When a patient is transitioned from another provider’s practice or has never before been seen, an electronic summary of care record should be received/retrieved to assist the provider in the coordination of care.
Medicaid Promoting Interoperability Objective and Calculation
The objective is to have the EP who sees a new patient or receives a patient from another setting or provider of care receive/retrieve a summary care record for such encounters.
Measure: For more than 40 percent of transitions or referrals received and patient encounters in which the provider has never before encountered the patient, the EP incorporates into the patient’s EHR an electronic summary of care document.
Denominator for calculations: Number of patient encounters during the PI reporting period for which an EP was the receiving party of a transition or referral or has never before encountered the patient and for which an electronic summary of care record is available.
Numerator for calculations: Number of patient encounters in the denominator where an electronic summary of care record received is incorporated by the provider into the certified EHR technology.
- Any EP who has a total of less than 100 inbound transitions of care PLUS new patient encounters during the reporting period.
- Any EP that conducts 50 percent or more of his or her patient encounters in a county that does not have 50 percent or more of its housing units with 4Mbps broadband availability according to the latest information available from the FCC on the first day of the PI reporting period may exclude the measures.
Promoting Interoperability Discussion
A transition of care is the movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. Optometrists and ophthalmologists may transition or refer patients into many of these types of settings and they may also receive patients from them. This measure seeks to track the actions taken on receipt.
When an inbound referral of an established patient is taking place, the user should check the “Transition of Care” box on the RFV screen: See Example
In these situations, it is incumbent on the requesting provider to send you an electronic summary of care document. Upon receipt (whether before or after the encounter has been signed) and addition to the patient record, the “e-TOC Document” field should be used to indicate “Received and Incorporated:”
The same workflow as above can be followed for encounters with patients that have never been seen before, however, it’s important to note that the Transition of Care checkbox for these patients is optional. RevolutionEHR will automatically consider all patients with a status of “New” at the time their encounter is started in the denominator of this measure.
In the event that an inbound transition of care or encounter with a new patient is taking place and despite the provider’s best effort a summary of care document is not available (i.e. requesting provider is on paper records, etc.), the e-TOC Document field should be used to indicate “Requested, but Unavailable:”
The above indication removes the patient from the denominator of the measure thereby avoiding negative impact. Official CMS Fact Sheet
Meeting this objective is significantly challenging because the provider’s ability to receive an electronic document depends on the requesting doctor being in touch with electronic workflows. Additionally, the transition of a new patient of their own volition introduces potential questions regarding “where” that document will come from.