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Closing the Referral Loop: Receipt of Specialist Report

Measure Information 2023 Performance Period
CMS eCQM ID CMS50v11
NQF Number Not Applicable
Description

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 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

Denominator Exclusions

None

Numerator

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

Denominator Exceptions

None

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

A higher score indicates better quality

Guidance

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
Meaningful Measure Transfer of Health Information and Interoperability
Telehealth Eligible Yes
Next Version No Version Available
Previous Version

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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)
Quality Domain Communication and Care Coordination Communication and Care Coordination Communication and Care Coordination
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 (https://ecqi.healthit.gov/qdm) 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
Meaningful Measure Transfer of Health Information and Interoperability Transfer of Health Information and Interoperability Transfer of Health Information and Interoperability
Telehealth Eligible Yes Yes Yes
Next Version CMS50v10 CMS50v11 No Version Available
Previous Version No Version Available

Release Notes

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Made minor updates to grammar, wording, and formatting to improve readability and consistency.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

    Measure Section: Guidance

    Source of Change: Standards/Technical Update

  • Standardized language to reference 'clinicians' throughout the specification rather than 'provider' or 'practitioner'.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Shortened the measurement period to 10 months to allow for a 2-month period to close the referral loop.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

Logic

  • Shortened the measurement period to 10 months to allow for a 2-month period to close the referral loop.

    Measure Section: Multiple Sections

    Source of Change: Expert Work Group Review

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Removed references to 'face to face' in logic definition titles and aliases to signal certain virtual visits may be considered as eligible encounters.

    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 Consultant Report (2.16.840.1.113883.3.464.1003.121.12.1006): Added 2 SNOMED CT codes (721916007, 721927009) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Aug 29, 2022