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 clinician receives a report from the clinician to whom the patient was referred. Description of issue The current logic for CMS50v11: Closing the Referral Loop: Receipt of Specialist Report is intended to identify the first referral for a patient during the first 10 months of the reporting period. The measure is only meant to capture first referrals between 12:00am on January 1 - 11:59pm on October 31 as stated in the measure guidance. However, upon further testing of the logic, referrals made on 12:00am on November 1 could be included in the measure. The measure developer proposes modifying the logic to align with the measure language and intent by excluding referrals on November 1. Goal of review Obtain technical feedback

Proposed solution CURRENT LOGIC: 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 ascending ) PROPOSED LOGIC: First(((["Intervention, Performed": "Referral"] ReferralPerform       where Global."NormalizeInterval"(ReferralPerform.relevantDatetime, ReferralPerform.relevantPeriod)ends during day of Interval[start of "Measurement Period", DateTime(year from start of "Measurement Period", 10, 31)]       return {         identification: ReferralPerform.id,         dateIntervention:         end of Global."NormalizeInterval"(ReferralPerform.relevantDatetime, ReferralPerform.relevantPeriod)      }  )     union(["Intervention, Order": "Referral"] ReferralOrder         where ReferralOrder.authorDatetime during day of Interval[start of "Measurement Period", DateTime(year from start of "Measurement Period", 10, 31)]         return {           identification: ReferralOrder.id,           dateIntervention: ReferralOrder.authorDatetime        }     ))ReferralInterventions     sort by dateIntervention ascending Rationale for change ​​This change will create agreement between measure logic and guidance for the measurement period (January 1 - October 31).