 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 the 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 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 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.

Reducing Inpatient Atrial Fibrillation (A-fib) Readmissions
Log on to eServices for your personalized Atrial Fibrillation MCG results

Atrial Fibrillation MCG Category Code (M 505) Defined 

MCG Code

Guideline Title

MCG Service Category

MCG Guideline Category

Goal Length of Stay

M-505

Atrial Fibrillation

MEDICAL

CARD

Ambulatory or 1 Days

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

Below is an example of eCBR Results that can be viewed using the eServices portal: 

Example of eCBR Results for Reducing Inpatient Atrial Fibrillation (A-fib) Readmissions