Closing the Referral Loop: Receipt of Specialist Report

Measure Information	2021 Performance Period
CMS eCQM ID	CMS50v9
NQF Number	Not Applicable
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	Equals Initial Population
Denominator Exclusions	None
Numerator	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)
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.
MIPS Quality ID	374
Telehealth Eligible	Yes
Next Version	CMS50v10
Previous Version	No Version Available

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period
Title	Closing the Referral Loop: Receipt of Specialist Report	Closing the Referral Loop: Receipt of Specialist Report	Closing the Referral Loop: Receipt of Specialist Report
CMS eCQM ID	CMS50v9	CMS50v10	CMS50v11
NQF Number	Not Applicable	Not Applicable	Not Applicable
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	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	Percentage of patients with referrals, regardless of age, for which the referring clinician receives a report from the clinician 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	Number of patients, regardless of age, who had a visit during the measurement period and were referred by one provider to another provider	Number of patients, regardless of age, who had an encounter during the measurement period and were referred by one clinician to another clinician on or before October 31
Denominator	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	None	None	None
Numerator	Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred	Number of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred	Number of patients with a referral on or before October 31, for which the referring clinician received a report from the clinician to whom the patient was referred
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Measure Steward	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure
Improvement Notation	A higher score indicates better quality	A higher score indicates better quality	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.	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 provider to whom the patient was referred is responsible for sending the consultant report that will fulfill the communication. Note: this is not the same provider who would report on the measure. The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. 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.	The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure. Only the first referral made between January 1 – October 31 of the measurement period will be considered for this measure to allow adequate time for the referring clinician to collect the consult report by the end of the measurement period. If there are multiple referrals for a patient during the measurement period, use the first referral. The clinician to whom the patient was referred is responsible for sending the consultant report that will fulfill the communication. Note: this is not the same clinician who would report on the measure. The consultant report that will successfully close the referral loop should be related to the first referral for a patient during the measurement period. If there are multiple consultant reports received by the referring clinician which pertain to a particular referral, use the first consultant report to satisfy the measure. Eligible clinicians reporting on this measure should note that all data for the performance period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who refer patients towards the end of the performance period (i.e., October), should request that clinicians 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 clinicians to whom patients are referred communicate the consult report as soon as possible with the referring clinician, 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 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID	374	374	374
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS50v10	CMS50v11	No Version Available
Previous Version	No Version Available	CMS50v9	CMS50v10

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Data Element Repository

Data Elements contained within CMS50v9

Value Sets

Value Sets to be used with CMS50v9

Release Notes

CMS50v9-TRN.xlsx

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