The following HEDIS® measures assess the percentage of emergency department (ED) visits for which the member received a follow-up appointment within seven days and 30 days of being seen in the ED for mental illness or for alcohol and other drug abuse and dependence.

 

Follow-Up After ED Visit for Mental Illness (FUM)

Evaluates the percentage of ED visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit with any practitioner for mental illness. Two rates are reported. The percentage of ED visits for which the member received:

  1. Follow-up within seven days of the ED visit (8 total days).
  2. Follow-up within 30 days of the ED visit (31 total days).

 

Timely follow-up care for people with mental illness can lead to fewer repeat visits to the ED and improved physical and mental health function.

 

Follow-Up After ED Visit for Alcohol and Other Drug Abuse or Dependence (FUA)

Evaluates the percentage of ED visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow-up visit with any practitioner for AOD. Two rates are reported. The percentage of ED visits for which the member received:

  1. Follow-up within seven days of the ED visit (8 total days).
  2. Follow-up within 30 days of the ED visit (31 total days).

 

According to studies, follow-up care for individuals with AOD who were seen in the ED is associated with reduced substance use, repeat ED visits, and hospital admissions.

 

Helpful tips:

  • Maintain appointment availability for patients with recent ED visits.
  • Assist in scheduling in-person or telehealth follow-up appointments as soon as possible after the ED visit.
  • Use appropriate documentation and correct coding. Use the same diagnosis for mental illness or substance use for follow-up visits (a non-mental health/non-substance diagnosis code will not fulfill the measure).
  • Reference the Plan’s Quality Measures Desktop Reference for Medicaid Providers and the HEDIS Benchmarks and Coding Guidelines for Quality that is provided for coding information.
  • Educate patients on the importance of compliance with their discharge plan and their follow-up appointments.
  • Reach out to patients who cancel their appointments and assist with rescheduling as soon as possible.
  • Facilitate referrals to behavioral healthcare specialists when appropriate.

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

AKY-NU-0344-21



Featured In:
December 2021 Anthem Provider News - Kentucky