Closing the Referral Loop: Receipt of Specialist Report

Last updated: February 1, 2017

CMS Measure ID: CMS50v5
Version: 5
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 (CMS)
National Quality Strategy Domain: Communication and Care Coordination
Previous Version: Closing the Referral Loop: Receipt of Specialist Report
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.

The consultant report that will fulfill the referral should be completed after the referral. Eligible professionals 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 who see patients towards the end of the reporting period (ie, December in particular), should communicate the consultant report as soon as possible in order for those patients to be counted in the measure numerator. Communicating the report as soon as possible will ensure the data is included in the submission to CMS.

Specifications

Release Notes

Header

  • ‚ÄčUpdated Copyright.

    Section: Copyright

    Source: Annual Update

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Added Guidance to account for the numerator actions intentionally not having an end parameter. If the consultant report is communicated after the referral but falls outside the measurement period, that would satisfy the numerator criteria as long as the communication occurs before the submission of measure results is required.

    Section: Guidance

    Source: Measure Lead

  • Updated Reference.

    Section: Reference

    Source: Measure Lead

Logic

  • Updated numerator timing from 'during 'Measurement Period'' to 'starts after start of 'Occurrence A of Intervention, Performed: Referral''. This update further connects the Referral and the communication of the Consultant Report, by requiring the correct workflow sequencing and allows additional time for closing the referral loop in instances of referrals nearing the end of the measurement period.

    Section: Numerator

    Source: Measure Lead

External Resources