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

HEDIS Measure

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

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of emergency department (ED) visits among members age 13 years and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up. Two rates are reported:

• The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
• The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

Numerator Compliance

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.

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.

For both indicators, any of the following meet criteria for a follow-up:

• Outpatient, Intensive outpatient, partial hospitalization, non-residential substance abuse treatment facility, community mental health center visit or observation visit with any diagnosis of SUD, substance use or drug overdose or a mental health provider
• Peer support service with any diagnosis of SUD, substance use or drug overdose
• Opioid treatment service that bills monthly or weekly with any diagnosis of SUD, substance use or drug overdose
• Telehealth or Telephone visit with any diagnosis of SUD, substance use or drug overdose or with a mental health provider
• E-visit or virtual check-in with any diagnosis of SUD, substance use or drug overdose or with a mental health provider
• A substance use disorder service
• A behavioral health screening or assessment for SUD or mental health disorders
• A substance use service Pharmacotherapy dispensing event or medication treatment event

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 the patient to bring their discharge paperwork to their first appointment
• Educate the patient about the importance of follow-up 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 EHR or develop tracking method for patients due or past due for follow-up after discharge visits and require staff to follow up with patients that miss or cancel their appointment
• Use the same diagnosis for AOD abuse or dependence at each follow-up (a non-mental illness diagnosis code will not fulfill this measure)

Quality Value Set Directory Coding Tips

Per NCQA HEDIS Specifications there are additional codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

AOD Abuse and Dependence

AOD Medication Treatment

Behavioral Health Assessment

BH Outpatient

Community Mental Health Center POS

Non-residential Substance Abuse Treatment Facility POS

Observation

Online Assessments

OUD Monthly Office Based Treatment

OUD Weekly Drug Treatment Service

OUD Weekly Non Drug Service

Outpatient POS

Partial Hospitalization or Intensive Outpatient

Partial Hospitalization POS

Peer Support Services

Substance Induced Disorders

Substance Use Services

Substance Use Disorder Services

Telehealth POS

Telephone Visits

Unintentional Drug Overdose

Visit Setting Unspecified