| Title |
Closing the Referral Loop: Receipt of Specialist Report |
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|---|---|---|---|
| CMS eCQM ID | CMS50v14 | CBE ID | Not Applicable |
| MIPS Quality ID | 374 | ||
| Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
| 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 | ||
| Measure Scoring | Proportion | ||
| Measure Type | Process | ||
| Stratification | None | ||
| Risk Adjustment | None | ||
| Rationale | Problems in the outpatient referral and consultation process have been documented, including inadequate care pathways between specialty and primary care. Studies suggest that both specialists and primary care providers (PCPs) are not satisfied with current processes (Institute for Healthcare Improvement / National Patient Safety Foundation, 2017; Greenwood-Lee et. al, 2018). Breakdowns in referral communication leads to worse health outcomes, increased cost, and appointment delays (Patel et. al, 2018; Odisho et. al, 2020). A 2018 analysis of primary care referrals to specialists found that of the 103,737 referral scheduling attempts analyzed, only 36,072 (34.8%) resulted in documented complete appointments, defined by the specialty clinician providing report to the PCP after the referral visit (Patel et. al, 2018).
Technological and process-based updates can improve the referral loop process and increase rates of closing the referral loop. Ramelson et. al (2018) enhanced an EHR’s Referral Manager module to meet the Controlled Risk Insurance Company’s best practice steps and the requirements of both the CMS EHR Incentive Program and the National Committee for Quality Assurance Patient-Centered Medical Home program. Following the updates, 76.8% of referrals were completed and all defined referral process steps were easier to accomplish. Odisho et. al (2020) developed a referrals automation software to simplify the fax to referral process. Feedback from key stakeholder interviews noted that the software enhanced the referrals process by further streamlining and organizing the patient referral process. The Institute for Healthcare Improvement and the National Patient Safety Foundation (2017) reviewed the referrals process in the ambulatory care setting and found that organizational leaders, EHR vendors, regulatory agencies, clinicians, and patients all play a role in creating a referrals system that is effective, safe, convenient, and patient-centered. |
||
| Clinical Recommendation Statement | None | ||
| Improvement Notation | Higher score indicates better quality | ||
| Definition | Referral: A request from one clinician to another clinician for evaluation, treatment, or co-management of a patient’s condition. This term encompasses referral and consultation as defined by Centers for Medicare & Medicaid Services. Report: A written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician. | ||
| 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 measurement period is to be submitted by the deadline established by CMS. Therefore, eligible clinicians who refer patients towards the end of the measurement 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. A procedural report received from a specialist for an exam or procedure conducted (e.g., diabetic eye exam, colonoscopy, etc.) can satisfy the numerator requirement and successfully close the referral loop. A separate consultant note or consultant report is not required to close the referral loop in these circumstances. 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. |
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| Initial Population | Number of patients, regardless of age, who had an encounter during the measurement period and were referred by one clinician to another on or before October 31 | ||
| Denominator | Equals Initial Population | ||
| Denominator Exclusions | None | ||
| Numerator | Number of patients with a referral on or before October 31, for which the referring clinician received a report from the first clinician to whom the patient was referred | ||
| Numerator Exclusions | None | ||
| Denominator Exceptions | None | ||
| Telehealth Eligible | Yes | ||
| Next Version | No Version Available | ||
| Previous Version | CMS50v13 | ||
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