Assesses emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, who had a follow up visit for SUD.
Two rates are reported:
- ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
- ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).
Why It Matters
In 2022, 48.7 million Americans over 12 years of age (about 17.3% of the population) were classified as having an SUD.1 Between 2018 and 2021, the use of ED services for substance use increased 39%, and the rate of ED visits related to substance use went up from 74.4 to 103.8 visits per 10,000 individuals.2 The ED plays a crucial role in helping individuals with substance use by providing immediate care and timely diagnosis, and connecting individuals to further care.3 This measure focuses on making sure that people leaving the ED after a high-risk substance use event get coordinated care, because they might be at a higher risk of losing touch with the health care system.
Results – National Averages
Follow-Up Within 7 Days of ED Visit (Total)
| Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 21.6 | 20.8 | 25 | 25 | 23.1 |
| 2021 | 11.8 | 11 | 13.4 | 11.4 | 11 |
| 2020 | 12.7 | 11.6 | 13.8 | 11.0 | 9.7 |
| 2019 | 11.3 | 10.5 | 13.3 | § | § |
| 2018 | 11.3 | 9.9 | 13.0 | 8.9 | 7.7 |
| 2017 | 10.9 | 10.1 | 12.2 | 8.4 | 8.3 |
Follow-Up Within 30 Days of ED Visit (Total)
| Year | Commercial HMO | Commercial PPO | Medicaid HMO | Medicare HMO | Medicare PPO |
|---|---|---|---|---|---|
| 2022 | 32 | 31.5 | 36.4 | 38.4 | 35.6 |
| 2021 | 16.2 | 15.2 | 19.8 | 16.8 | 15.9 |
| 2020 | 17.2 | 15.7 | 20.2 | 16.1 | 13.7 |
| 2019 | 15.2 | 14.2 | 19.6 | § | § |
| 2018 | 15.5 | 13.9 | 19.2 | 13.0 | 10.9 |
| 2017 | 15.0 | 13.8 | - | 12.2 | 11.8 |
§ Not available due to CMS suspension of data reporting during COVID-19 pandemic.
This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.
Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via my.ncqa.org for analysis that accounts for trend breaks.
References
- Substance Abuse and Mental Health Services Administration. 2023. “Key Substance Use and Mental Health Indicators in the United States: Results from the 2022 National Survey on Drug Use and Health.” HHS Publication No. PEP23-07-01-006, NSDUH Series H-58. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/
- Centers for Disease Control and Prevention (CDC). 2023. “Rate of Emergency Department Visits for Substance Use Disorders Among Adults Aged ≥18 Years, by Age Group—National Hospital Ambulatory Medical Care Survey, United States, 2018–2019 and 2020–2021.” MMWR Morb Mortal Wkly Rep 72:1073. DOI: http://dx.doi.org/10.15585/mmwr.mm7239a6
- Samuels, E.A., K. Dwyer, M.J. Mello, J. Baird, A.R. Kellogg, & E. Bernstein. 2016. “Emergency Department‐Based Opioid Harm Reduction: Moving Physicians from Willing to Doing.” Academic Emergency Medicine 23(4), 455–65