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How do we optimise DES and QOF performance before the end of March?

How can we optimise QOF prevalence?

Your practice may be on course to a high QOF points total but prevalence can have a huge effect on the amount of cash that your practice receives.

Osteoporosis can be a valuable area with a total of nine points and only around five patients per practice. This means that each extra patient added to the register is worth the equivalent of nearly two points in an average practice. All patients require a fragility fracture code (since April 2012) and an osteoporosis diagnosis code. For patients aged between 50 and 74 a further DEXA scan code is required. The osteoporosis code is easy to miss, particularly in patients over 75 as this was not needed in some previous years. Make sure all patients with a fragility fracture have been assessed for osteoporosis – and that they receive bone sparing agents if indicated. Having no patients on the osteoporosis registers is the most common reason that practices miss out on points.

What code changes should we be looking out for?

There have been some changes to the business rules through the year about disease registers for Chronic Kidney Disease and these have appeared on clinical systems only fairly recently. Codes for ‘GFR category’ 1 or 2 will now not put the patient onto the register for CKD and if you have seen a recent fall in the numbers on your practice register it would be worth checking if these patients have been coded correctly.

There is a similar situation for a more obscure register for patients with heart failure due to left ventricular systolic dysfunction which applies to HF003 and 4 – prescribing ACE inhibitors and beta blockers. The code used must specify systolic dysfunction and so the codes G5yyD or Xaacj no longer apply. The suggested code is now G5yy9 or Xallq. The nineteen points available are again likely to outnumber the patients on the register making this worth keeping up to date.

What can we do to get paid for the Avoiding unplanned admissions DES?

Admission avoidance represents a large chunk of money for practices. The requirements this year are that an average of 2% of patients over the age of 18 should be on the register and have received a care plan or review in the previous 12 months. Patients who were on the register last year will have had a care plan between January and March 2015 so a large group of patients could need a care plan review about now.

If your register was between 1.8% and 2% in September then you will need some extra patients at the end of March so that you have an average of 2% over the year. Remember that you can include patients who had died or left the practice whilst on the register in the last six months, although they will need to be manually entered on CQRS.

If you are short of patients on the register then it can be worth looking at patients on the dementia register. They should have a care plan created or reviewed in a face to face consultation this year anyway for the QOF indicator DEM004. This carries 39 points – the relatively high points to patients ratio reflects the importance attached to this by the Department of Health.

Are there any other ‘easy wins’?

The specification for the Dementia screening (officially ‘facilitating timely diagnosis’) DES is complicated but the payment of component 2 is relatively simple being based on a code for dementia assessment. GPCOG or MMS examinations will count if they are coded correctly. The dementia DES has a fixed payment about £21 million for the whole of England which is divided according to the number of assessments at each practice. Numbers have been relatively low in the past years and so each code carries a good amount of cash although the exact amount won’t be confirmed until sometime after the data has been submitted. It can certainly be worth reviewing patients referred to memory clinics to ensure that their assessment is coded properly.

Component one is based on your list size and should have been paid earlier in the year.

Is there anything else we need to watch out for when claiming?

CQRS has had a somewhat chequered course over this year but, when it works, checking DES codes becomes as important and urgent as getting QOF data ready. In the past it has been possible to deal with QOF and then have a few weeks during April to submit DES claims. For services with automatic extraction such as unplanned admissions and dementia this is no longer the case and all codes should be entered and correct by the end of March.

Dr Gavin Jamie is a GP in Swindon and runs the QOF Database website