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

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

Lucet is committed to working with participating physicians to improve the quality of care for members. Research suggests that follow-up care for people with mental illness is linked to fewer repeat ED visits, improved physical and mental function and increased compliance with follow-up instructions. 1,2,3

To evaluate performance on important care and service measures, we use the Healthcare Effectiveness Data and Information Set (HEDIS®) tool developed by the National Committee for Quality Assurance (NCQA®). This bulletin provides information about a HEDIS measure concerning the importance of follow-up visits for members with a principal diagnosis of mental illness after being seen in the Emergency Department (ED).

Meeting the Measure: Measurement Year 2024 HEDIS Guidelines

The measure assesses ED visits for adults and children 6 years of age and older with a principal diagnosis of mental illness or with a principal diagnosis of intentional self-harm plus a secondary diagnosis of a mental health disorder and who received a follow-up visit for mental illness with any health care practitioner preferably within 7 days but no later than 30 days of the ED visit.

Note: Follow-up visits may occur on the same date of the ED visit.

Two rates are reported:

  • Emergency Department visits for which member received follow-up within 7 days of the ED visit (8 total days)
  • Emergency Department visits for which member received follow-up with 30 days of the ED visit (31 days total)

The measure does not apply to members admitted to inpatient or residential treatment within 30 days of the ED visit. It also does not apply to members in hospice or members with a principal diagnosis of substance use disorder.

Any of the following qualifies as a follow-up visit (with a principal diagnosis of a mental health disorder or with a principal diagnosis of intentional self-harm plus a secondary diagnosis of a mental health disorder):

  • Observation
  • Partial hospitalization
  • Intensive outpatient
  • Electroconvulsive therapy
  • Behavioral health outpatient
  • Primary Care outpatient
  • Mental health outpatient
  • Community mental health center
  • Telehealth
  • Telephone
  • On-line assessment (E-visit or virtual check-in)

You can help

Emergency Department

  • Talk about the importance of follow-up to help the member engage in treatment.
  • Assist the member with coordination of care by providing appropriate referrals and helping with scheduling.
  • Make sure that the member has an appointment scheduled; preferably within 7 days but no later than 30 days of the ED visit. Tip: Schedule the follow-up visit within 5 days of the ED visit to allow flexibility in rescheduling within 7 days of the ED visit.
  • Before scheduling an appointment, verify with the member that it is a good fit considering things like transportation, location and time of the appointment.
  • Involve the member’s support system such as spouse, parent, or guardian regarding the follow-up plan after ED visit, if applicable.

Follow-up Provider

  • Call to remind the member a day or two before the appointment
  • Reach out to the member within 24 hours if the member does not keep the scheduled appointment to reschedule.
  • In interactions with the member, emphasize your caring support and the importance of follow up for the best treatment outcome for the member.
  • Provide timely submission of claims with the correct service coding and principal diagnosis.
  • Prioritize follow-up appointment availability for members with recent ED visits.
  • Reinforce the treatment plan and evaluate the medication regimen considering presence/absence of side effects etc.
  • If the appointment doesn’t occur within the first 7 days, schedule within 30 days of the ED visit.

Both Emergency Department and Follow-up Provider

  • Always express support, empathy, and the shared objective of helping the member
  • Identify and address any barriers to the member keeping the appointment.
  • Provide reminder calls to confirm the appointment.
  • Encourage communication between the behavioral health specialist and Primary Care Physician (PCP).
  • Ensure that the member has a PCP and that care transition plans with the PCP are shared.

Lucet is here to help

If you need to refer a member or receive guidance on appropriate services, please call us at 877-206-4865.

While we encourage providers to help members with a referral at the time of service for best results and compliance, members can contact Lucet directly.

  • Ask them to call the Customer Services telephone number on the back of their insurance card.

References

1. Bruffaerts, R.., Sabbe, M., Demyffenaere, K. (2005). Predicting Community Tenure in Patients with Recurrent Utilization of a Psychiatric Emergency Service. General Hospital Psychiatry, 27, 269-74

2. Griswold, K.S., Zayas, L.E., Pastore, P.A., Smith, S.J., Wagner, C.M., Servoss, T.J. (2018) Primary Care After Psychiatric Crisis: A Qualitative Analysis. Annals of Family Medicine, 6 (1), 38-43. doi:10.1370/afm.760.

3. Kyriacou, D.N., Handel, D., Stein, A.C., Nelson, R.R. (2005). Brief Report: Factors Affecting Outpatient Follow-up Compliance of Emergency Department Patients. Journal of General Internal Medicine, 20(10), 938-942. doi:10.1111/j.1525-1497.2005.0216_1.x.


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