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Quick QOF tips, 2013-4: Cardiovascular disease, primary prevention (CVD-PP)

Dr Simon Clay explains the changes to the rules relating to CVD-PP in the 2013-14 QOF

The business rules covering CVD-PP were changed significantly in version 25 (April 2013). These changes relate mainly to the first indicator (CVD-PP 001).

CVD-PP 001

New hypertensives, aged 30-74, diagnosed during the present QOF year and not before (excluding those who have already been coded as having any one of CVA, DM, CHD, CKD grade 3-5, PAD or familial hypercholesterolaemia), who have also had (during the same QOF year that their hypertension was added), a valid CVD Risk score done and coded, which showed a risk score of ≥ 20%, should be prescribed a statin.

This is quite a complex sentence, so let me break that down a little.

To be in the denominator for CVD-PP 001 indicator, the patient must fulfil four criteria:

* Hypertension added from April 1st this QOF year.

* No previous diagnosis of any one of the following: CVA, DM, CHD, CKD grade 3-5, PAD or familial hypercholesterolaemia, at any time.

* A valid CVD risk score calculated & added during the same QOF year as the hypertension is added (i.e. the present QOF year)

* The risk score of that CVD risk calculation is ≥ 20%

Then, of this group of new hypertensives, with a risk score which is 20% plus, the patient will score the indicator & be included in the numerator if they are prescribed a statin during the last 6 months of that same QOF year (from October each QOF year).

Hence, last year’s rule 1, which required such new patients to merely have a risk score done, is rescinded.  Now they don’t need one done (or at least the rules don’t penalise you if the patient does not have an assessment). However, if they do have a CVD risk score done (good practice) and if that risk score is ≥ 20%, then they should be demonstrably issued statins to score the indicator.

In version 25.0 patients needed both a JBS CVD risk score of >20% coded AND one of the codes below with a numeric of ≥ 20%. This was an error & has now been corrected in Version 25.1.

So now, as of version 25.1, patients only need:

EITHER a code showing JBS CVD risk score of ˃20% (one of the two code options below):

- 662m.  JBS CVD risk of 20-30% in next 10 yrs.

- 662n.   JBS CVD risk of > 30% in next 10 yrs.

OR one of the 6 codes listed below, with a numeric of ≥ 20%.

- 38DR.  Framingham 1991 cardiovascular disease 10 year risk score

- 38DF.  QRISK cardiovascular disease 10 year risk score

- 38DP.  QRISK2 cardiovascular disease 10 year risk score

- 38B10  CVD (cardiovascular disease) risk assessment by third party

- 38G6.  Joint British Societies cardiovascular disease risk score

- 38G8.  Dundee CVS risk score.

Finally, having calculated the CVD Risk score for your new hypertensive patient, if the result is  ≥ 20% and if they’re not excluded by the presence of one of the exempting pre-existing conditions, prescribing any of the five presently available statin drugs will then “score” for CVD-PP1 rule!

Note that if the CVD risk score Read code is not added within that same QOF year as the hypertension is added, or if it’s not present in the record at all, the patient will not even enter the denominator for CVD-PP1.

This means that the patient doesn’t have the opportunity to score for the practice, (if the CVD risk score would have been ≥ 20% and they are on a statin) but nor do they penalise the practice if the score would have been ≥ 20% but they are not on a statin.

10 points are available for CVD-PP 001, with a payment threshold of 40-90%. This indicator should be eminently achieveable and should not present major problems to most practices I suspect.

CVD-PP 002

The only other change in the CVD-PP business rules is that for CVD-PP2 (“Lifestyle advice annually for hypertensives diagnosed since April 09”), the lifestyle advice doesn’t have to address exercise any more - just smoking, alcohol & diet.

The valid Read code options remain unchanged: 

- 67H. Lifestyle counselling

- 67H8. Lifestyle advice regarding hypertension

Dr Simon Clay is a GP in Erdington, Birmingham

For details of Dr Clay’s comprehensive QOF Resource disc go to tinyurl.com/qofdisc

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