Brief Description of Measure:
​CMS50: Closing the Referral Loop: Receipt of Specialist Report
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

Description of Issue:
Clinical societies whose members report on this measure indicated that clinicians who refer patients at the end of the reporting period may not have enough time to collect the consultant report from the specialist to close the referral loop before the measurement period ends. The measure developer addressed these concerns with the expert work group, who agreed modifying the measure requirements to limit the timeframe of the referrals included in the initial population will allow all clinicians a comparable timeframe to close the referral loop.

Proposed Solution:
Decrease the timeframe for the initial population inclusion criteria by two months so that only the first referral made between January 1-October 31 of the measurement period will be considered denominator-eligible for this measure. 
 
Changes to the measure will include:
1. Adding Guidance to the header: "Only referrals made between January 1 – October 31 of the reporting period will be considered for this measure to allow adequate time for the referring provider to collect the consult report.
 
2. Revising the Initial Population statement: "Number of patients, regardless of age, who had a visit during the measurement period and were referred by one provider to another provider on or before October 31.
 
3. Revise logic to constrain referrals to January 1 – October 31.
​Initial population:
"Has Face to Face Encounter during Measurement Period"
  and "First Referral during First 10 Months of Measurement Period" is not null
First Referral during First 10 Months of Measurement Period:
First(((["Intervention, Performed": "Referral"] ReferralPerform
      where Global."NormalizeInterval"(ReferralPerform.relevantDatetime, ReferralPerform.relevantPeriod)ends during Interval[start of "Measurement Period", start of "Measurement Period" + 10 months]
      return

{         identification: ReferralPerform.id,         dateIntervention:         end of Global."NormalizeInterval"(ReferralPerform.relevantDatetime, ReferralPerform.relevantPeriod)       }

  )
    union(["Intervention, Order": "Referral"] ReferralOrder
        where ReferralOrder.authorDatetime during Interval[start of "Measurement Period", start of "Measurement Period" + 10 months]
        return

{           identification: ReferralOrder.id,           dateIntervention: ReferralOrder.authorDatetime         }

    ))ReferralInterventions
    sort by dateIntervention asc
)
​
Rationale for Change:
​Constraining the referral to the first 10 months of the measurement period will provide reporting clinicians with adequate time to complete the referral loop by the end of the measurement period.