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  2. CQM-7590

2024 Reporting Period - 50V12 Clarification - Follow up

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    • Icon: EC eCQMs - Eligible Clinicians EC eCQMs - Eligible Clinicians
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    • Jackson Keller
    • Vanguard Medical Specialists
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      Thank you for your follow up question regarding CMS50v12 Closing the Referral Loop: Receipt of Specialist Report eCQM.
      To answer your first question, the intent of the measure is to capture the number of cases where the consultant report is received by the referring physician; it does not provide advice on how to handle situations between providers and patients. If the consultant report received by the specialist is mapped to one of the codes within the ‘Consultant Report’ value set, this would meet the numerator criteria for the measure, regardless of what is communicated within the report. The measure specification does not dictate what the content of the consultant report must be.
      To answer your second question, we must reiterate that the measure does not provide guidance on how to handle situations where the patient does not see the specialist, regardless of the reason. At this time the measure can only be met if a consultant report is received from the clinician to whom the patient was referred as this is the intent of the measure. In response to your reference to punishing providers, this measure is not a mandatory measure for eCQM reporting; eligible clinicians can self-select from the list of voluntary eCQMs for reporting to CMS. We will investigate cases where patients do not attend referral appointments and may consider addressing this in a future update cycle.
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      Thank you for your follow up question regarding CMS50v12 Closing the Referral Loop: Receipt of Specialist Report eCQM. To answer your first question, the intent of the measure is to capture the number of cases where the consultant report is received by the referring physician; it does not provide advice on how to handle situations between providers and patients. If the consultant report received by the specialist is mapped to one of the codes within the ‘Consultant Report’ value set, this would meet the numerator criteria for the measure, regardless of what is communicated within the report. The measure specification does not dictate what the content of the consultant report must be. To answer your second question, we must reiterate that the measure does not provide guidance on how to handle situations where the patient does not see the specialist, regardless of the reason. At this time the measure can only be met if a consultant report is received from the clinician to whom the patient was referred as this is the intent of the measure. In response to your reference to punishing providers, this measure is not a mandatory measure for eCQM reporting; eligible clinicians can self-select from the list of voluntary eCQMs for reporting to CMS. We will investigate cases where patients do not attend referral appointments and may consider addressing this in a future update cycle.
    • CMS0050v13
    • CMS0050v12

      Hi,

      Thank you for your response regarding the numerator specifications for measure 50v12 ( (CQM-7572). I do still have a couple of questions.

      1. In the event that the specialist to whom the patient was referred reached out to the patient and the patient declines to schedule or does not respond, how should they handle that situation? If that specialist sends us back a report that the patient declined to schedule, would that meet the numerator criteria for the measure?
      2. Why is it that, “If the patient does not see the specialist, then the measure would process the patient as being in the denominator only”? The measure rationale states, “In a study of physician satisfaction with the outpatient referral process, Gandhi et al. (2000) found that 68% of specialists reported receiving no information from the primary care provider prior to referral visits, and 25% of primary care providers had still not received any information from specialists 4 weeks after referral visits.” It is clear that this measure focuses on receiving specialist visit report information when a patient is seen by a specialist. The rationale for the measure does not discuss if patients choose not to see specialists to whom they are referred. Why would it be appropriate to punish providers for patients choosing not to schedule specialist appointments when that is not the rationale for the measure?

      Thanks,

      Jackson

            AIR EC eCQM Team AIR EC eCQM Team
            jkeller@vanguardskin.com Jackson Keller
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