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Closing the Referral Loop: Receipt of Specialist Report

Compare Versions of: "Closing the Referral Loop: Receipt of Specialist Report"

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Measure Information 2022 Performance Period 2023 Performance Period 2024 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 CMS50v10 CMS50v11 CMS50v12
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 clinician receives a report from the clinician 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 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

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 on or before October 31, for which the referring clinician received a report from the clinician 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 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.

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 No Version Available
Previous Version No Version Available

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Rationale

    Source of Change: Annual Update

Logic

  • Revised the logic to capture referrals through the end of the day on October 31 to better align with the measure language and intent.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5442

  • Updated the timing precision in definitions by adding 'day of' to align with the measure intent.

    Measure Section: Definitions

    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 13 LOINC codes based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Referral (2.16.840.1.113883.3.464.1003.101.12.1046): Added 1 SNOMED CT code (1186918003) based on terminology update. Deleted 1 SNOMED CT code (306294000) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

Last Updated: Jan 22, 2024