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

What is the FUA — HEDIS® Measure?

Based on current 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 or a pharmacotherapy dispensing event within 7 days after the ED visit (8 total days). Include visits and pharmacotherapy events that occur on the date of the ED visit.

30-Day Follow-Up

A follow-up visit or a pharmacotherapy dispensing event within 30 days after the ED visit (31 total days). Include visits and pharmacotherapy events 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.
• Consider social determinants of health (SDOH) factors as possible barriers to health equity.
• 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. Members in this population will be stratified by race and ethnicity.

Line of Business: Commercial, Medicaid, Medicare

To learn more about your practice's current HEDIS performance, 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 Provider Tips for Optimizing HEDIS Results Booklet.