Measure 374
Closing the Referral Loop: Receipt of Specialist Report
DESCRIPTION:
The percentage of patients with referrals during the reporting period whose referring physician received a report back from the other physician.
| MEASURE ID: | 374 |
|---|---|
| Type: | Process |
CMS Derm Specialty Set: | Yes |
| High priority: | Yes |
| Topped out: | Registry/QCDR: Yes | EHR: No |
| Telehealth Eligible: | Yes |
| Reporting methods: | Registry/QCDR, or EHR |
| Maximum points: | 10 |
MEASURE PURPOSE:
This measure encourages coordination of care and communication between the referring physician and the physician who receives the referral. Such communication can reduce costs and improve patient outcomes.
Measure 374 FAQs
Q. Is this measure reportable via claims?
A. No.
Q. Are patient encounters conducted via telehealth allowable?
A. Yes, encounters coded with GQ, GT, 95, POS 02, or POS 10 modifiers are allowable.
Q. As a dermatologist, do we have to report patients who were referred to us by other providers? Or does this only pertain to our referrals to other providers?
A. The measure is to be reported if the dermatologist is the referring provider. The measure determines if the dermatologist received a report from the provider, they referred the patient to.
Q. Do I have to report this measure every time I refer a patient?
A. This measure is to be reported once per performance period for all patients with a referral during the performance period for each applicable patient.
Q. Who should send the report?
A. The provider to whom the patient was referred should be the same provider that sends the report.
Q. What if I do not receive a report from the provider I referred the patient to?
A. Please contact the provider and ask them to send a report.
Q. What if I refer a patient towards the end of the year and they are not seen by the other provider until the following year? If I receive the report next year, will that meet the measure?
A. The measure is only applicable for encounters on or before Oct. 31. Patients seen between November – December are not eligible.
Calculation
The numerator: Number of patients with a referral on or before Oct. 31, for which the referring clinician received a report from the clinician to whom the patient was referred
The denominator: Number of patients, regardless of age, who had an encounter during the performance period and were referred by one clinician to another clinician on or before Oct. 31
Measure calculation example
Dr. Sitarides referred 68 patients to another physician during the reporting period. This is the denominator.
For 59 of these 68 referrals, Dr. Sitarides received a report back from the other physician. This is the numerator.
Quality of patient care = 59/68. Dr. Sitarides has a score of 86.7% for this measure. This translates to 2.0 to 2.9 points when reporting by registry. Alternatively, if reporting via EHR a score of 86.7% would translate to 9.0-9.9 points.
Important note
Physicians who achieve a 99.99% score receive 4.9 points. They must score a perfect 100% to earn the full 10 points available when reporting via registry. Clinicians score 3 points even if they report on only one patient. This is applicable only to small practices with 15 providers or fewer.
Quality measure score benchmark
CMS will award points based on a comparison of your performance rate to CMS benchmarks listed below. Reach the performance rate listed to achieve the corresponding points per measure. Points achieved for the Quality category will account for 30% of the overall MIPS score.
Benchmarks for Registry submissions
The table below shows CMS benchmarks for Registry submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | Decile 8 | Decile 9 | Decile 10 | |
|---|---|---|---|---|---|---|---|---|---|---|
Performance rate |
3.26 - 54.70 |
54.71 - 88.78 |
88.79 - 97.74 |
97.75 - 99.99 |
-- |
-- |
-- |
-- |
-- |
100 |
Points |
1.0 - 1.9 |
2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
-- |
-- |
-- |
-- |
-- |
10 |
Benchmarks for EHR submissions
The table below shows CMS benchmarks for EHR submissions.
Decile 1 | Decile 2 | Decile 3 | Decile 4 | Decile 5 | Decile 6 | Decile 7 | Decile 8 | Decile 9 | Decile 10 | |
|---|---|---|---|---|---|---|---|---|---|---|
Performance rate |
0.65 - 6.92 |
6.93 - 17.38 |
17.39 - 26.78 |
26.79 - 34.83 |
34.84 - 43.30 |
43.31 - 51.99 |
52.00 - 61.53 |
61.54 - 78.16 |
78.17 - 95.23 |
>= 95.24 |
Points |
1.0 - 1.9 |
2.0 - 2.9 |
3.0 - 3.9 |
4.0 - 4.9 |
5.0 - 5.9 |
6.0 - 6.9 |
7.0 - 7.9 |
8.0 - 8.9 |
9.0 - 9.9 |
10 |
