Follow-Up After Emergency Department Visit for Mental Illness (FUM)

HEDIS Measure

Follow-Up After Emergency Department Visit for Mental Illness (FUM)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of emergency department (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 for mental illness.

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 with any practitioner, with a principal diagnosis of a mental health disorder or with a principal diagnosis of intentional self-harm and any diagnosis of a mental health disorder within 30 days after the ED visit (31 total days). Include visits that occur on the date of the ED visit.

7-Day Follow-Up - A follow-up visit with any practitioner, with a principal diagnosis of a mental health disorder or with a principal diagnosis of intentional self-harm and any diagnosis of a mental health disorder within 7 days after the ED visit (8 total days). Include visits that occur on the date of the ED visit.

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

• Outpatient, BH outpatient visit, intensive outpatient encounter, partial hospitalization or community mental health center visit with a principal diagnosis of a mental health disorder.
• Electroconvulsive therapy with a principal diagnosis of a mental health disorder
• Telehealth, observation, telephone, e-visit, virtual check- in visit with a principal diagnosis of a mental health disorder
• Outpatient visit, intensive outpatient encounter, partial hospitalization or community mental health center visit, with a principal diagnosis of intentional self-harm, with any diagnosis of a mental health disorder
• Electroconvulsive therapy with a principal diagnosis of intentional self-harm, with any diagnosis of a mental health disorder
• Telehealth, observation, telephone, e-visit or virtual check-in with a principal diagnosis of intentional self-harm, with any diagnosis of a mental health disorder

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
• Coordinate care with behavioral health practitioners by sharing progress notes and updates
• Outreach 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 mental illness at each follow up (a non-mental illness diagnosis code will not fulfill this measure)

Quality Value Set Directory Coding Tips

Ambulatory Surgical Center POS

BH Outpatient

Community Mental Health Center POS

Electroconvulsive Therapy

Intentional Self-Harm

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

Mental Health Diagnosis

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

Observation

Online Assessments

Outpatient POS

Partial Hospitalization or Intensive Outpatient

Partial Hospitalization POS

Telehealth POS

Telephone Visits

Visit Setting Unspecified