This year’s QOF brings in four main changes in relation to BP measurement:
- Firstly, some business rules have become more stringent in their BP target requirements.
- Secondly, some BP indicators have been removed completely.
- Thirdly, a new cohort of patients who were previously ignored by the QOF is now considered.
- Fourthly, a number of indicators looking at BP have had their thresholds raised, so it is harder to score full points.
Lower hypertension target
Within the hypertension ruleset, we have for the first time a two-stage target similar to that introduced in diabetes last year.
Last year there were 55 points on offer for getting hypertensives’ BPs down to 150/90. This year we are offered 10 points for getting the reading down to 150/90 or better, but a further 50 points for getting the patient’s BP down to 140/90.
Two indicators are removed:
- BP4, where we were paid a maximum of eight points for documenting the BP of up to 90% of our hypertensives, and
- CKD2, where we were paid four points for checking and documenting the BP of 90% of our CKD patients. Of course, we still have to measure these patients’ BPs as we are scored on their values - they just don’t pay us for measuring it any more.
The new BP business ruleset
A new business rule is introduced, called BP. This is different to the hypertension ruleset, which considers diagnosed hypertensives. The new BP ruleset replaces Records 11 and Records 17, the organisational indicators which required us to check the BPs of patients aged 45 or older every five years and paid us 10 and five points respectively for documenting the BP of these patients in 65% or 80% of the catchment group.
The new ruleset simply requires us to start checking BPs on all our patients from the age of 40. The same 15 points are available for documenting the BP readings of 90% of such patients every five years, so the same money is paid for measuring a wider age group cohort and with a higher required total coverage.
In addition to the changes above, there is a whole raft of changes applied to the thresholds – the minimum and maximum coverages we need to achieve to score any points or total available points respectively:
- In CHD, the thresholds for CHD2 (last BP ≤150/90 in L12M) are raised from 40-75% to 53-93%.
- In hypertension, the thresholds for HYP2 (last BP ≤ 150/90) are raised from 40-80% last year to 44-84%. The new indicator HYP3 mentioned above, requiring target BP of ≤ 140/90, has thresholds of 40-80%.
- In diabetes, DM2 (last BP ≤ 150/90) rises from 45-71% to 53-93%. The DM3 indicator (last BP ≤ 140/80) rises from 40-65% to 38-78%
- Finally, in CKD, CKD2 (last BP ≤ 140/85) rises from 45-70% to 41-81%.
Overall, the changes in BP management are not complex. But the raised thresholds, particularly in diabetes, are strikingly challenging. Unless practices work hard at achieving these new tighter targets and are free with their use of the appropriate exception codes (see my previous article on hypertension indicators) they are likely to fail to achieve the new, more stringent requirements with consequent financial loss.
Dr Simon Clay is a GP in Erdington, Birmingham
For details of Dr Clay’s comprehensive QOF Resource disc, click here