Request the FMC White Paper

The full measure walkthrough, with intervention design and contract-level considerations. Or schedule a Stars strategy session with our Client Success team to review your contract's performance.

Request the White Paper Schedule a Session

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

A HEDIS measure that reports the percentage of emergency department (ED) visits by members 18 and older with two or more high-risk chronic conditions that were followed by a follow-up service within seven days. The unit of measurement is the ED visit, so one member can count more than once in a year.

Measure steward

NCQA

Data source

HEDIS, administrative

Weighting category

Process

2027 Star weight

Direction

Higher is better

Period

Jan 1 to Dec 24 ED visits

Specification

Swipe to see all columns →

Element	Definition
Denominator	ED visits from January 1 through December 24 by members 18 and older with two or more different high-risk chronic conditions diagnosed before the ED visit, during the measurement year or the year prior. If a member has more than one ED visit in an eight-day period, only the first counts.
High-risk chronic conditions	Chronic respiratory conditions (COPD, asthma, emphysema); Alzheimer's disease and related disorders; chronic kidney disease; depression; heart failure; acute myocardial infarction; atrial fibrillation; stroke and transient ischemic attack.
Numerator	A follow-up service on the date of the ED visit or within the seven days after it. Qualifying services include an outpatient, telephone, or telehealth visit (including behavioral health); intensive outpatient or partial hospitalization, including observation; transitional care management; a case management visit; complex care management; an e-visit or virtual check-in; a substance use disorder service; monitored electroconvulsive therapy; and a domiciliary or rest home visit.
Exclusions	ED visits followed by an acute or nonacute inpatient admission on the ED date or within the seven days after, regardless of diagnosis; hospice; members who died during the measurement year.
Continuous enrollment	365 days before the ED visit through seven days after, with no more than one gap of up to 45 days before the visit and no gap from the ED date through day seven.

FMC is administrative only, and supplemental data is accepted. The specification does not define a provider type, and the follow-up diagnosis does not need to match the ED diagnosis.

The follow-up window

Swipe to see the full window →

Day 0

ED visit

Day 1

Follow-up counts

Day 2

Follow-up counts

Day 3

Follow-up counts

Day 4

Follow-up counts

Day 5

Follow-up counts

Day 6

Follow-up counts

Day 7

Follow-up counts

Day 8

Too late

Day 9

Too late

Figure 1. The follow-up window includes the date of the ED visit and the seven days after it, eight days in total. ED visits from January 1 through December 24 are eligible, so every window closes by December 31.

Clinical and operational considerations

The clock starts at the ED visit. Most ED discharges reach the plan through claims days later, so daily visibility into ED events, through ADT feeds or real-time notifications, decides whether the window is still open.
A phone call can close the gap. A telephonic follow-up conversation is enough; it does not have to schedule an appointment. Acknowledging the ED visit and checking whether the member needs help meets the intent, as long as the contact is captured with a qualifying code.
The diagnosis doesn't have to match. A visit for any reason counts, so a scheduled routine appointment inside the window closes the gap.
Conditions must predate the ED visit. A heart failure diagnosis made at the ED visit itself does not qualify the member for that episode.
Every ED visit is a separate opportunity. High utilizers can appear many times in the denominator, and each visit needs its own follow-up.
Coding is where gaps are lost. Follow-up that happens but is not billed or submitted as supplemental data with a qualifying code does not count.
Medication changes at the ED are a natural reason to call. New prescriptions, held medications, and discharge instructions give the follow-up clinical substance beyond a check-in.

Policy watch

Swipe to see all columns →

	Change
2027 Star Ratings (MY2025)	Weight 1.
2028 and 2029 Star Ratings	FMC is not among the 11 measures removed by the CY 2027 final rule.
Measure set	With measures focused on administrative processes or little variation leaving, each remaining clinical measure carries a larger share of the summary and overall ratings.

References

CMS. 2027 Star Ratings Measures and Weights.
National Committee for Quality Assurance. HEDIS Volume 2: Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC).
CMS. Contract Year 2027 Medicare Advantage and Part D Final Rule (CMS-4208-F3), April 2, 2026.
CMS. Contract Year 2027 Medicare Advantage and Part D Final Rule fact sheet, April 2, 2026.

Specifications are summarized for education. Consult the PQA measure specifications and CMS Star Ratings Technical Notes for the measurement year in question. Prepared by the MedWatchers clinical pharmacy team, October 2026.