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Emergency Department Toolkit

Follow-Up after Emergency Department Visit for Substance Use (FUA)

New Directions Behavioral Health® is committed to working with participating physicians to improve the quality of care for members. In 2016, 20.1 million Americans over 12 years of age (about 7.5% of the population) were classified as having a substance use disorder involving alcohol or other drugs.1 High ED use for individuals with SUD may signal a lack of access to care or issues with continuity of care.2 Timely follow-up care for individuals with SUD who were seen in the ED is associated with a reduction in substance use, future ED use, hospital admissions and bed days.3,4,5

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 Substance Use Disorder (SUD) or any diagnosis of drug overdose after being seen in the Emergency Department (ED).

Meeting the Measure: Measurement Year 2022 HEDIS Guidelines

Assesses ED visits for members 13 years of age and older with a principal diagnosis of SUD, or any diagnosis of drug overdose, who had a follow-up visit or a pharmacotherapy dispensing event for SUD, substance use, or drug overdose with any health care practitioner preferably within 7 days but no later than 30 days of the ED visit.

Note: Follow-up visits and pharmacotherapy dispensing events 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 does not apply to members in hospice or to members with a principal diagnosis of mental illness disorder or intentional self-harm.

Any of the following qualifies as a follow-up visit (with a principal diagnosis of SUD, substance use, or drug overdose):
  • Observation
  • Partial hospitalization
  • Intensive outpatient
  • Outpatient
  • Behavioral health outpatient
  • Primary Care outpatient
  • Medication assisted treatment
  • 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 ED visit to allow flexibility in rescheduling within 7 days of 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 appointment doesn’t occur within the first 7 days, schedule within 30 days of 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 their 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.

New Directions 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 New Directions directly.
  • Ask them to call the Customer Services telephone number on the back of their insurance card.
  • Access New Directions’ Substance Use Disorder Resource Center: https://www.ndbh.com/Resources/SubstanceUseCenter
  • For substance use disorder specifically, members may call our member SUD Hotline at (877) 326-2458. The Clinical 365 team staffs the SUD Hotline and is comprised of licensed clinicians who are available 24 hours a day, 7 days a week. A licensed team member will take time to fully understand and assess potential treatment needs, provide information regarding treatment options, and assist in searching for the right provider for the member.
Medication assisted treatment (MAT) prescriptions are considered one of the appropriate forms of follow up. The medications are listed below. If you/your provider group does not prescribe MAT, please contact New Directions for assistance with locating a participating MAT provider.

Alcohol or other drug abuse disorder or dependence (AOD) or opioid use disorder (OUD) weekly drug treatment
Description Prescription
Aldehyde dehydrogenase inhibitor Disulfiram (oral)
Antagonist Naltrexone (oral and injectable)
Other Acamprosate (oral and delayed-release tablet)

Opioid use disorder (OUD) treatment medications
Description Prescription
Antagonist Naltrexone (oral and injectable)
Partial agonist Buprenorphine (sublingual tablet, injection, or implant)1
Buprenorphine/naloxone (sublingual tablet, buccal film, sublingual film)
1Buprenorphine administered via transdermal patch or buccal film are not included because they are FDA-approved for the treatment of pain, not for opioid use disorder. Methadone is not included on the list for this measure. Methadone for OUD administered or dispensed by federally certified opioid treatment programs (OTP) is billed on a medical claim. A pharmacy claim for methadone would be indicative of treatment for pain rather than OUD.

References:

  1. Substance Abuse and Mental Health Services Administration. (2017). Key substance use and mental health indicators in the United States: Results from the 2016 National Survey on Drug Use and Health (HHS Publication No. SMA 17-5044, NSDUH Series H-52). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/
  2. New England Health Care Institute (NEHI). 2010. “A Matter of Urgency: Reducing Emergency Department Overuse, A NEHI Research Brief.” Available from URL: http://www.nehi.net/writable/publication_files/file/nehi_ed_overuse_issue_brief_032610finaledits.pdf.
  3. Kunz, F.M., French, M.T., Bazargan-Hejazi, S. (2004). Cost-effectiveness analysis of a brief intervention delivered to problem drinkers presenting at an inner-city hospital emergency department. Journal of Studies on Alcohol and Drugs, 65, 363-370.
  4. Mancuso, D., Nordlund, D.J., Felver, B. (2004). Reducing emergency room visits through chemical dependency treatment: focus on frequent emergency room visitors. Olympia, Wash: Washington State Department of Social and Health Services, Research and Data Analysis Division.
  5. Parthasarathy, S., Weisner, C., Hu, T.W., Moore, C. (2001). Association of outpatient alcohol and drug treatment with health care utilization and cost: revisiting the offset hypothesis. Journal of Studies on Alcohol and Drugs, 62, 89-97.
  6. NCQA: https://www.ncqa.org/hedis/measures/follow-up-after-emergency-department-visit-for-alcohol-and-other-drug-abuse-or-dependence/

Resources

Substance Use
ED Follow-up (FUA)
Mental Illness
ED Follow-up (FUM)
Care Management
Services and Referrals
Coordination
of Care
Substance Use
Disorder Toolkit