Closing the Referral Loop: Receipt of Specialist Report

Last updated: July 12, 2017

CMS Measure ID: CMS50v4
Version: 4
NQF Number: None
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 Patient 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
Domain: Communication and Care Coordination
Next Version: Closing the Referral Loop: Receipt of Specialist Report
Previous Version: Closing the Referral Loop: Receipt of Specialist Report
Measure Score: Proportion
Improvement Notation:

A higher score indicates better quality

Guidance:

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.

Specifications

Release Notes

Header

  • eMeasure version number incremented.
  • Copyright updated.
  • Disclaimer updated.

Logic

  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Occurrence A of Intervention, Performed: Referral' ends before start of ('Occurrence A of Communication: From Provider to Provider: Consultant Report' during 'Measurement Period') has been replaced with: 'Occurrence A of Communication: From Provider to Provider: Consultant Report' fulfills 'Occurrence A of Intervention, Performed: Referral' during 'Measurement Period' to better meet measure intent.
  • The FULFILLS general operator is used to show that one data element fulfills the other, streamlining the language of the numerator expression.
  • Added a FIRST operator to the initial population to indicate which referral to use to look for numerator compliance.
  • Added ophthalmology codes to the Initial Population to allow more providers to report the measure.

Value Sets

  • Value set Ophthalmological Services (OID 2.16.840.1.113883.3.526.3.1285): Added value set to measure.

External Resources