New HEDIS measure: Follow-up after emergency department visit is key to good patient care

Many patients discharged from the emergency department require urgent follow-up care with their providers due to high-risk chronic conditions. Often, an ED discharge is based on the presumption of continued care, and if it doesn’t happen, problems can arise.

The Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) is a new HEDIS^® measure that is also a Medicare Star Ratings measure. It focuses on the percentage of members ages 18 and older who have multiple high-risk chronic conditions and who had a follow-up visit within seven days of an emergency department visit.

There are many ways to conduct a follow-up visit, including:

• Outpatient visit
• By telephone
• Through Transitional Care Management, case management or complex care management
• Outpatient or telehealth behavioral health visit
• Intensive outpatient encounter or partial hospitalization
• Community mental health center visit
• Through electroconvulsive therapy
• Through a telehealth appointment, observation stay, e-visit or virtual check-in

Read this tip sheet to learn more about this measure, including information about eligible chronic conditions, exclusions, best practices, documentation requirements and more.  

HEDIS^®, which stands for Healthcare Effectiveness Data Information Set, is a registered trademark of the National Committee for Quality Assurance, or NCQA.