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Type:
EC eCQMs - Eligible Clinicians
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Resolution: Answered
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Priority:
High
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Component/s: None
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None
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Deborah Young
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Signature Medical Group of KC PA
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CMS0050v14
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CMS0050v13
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Our surgeons have an inaccurate denominator (and numerator) because eClinicalWorks is counting orders entered for surgery as a referral back to the ordering surgeon.
We report as individuals and our EMR vendor, eClinicalWorks, includes surgery orders in the denominator of Closing the Referral Loop. For example, Dr. X will see Jane Doe and recommend surgery. The surgery order to do her right total knee replacement at Outpatient Surgery Center Z by Dr. X is counting in our denominator. Most of the time the surgeries are performed and we can close the loop based on the operative note, but I don't believe this is the intent of the measure. I'm afraid if I report and we get audited that this would count against us. I opened a ticket with the QPP Help Desk and they said I had to post the issue here to see if I could still use this data. I need to report for 2025 ASAP.