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Closing the Referral Loop: Receipt of Specialist Report

General eCQM Information

CMS Measure ID CMS50v9
NQF Number Not Applicable
Measure Description

Percentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred

Initial Population Number of patients, regardless of age, who were referred by one provider to another provider, and who had a visit during the measurement period
Denominator Statement

Equals Initial Population

Denominator Exclusions

None

Numerator Statement

Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred

Numerator Exclusions

Not Applicable

Denominator Exceptions

None

Measure Steward Centers for Medicare & Medicaid Services (CMS)
Domain Communication and Care Coordination
Measure Scoring Proportion measure
Measure Type Process measure
Improvement Notation

A higher score indicates better quality

Guidance

The provider who refers the patient to another provider is the provider who should be held accountable for the performance of this measure.

The provider to whom the patient was referred should be the same provider that sends the report.

If there are multiple referrals for a patient during the measurement period, use the first referral.

The consultant report that will fulfill the referral should be completed after the referral and should be related to the referral for which it is attributed. If there are multiple consultant reports received by the referring provider which pertain to a particular referral, use the first consultant report to satisfy the measure. Eligible professionals or eligible clinicians reporting on this measure should note that all data for the reporting year is to be submitted by the deadline established by CMS. Therefore, eligible professionals or eligible clinicians who refer patients towards the end of the reporting period (i.e., November - December), should request that providers to whom they referred their patients share their consult reports as soon as possible in order for those patients to be counted in the measure numerator during the measurement period. When providers to whom patients are referred communicate the consult report as soon as possible with the referring providers, it ensures that the communication loop is closed in a timely manner and that the data are included in the submission to CMS.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

Quality ID 374
Meaningful Measure Transfer of Health Information and Interoperability
Telehealth Eligible Yes
Previous Version

Release Notes

Header

  • Updated eCQM Version Number.

    Measure Section: eCQM Version Number

    Source of Change: Standards Update

  • Updated the measure developer field.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Standards Update

  • Updated existing references to align with American Psychological Association (APA) formatting.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated abbreviation in the definition field.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Added text to identify the Quality Data Model (QDM) version used in the measure specification.

    Measure Section: Guidance

    Source of Change: Standards Update

  • Added text to indicate whether the measure is patient-based or episode-based.

    Measure Section: Guidance

    Source of Change: Standards Update

Logic

  • Added alternate datatype option for identifying the first referral based upon feedback.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (Jira): CQM-3561

  • QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • QDM v5.5 standards update: Updated 'Communication, Performed' timing to use new 'sent dateTime' and 'received dateTime' attributes to better align with measure intent.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Revised Clinical Quality Language (CQL) definition construction to reduce the overall complexity of the measure logic without changing the intent and/or application of data element. These revisions were intended to make the definition logic less complex, easier to understand, and more meaningful.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated CQL expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated CQL definition names and aliases used to more closely align with clinical concept intent or create consistency of naming across measures.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Referral (2.16.840.1.113883.3.464.1003.101.12.1046): Deleted 1 SNOMED CT code (306274009) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Consultant Report (2.16.840.1.113883.3.464.1003.121.12.1006): Deleted 1 LOINC code (60570-9).

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: Dec 18, 2020