Closing the Referral Loop: Receipt of Specialist Report eCQM CMS50v12

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.

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 eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM

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.

Encounter Codes

CPT codes can be entered into the billing section for the encounter. Below is an example from the appointment window.

You can enter the code or search by keyword. Select an appointment, performed or ordered, and then click Create.

SNOMED Codes

Denominator

Equals Initial Population

Denominator Exclusions

None

Denominator Exceptions

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.

The LOINC codes for the report can be entered in the patient's chart under the Communication area of the CQMs section. Click the +New button.

LOINC Codes

Numerator Exclusions

None

Measure Information