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Follow-Up After Emergency Department Visit for Substance Use (FUA)

What is the FUA — HEDIS® Measure?

Based on current NCQA HEDIS recommendations for best practices, members ages 13 and older with a principal diagnosis of Substance Use Disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up during the measurement year:

7-Day Follow-Up

A follow-up visit with any practitioner, with a principal diagnosis of SUD within seven days of the emergency department (ED) visit (eight total days)

  • Per HEDIS specifications, include visits that occur on the date of the ED visit

30-Day Follow-Up

A follow-up visit with any practitioner, with principal diagnosis of SUD within 30 days of the ED visit (31 total days)

  • Per HEDIS specifications, include visits that occur on the date of the ED visit

Best Practices:

  • Schedule follow-up appointments as soon as possible, particularly those patients recently discharged from the ED.
  • Train patients and staff on the “Teach-Back Method” to ensure patients and caregivers review and understand discharge instructions and the next steps in their care for follow-up.
  • Encourage patients to bring their discharge paperwork to their first appointment.
  • Educate patient about the importance of follow-up care and adherence to treatment recommendations.
  • Outreach to patients who cancel appointments and assist them with rescheduling as soon as possible.
  • Set flags, if available, in electronic health records or develop a tracking method for patients due or past due for follow-up after discharge visits.
  • Use the same diagnosis for SUD at each follow up (a non-mental illness diagnosis code will not fulfill this measure).
  • Coordinate care with other behavioral health and/or Primary Care Physicians by sharing progress notes and updates.

NCQA HEDIS Population Definition for This Measure

Population: Members ages 13 years and older on the date of the ED visit with a principal diagnosis of SUD or any diagnosis of drug overdose on or between January 1 and December 1 of the measurement year.

Line of Business: Commercial, Medicaid, Medicare

To learn more about your practice’s current HEDIS performance, 2022 HEDIS Value sets for this or other measures, or for assistance in compliance with the HEDIS guidelines, please email BH_HEDISTeam@HorizonBlue.com or visit https://www.horizonblue.com/providers/resources/guidelines/hedis-measurement-year-my-2022-provider-tips-optimizing-hedis-results

Reference: Follow-Up After Emergency Department Visit for AOD Abuse or Dependence (FUA), NCQA HEDIS 2022 Tech Specifications