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  2. CQM-6184

Question about measure CMS 50

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      ​Thank you for your inquiry on CMS50v11 Closing the Referral Loop: Receipt of Specialist Report. In the scenario where there is only one referring clinician with multiple referrals for a single patient, only the first referral can meet or fail to meet the numerator criteria. This is true regardless of whether the first referral is to the same or different specialties. Your conclusion is correct “since cardiology was temporally ordered first and it is not closed, this patient fails the measure.” Additionally, to answer your last question, the numerator consists of individual patients, so if a patient has multiple referrals in the system, only the first referral can pas or fail the measure.
      To address your question regarding two separate clinicians, recall that the clinician who refers the patient is the responsible clinician held accountable for this measure, as stated in the guidance section. In the scenario where there are two separate clinicians who refer a patient to the same specialty, then each of their referral loops would be closed when the specialty sends a report back to the referring clinician. If the specialty sent back a report to only one of the clinicians, then only that clinician had the referral loop closed.
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      ​Thank you for your inquiry on CMS50v11 Closing the Referral Loop: Receipt of Specialist Report. In the scenario where there is only one referring clinician with multiple referrals for a single patient, only the first referral can meet or fail to meet the numerator criteria. This is true regardless of whether the first referral is to the same or different specialties. Your conclusion is correct “since cardiology was temporally ordered first and it is not closed, this patient fails the measure.” Additionally, to answer your last question, the numerator consists of individual patients, so if a patient has multiple referrals in the system, only the first referral can pas or fail the measure. To address your question regarding two separate clinicians, recall that the clinician who refers the patient is the responsible clinician held accountable for this measure, as stated in the guidance section. In the scenario where there are two separate clinicians who refer a patient to the same specialty, then each of their referral loops would be closed when the specialty sends a report back to the referring clinician. If the specialty sent back a report to only one of the clinicians, then only that clinician had the referral loop closed.
    • CMS0050v11
    • Uncertainty of meeting the metric

      I am just writing for a clarification on the MIPS measure CMS 50. In the description, it states the following: "If there are multiple referrals for a patient during the measurement period, use the first referral." 

       

      Is this statement meant to refer to instances in which a provider has placed multiple referrals to the same specialty? Is the following scenario correct?

       

      If two separate providers both place a referral to cardiology, or the same provider places two separate orders for cardiology, closing the loop on the first order satisfies the measure and the subsequent orders are not included in the numerator. 

       

      Alternatively, does it mean that for any given patient, closing the loop on the absolute first referral placed in the system by any provider to any specialty satisfies the measure? Please see example below: 

       

                      A patient has been referred to cardiology, gastroenterology, and nephrology (in that order). The loop does notget closed on cardiology, but it does get closed for gastroenterology and nephrology. Since cardiology was temporally ordered first and it is not closed, this patient fails the measure. 

       __ 

      Also, does the numerator only consist of individual patients, or can a patient be in the numerator multiple times if they have multiple referrals in the system? 

       

      Thanks in advance for your guidance. 

            edave Mathematica EC eCQM Team
            bparris Brent Parris (Inactive)
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