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Last-minute QOF tips: Cancer, 2012-13

Dr Simon Clay covers ‘catches’ in the QOF business rules 2012-3 for cancer, to help practices avoid missing out on valuable points

Let’s take a hypothetical 18-month period from 1 October 2011, to 1 April 2013 (the ‘Reference’ date).

In the rule set analysis for the indicator Cancer 3 (whether a cancer review was done), all cancers diagnosed in the 18 months before the reference date are looked at, but of these cancers, only those whose cancer reviews were done in the twelve months before the reference date count ‘for’ the practice.

If a cancer was diagnosed from 2 October in the QOF year you’re in and the review was not done by the end of that particular QOF year (by 31 March), the patient is exempted from the Ca3 indicator for that year because there was not a complete six-month period available for the practice to get the review done before the Reference date for that QOF year (1 April).

If a cancer is diagnosed after 1 October in the ‘active’ QOF year and the review is never done at all, the patient is removed from the denominator for Ca3 for that year (as explained in the paragraph above). But the patient will remain in the denominator for Ca3 the following year, when he or she will count ‘against’ the practice (because the patient remains in the 12-18 month window for the following QOF year).

If a patient diagnosed after 1 October in the ‘active’ QOF year does have a Ca review done in the following 6 months and before the following April, the practice will ‘score’ the Ca3 indicator in that year but not the following QOF year. So this patient’s cancer review, will neither count for the practice nor against the practice in the following QOF year.

If a patient diagnosed after 1 October 2012 does not have a Ca review done before the following reference date on 1 April but does have one done after 1 April and within six months of the diagnosis being added, he or she will count for the practice in the following QOF year (that is, 2013-14).

So although it might be tempting to relax about patients whose cancers are diagnosed in the second half of the year (because they won’t penalise the practice in that year) you should be aware that they can count for the practice if the review is done that year, even though they do not count against the practice that year, if the review is not done. They will however count against the practice the following year, if not done.

A simple way of summarising this fairly complex rule is to say that if every patient with a cancer has a cancer review added within six to 12 months of the diagnosis being added, the practice must score full points for Ca3.

Cancer Top tips:

  1. All cancers diagnosed in the 12-18 months before the Reference date are considered each year, although only ones diagnosed in the same QOF year can count for you.
  2. Non-melanoma Skin cancers (even Squamous cell cancers B338. or Dermatofibrosarcoma Protruberans B339.) are excluded and therefore do not require a cancer review code adding.
  3. Morphology codes (they start with an [M] in square brackets and have BB as their initial Read code characters) are not valid cancer codes. A clinician using such a code to code a new cancer, reduces the practice’s denominator for cancer patients. For example BB14. [M]Carcinomatosis rather than B590 Carcinomatosis, or BBTA. [M]Kaposi’s Sarcoma rather than B33z0 Kaposi’s sarcoma of skin. This is the commonest error made in cancer, in my experience. Do a search for BB codes added in the last six months to find them.

For information on Dr Clay’s QOF resources, go to http://tinyurl.com/dy9cea8

Dr Simon Clay is a GP in Erdington, Birmingham.

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