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Closing the Referral Loop: Receipt of Specialist Report

Last updated: May 9, 2019

CMS Measure ID: CMS50v8
Version: 8
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 Populationinfo-icon

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
Previous Version:
Measure Scoring: Proportion
Measure Type: Process
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 professionalsinfo-icon or eligible cliniciansinfo-icon 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 numeratorinfo-icon 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.

Quality ID: 374
Meaningful Measure: Transfer of Health Information and Interoperability

Specifications

Release Notes

Header

  • Updated eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

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

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated definition statement to clarify what constitutes a consultant report.

    Measure Section: Definition

    Source of Change: Measure Lead

  • Updated guidance statement to clarify the referral process and action measured to improve alignmentinfo-icon with measure intent.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Merged Quality Data Model (QDM)info-icon Communication Datatypes to a single Datatype 'Communication, Performed.'

    Measure Section: Numeratorinfo-icon

    Source of Change: Standards Update

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Consultant Report (2.16.840.1.113883.3.464.1003.121.12.1006): Added LOINC extensional value set (2.16.840.1.113883.11.20.9.31) including 193 codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Ophthalmological Services (2.16.840.1.113883.3.526.3.1285): Added SNOMED CT extensional value set (2.16.840.1.113883.3.526.2.1771) including 4 codes.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

External Resources