Follow Up After People with Complex Conditions Visit Emergency Department

Many patients discharged from the emergency department (ED) require urgent follow-up care with their providers. This is particularly true for patients with high-risk chronic conditions. According to the National Committee for Quality Assurance (NCQA), Medicare beneficiaries are at increased risk following ED visits due to their health status. Adverse health outcomes in this group often persist because ED providers may fail to send medical records to the patients’ outpatient providers following discharge.

The Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC) HEDIS measure offers providers guidance for members 18 years and older who have multiple high-risk chronic conditions, and who had a follow-up service within seven days of an ED visit.

There are many ways to provide follow-up service, including outpatient visits, virtual care visits, behavioral health visits, case management visits, complex care management (CCM) services, transitional care management (TCM) services, and intensive outpatient encounter or partial hospitalization.

We encourage providers to review the Premera tip sheet to learn more about this HEDIS measure. It includes information about focus chronic conditions, exclusions, best practices, and documentation requirements.

Healthcare Effectiveness Data Information Set. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA).