CMS 50 - Closing the Referral Loop: Receipt of Specialist Report

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
    • None
    • Katie Haun
    • 9148412282
    • Garnet Health Medical Center
    • Hide
      Thank you for inquiring about CMS50v14 (Closing the Referral Loop: Receipt of Specialist Report). The measure requires that the referring clinician receives a report from the clinician to whom the patient was referred. As noted in the measure’s Definition section, this report is “a written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician.” Therefore, the proposed “Failure to Close the Loop Letter” does not meet the numerator requirements for the measure. In the scenario provided, the patient would not be included in the numerator of the measure.
      Show
      Thank you for inquiring about CMS50v14 (Closing the Referral Loop: Receipt of Specialist Report). The measure requires that the referring clinician receives a report from the clinician to whom the patient was referred. As noted in the measure’s Definition section, this report is “a written document prepared by the eligible clinician (and staff) to whom the patient was referred and that accounts for his or her findings, provides summary of care information about findings, diagnostics, assessments and/or plans of care, and is provided to the referring eligible clinician.” Therefore, the proposed “Failure to Close the Loop Letter” does not meet the numerator requirements for the measure. In the scenario provided, the patient would not be included in the numerator of the measure.
    • CMS0050v14
    • Low compliance rates due to Patients not following thru with the referral.

      The metric is based on the consultant report being from the referred to provider to the referred from provider. 

      Issue:

      If the patient has not followed thru with the referral DESPITE 3 weeks' worth of follow-up from scheduling staff, can the referred to provider send a Consultant Report - Failed to Close the Loop to meet the measure?

      Draft letter below:

      Failure to Close the Loop letter

      To Whom It May Concern,

      I am writing to inform you that the referral initiated for [Patient’s Full Name], DOB: [Date of Birth], to [Specialist or Service Name] has not been completed.

      Despite our efforts to facilitate the referral process, including providing the necessary documentation and contact information, we have not received confirmation that the patient has scheduled or attended the referred appointment. Timely follow-through on referrals is essential to ensure continuity of care and appropriate management of the patient's condition.

      We encourage [Patient’s Name] to contact the referred provider as soon as possible to complete the referral process. If additional assistance is needed, our office is available to help coordinate care and answer any questions.

      Thank you for your attention to this matter.

      The scenario that we can give is this:

      Provider A (PCP) refers patient Q to Provider B (Cardiologist) because the patients' blood pressure is continuously high despite prescribed medications. Patient Q also has goals of weight loss thru exercise and eating healthier.  The patient accepts the referral because they don't want to say no to Provider A. However, Patient Q does NOT want to see the Cardiologist and therefore ignores the office when they call to schedule an appointment.  When patient Q sees provider A in 6 months the weight loss has lowered the B/P to an acceptable range. 

      In this scenario the pt would fail the measure since they did not follow through with the referral appt. However, If Provider B sent Provider A a Failed to Close the Loop letter, then Provider A could have also called the pt to see what was going on. At the very least Provider A would have KNOWN that the patient did not follow-up with Provider B. 

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Katie Haun
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              Created:
              Updated:
              Resolved:
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