Follow-Up After Emergency Department Visit for People With High-Risk Multiple Chronic Conditions (FMC)

The percentage of emergency department (ED) visits for persons 18 years of age and older who have multiple high-risk chronic conditions who had a follow-up service within 7 days of the ED visit. 

Why It Matters

The Medicare population includes a large number of individuals and older adults with multiple high-risk chronic conditions (MCC) who often receive care from multiple providers and settings and, as a result, are more likely to experience fragmented care and adverse health care outcomes, including an increased likelihood of ED visits (1, 2). Medicare beneficiaries with MCCs require high levels of care coordination, particularly as the transition from the ED to the community. During these transitions, they often face communication lapses between ED and outpatient providers and inadequate patient, caregiver and provider understanding of diagnoses, medication and follow-up needs (3,4,5,6). This poor care coordination results in an increased risk for medication errors, repeat ED visits, hospitalization, nursing home admission and death (7,8). Medicare beneficiaries with MCCs not only experience poorer health outcomes, but also greater health care utilization (e.g., physician use, hospital and ED use, medication use) and costs (e.g., medication, out-of-pocket, total health care) (9). Medicare beneficiaries with MCCs are some of the heaviest users of high-cost, preventable services such as those offered by the ED(10,11). An estimated 75% of health care spending is on people with MCCs (12, 13). 

Historical Results – National Averages

Get Access to the Historical Results

By completing the form below, you’ll gain free access to national performance data.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

References

  1. AHRQ. 2010. Multiple Chronic Conditions Chartbook. “2010 Medical Expenditure Panel Survey Data.” https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf)
  2. Agency for Healthcare Quality and Research (AHRQ). 2012. “Coordinating Care for Adults with Complex Care Needs in the Patient-Centered Medical Home: Challenges and Solutions.” https://pcmh.ahrq.gov/sites/default/files/attachments/coordinating-care-for-adults-with-complex-care-needs-white-paper.pd
  3. Altman, R., J.S. Shapiro, T. Moore and G.J. Kuperman. 2012. “Notifications of Hospital Events to Outpatient Clinicians Using Health Information Exchange: A Post-Implementation Survey.” Journal of Innovation in Health Informatics 20(4).
  4. Coleman, E.A., R.A. Berenson. 2004. “Lost in Transition: Challenges and Opportunities for Improving the Quality of Transitional Care.” Annals of Internal Medicine 141(7).
  5. Dunnion, M.E., and B. Kelly. 2005. “From the Emergency Department to Home.” Journal of Clinical Nursing 14(6), 776–85.
  6. Rowland, K., A.K. Maitra, D.A. Richardson, K. Hudson and K.W. Woodhouse. 1990. “The Discharge of Elderly Patients from an Accident and Emergency Department: Functional Changes and Risk of Readmission.” Age and Ageing 19(6), 415–18.
  7. Hastings, S.N., E.Z. Oddone, G. Fillenbaum, R.J. Sloane and K.E. Schmader. 2008. “Frequency and Predictors of Adverse Health Outcomes in Older Medicare Beneficiaries Discharged from the Emergency Department.” Medical Care 46(8), 771–7.
  8. Niedzwiecki, M., K. Baicker, M. Wilson, D.M. Cutler and Z. Obermeyer. 2016. “Short-Term Outcomes for Medicare Beneficiaries After Low-Acuity Visits to Emergency Departments and Clinics.” Medical Care 54(5), 498–503.
  9. Lehnert, T., D. Heider, H. Leicht, S. Heinrich, S. Corrieri, M. Luppa, S. Riedel-Heller and H.H. Konig. 2011. “Review: Health Care Utilization and Costs of Elderly Persons With Multiple Chronic Conditions.” Medical Care Research & Review 68(4), 387–420.
  10. CMS. 2012. Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/chronic-conditions/downloads/2012chartbook.pdf (Accessed July 19, 2016)
  11. Lochner, K.A., and C.S. Cox. 2013. Prevalence of Multiple Chronic Conditions Among Medicare Beneficiaries, United States, 2010. https://www.cdc.gov/pcd/issues/2013/12_0137.htm (Accessed January 11, 2017)
  12. CDC. 2009. The Power of Prevention: Chronic Disease… the Public Health Challenge of the 21st Century. http://www.cdc.gov/chronicdisease/pdf/2009-power-of-prevention.pdf (Accessed January 24, 2017)
  13. Care Innovations. 2013. “Cost Control for Chronic Conditions: An Imperative for MA Plans.” The Business Case for Remote Care Management (RCM). https://www.rmhpcommunity.org/sites/default/files/resource/The%20Business%20Case%20for%20RCM.pdf (Accessed January 24, 2017) 

  • Save
  • Email
  • Print