Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

HEDIS Measure

Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

Line of business: Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of emergency department (ED) visits for members 18 years of age and older who have multiple high-risk chronic conditions who had a follow-up service within 7 days of the ED visit.

Numerator Compliance

A follow-up service within 7 days after the ED visit (8 total days).

Include visits that occur on the date of the ED visit. The following meet criteria for follow-up:

• An outpatient visit
• A telephone visit
• Transitional care management services
• Case management visits
• Complex Care Management Services
• An outpatient or telehealth behavioral health visit with Outpatient POS
• An outpatient or telehealth behavioral health visit
• An intensive outpatient encounter or partial hospitalization with Partial Hospitalization
• An intensive outpatient encounter or partial hospitalization
• A community mental health center visit with Community Mental Health Center POS
• Electroconvulsive therapy with Ambulatory Surgical Center, Community Mental Health Center POS, Outpatient POS or Partial Hospitalization POS
• A telehealth visit with Telehealth POS
• An observation visit
• A substance use disorder service
• An e-visit or virtual check-in
• A domiciliary or rest home visit

Best Practices

• Educate the patient about the importance of follow-up and adherence to treatment recommendations
• Discuss the importance of timely, recommended follow-up visits
• Schedule follow-up appointments as soon as possible, particularly those patients recently discharged
• 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
• Consider telemedicine visit when in-person visits are not available
• Discuss the importance of seeking follow-up with a mental health provider
• Develop outreach internal team and/or assign care/case managers to members to ensure members keep follow-up appointments or reschedule missed appointments
• Set flags if available in EHR or develop tracking method for patients who may need screenings and follow-up visits

Quality Value Set Directory Coding Tips

Ambulatory Surgical Center POS

BH Outpatient

Case Management Encounter

Community Mental Health Center POS

Complex Care Management Services

Domiciliary or Rest Home Visit

Electroconvulsive Therapy

Observation

Online Assessments

Outpatient

Outpatient POS

Partial Hospitalization or Intensive Outpatient

Partial Hospitalization POS

Substance Use Disorder Services

Telehealth POS

Telephone Visits

Transitional Care Management Services

Visit Setting Unspecified