Closing the Referral Loop eCQM 50

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Emily Ulloa
    • 3212303843
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      Thank you for your feedback on the Closing the Referral Loop: Receipt of Specialist Report eCQM. We will consider this change for future updates to the measure.
       
      We are aware of the reporting differences when healthcare systems with the same EHR versus independent practices report on the measure. The measure’s Guidance section explicitly indicates, “The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure.” However, the current logic cannot assign attribution to the provider. The measure determines whether the numerator requirements have been met, based on the information in the patient’s EHR. For patient-based measures, while a specific clinician may perform an action (or fail to) for a given patient, and by doing so meet (or fail to meet) the numerator requirements, any clinician who has a qualifying encounter with that same patient, who uses the same EHR and reports on that measure, can also receive credit.
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      Thank you for your feedback on the Closing the Referral Loop: Receipt of Specialist Report eCQM. We will consider this change for future updates to the measure.   We are aware of the reporting differences when healthcare systems with the same EHR versus independent practices report on the measure. The measure’s Guidance section explicitly indicates, “The clinician who refers the patient to another clinician is the clinician who should be held accountable for the performance of this measure.” However, the current logic cannot assign attribution to the provider. The measure determines whether the numerator requirements have been met, based on the information in the patient’s EHR. For patient-based measures, while a specific clinician may perform an action (or fail to) for a given patient, and by doing so meet (or fail to meet) the numerator requirements, any clinician who has a qualifying encounter with that same patient, who uses the same EHR and reports on that measure, can also receive credit.
    • Not measure related
    • CMS0050v14
    • Not measure related
    • Not measure related
    • CMS0050v13
    • Not measure related
    • Not measure related
    • Not measure related
    • Difficulty attaining this measure with widespread impact in a large provider multispecialty group

      We have a 2,000+ provider TIN reporting traditional MIPS, and although many of our providers close their own referral group, we are finding that their measure is very low and not meeting benchmark because they're impacted by the very first referral that was placed in the system. For example, we have a provider in burn surgery, who saw a patient, refers their patient to occupational therapy, receives the loop closure report, and ideally this would satisfy their measure on that patient for 2025. However, because the first referral placed from another provider to a completely separate, irrelevant provider, on that same patient for cardiology from their primary care doctor, was not yet satisfied, the burn surgery provider will be penalized with not met for that measure.

      Has CMS considered adjusting this to allow for the measure to apply to any referral loop in the measurement period to be closed? To account for these large, multispecialty groups reporting under tradiitonal MIPS. 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Emily Ulloa
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              Created:
              Updated:
              Resolved:
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