Healthcare Transformation – Pay for Performance

Healthcare payers, providers and government agencies across the world are focused on improving health outcomes whilst simultaneously reducing cost. Pay-for-performance is designed to use financial incentives for clinicians to yield better health outcomes. Long-term outcomes, such as higher life expectancy is too difficult to measure, so pay-for-performance systems usually measures process outcomes (& medium-term results) such as lowering of cholesterol levels, lower blood pressure, or counseling patients to stop smoking. Also known as “P4P” or “value-based purchasing,” this payment model rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures of quality and efficiency. It penalizes caregivers for poor outcomes, medical errors, or increased costs. In essence, there’s a shift in assumed risk from payers to providers i.e. payers holding providers accountable for medium-term outcomes.

Good or Bad?

As is always the case with such sweeping changes, there are staunch proponents and those who provide compulsive counter arguments based on results reported in the US and UK. Some folks claim that despite all the incentives and changes, the clinical outcomes haven’t improved, whilst proponents cite numerous year-on-year metrics such as reduced number of emergency care visits and chronic care complications as concrete measures of improvement. Critics say that pay for performance is a technique borrowed from corporate management, where the main outcome of concern is profit. They say that in medical practice, many important outcomes and processes, such as spending time with patients, can’t be quantified. However, healthcare professional societies have given qualified approval to incentive programs, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens.

Government Initiatives and Approach

That said, below are some of the approach and measures used by healthcare agencies across the world.

In the UK, the Health and Social Care Information Center (HSCIC) maintains and publishes the Quality and Outcomes Framework (QOF) that is being used for payment of providers since 2004. The QOF publishes general practice achievement results based on a voluntary reporting process for all surgeries in England and was introduced as part of the GP contract. It is reported in two formats; a publication, and an on-line search function.

QOF awards surgeries achievement points for: managing some of the most common chronic diseases, e.g. asthma, diabetes; implementing preventative measures, e.g. regular blood pressure checks; the extra services offered such as child health care and maternity services; the quality and productivity of the service, including the avoidance of emergency admissions to hospital; and compliance with the minimum time a GP should spend with each patient at each appointment.

UK map

In the US, various forms of the pay-for-reporting and pay-for-performance frameworks are being implemented as part of its Medicaid programs, especially under the 1115-waiver initiative, to provide high quality, cost-effective health care.

US DSRIP

Source: chcs.org

The first state to be approved for a waiver-based Medicaid incentive program by the Center for Medicare and Medicaid Services (CMS, an agency of the US Department of Human and Health Services) was California. Their program, called the Delivery System Reform Incentive Program (DSRIP) was approved in late 2010. Other states have since created similar programs, including KansasMassachusettsNew Jersey, New Mexico, New York, and Texas.  The Massachusetts’ program is called the Delivery System Transformation Initiatives (DSTI) and New Mexico’s program as the Hospital Quality Improvement Incentive program (HQII).

The early stages of California’s DSRIP focused on developing the infrastructure and building blocks for longer term success. Projects focused on quality reporting and data analysis, so that providers can assess what works best to improve the quality of care. The goal is to help save money in the short-term, while also benefiting patients and the broader community.

Massachusetts, with its DSTI, provide incentives for hospitals to build capacity, as the state transitions to a P4P model. Hospitals are creating and implementing plans to integrate and coordinate care within its provider network, as well as develop strong, patient-centered medical homes (PCMH).

Texas, meanwhile has developed a regional model, within their state. They have created regional healthcare partnerships (RHPs), to advance regional health care goals. Each of the RHPs must perform community needs assessments and hospital plans must address the issues found in these regional assessments.

Other states are using their DSRIP projects to support state policy priorities. For example, Kansas is addressing barriers to achieve statewide priorities from their Healthy Kansas initiative. New Jersey, meanwhile is combating and reducing chronic illness with its DSRIP program to help achieve its Healthy New Jersey 2020 goals. New Jersey hospitals will work on pre-approved projects based on improving care delivery around eight chronic diseases, including asthma, HIV/AIDS, substance abuse, and obesity.

More states are looking to roll out programs in the coming years and some are even in the process of finalizing plans with CMS.

NOTE: The DSRIP model is purported to hold great promise for producing effective transformations to healthcare delivery in the United States. However, as the states move forward with their plans, a few things to keep in mind:

1 Financial Management

It’s important that hospitals and providers have access to appropriate levels of payment for the care that they provide. They need to be able to cover the costs of the care they provide, as well as pay for the innovations that will help them be more cost-effective over the long-term. Ensuring that DSRIP incentives are funds in addition to money that the hospital receives for services that they provide, is vital.

2 Program & Milestone

The selection of specific programs and milestones is critical for achieving success within the programs. If milestones are tied to metrics that the hospital already tracks, the hospital will be able to use the information to make decisions about what is best for the patients.

3 Data & Infrastructure

Enhancing data management practices, tools and supporting infrastructure, which act as the foundation of delivery innovation is costly, both in time and in money. Current systems, their supporting infrastructure and the modalities used to ingest, store, process and report data is varied and highly complex. It will take a significant effort from a cross-discipline cross-function team to successfully achieve intended results.

Frameworks

Listed below are few of the published frameworks from around the world. Please note that the published frameworks tend to evolve over time. Hence, I would highly recommend that the information below be only used as a quick point-in-time reference rather than as an authoritative source.

UK Quality and Outcomes Framework (QOF)

--- QOF DOMAIN: Clinical

Respiratory

Asthma (45 points)
AST001 (4 pts) The contractor establishes and maintains a register of patients with asthma, excluding patients with asthma who have been prescribed no asthma-related drugs in the preceding 12 months
AST002 (15 pts) The percentage of patients aged 8 or over with asthma (diagnosed on or after 1 April 2006), on the register, with measures of variability or reversibility recorded between 3 months before or anytime after diagnosis
AST003 (20 pts) The percentage of patients with asthma, on the register, who have had an asthma review in the preceding 12 months that includes an assessment of asthma control using the 3 RCP questions, NICE 2011 menu ID: NM23
AST004 (6 pts) The percentage of patients with asthma aged 14 or over and who have not attained the age of 20, on the register, in whom there is a record of smoking status in the preceding 12 months
Chronic Obstructive Pulmonary Disease (COPD – 35 points)
COPD001 (3 pts) The contractor establishes and maintains a register of patients with COPD
COPD002 (5 pts) The percentage of patients with COPD (diagnosed on or after 1 April 2011) in whom the diagnosis has been confirmed by post bronchodilator spirometry between 3 months before and 12 months after entering on to the register
COPD003 (9 pts) The percentage of patients with COPD who have had a review, undertaken by a healthcare professional, including an assessment of breathlessness using the Medical Research Council dyspnoea scale in the preceding 12 months
COPD004 (7 pts) The percentage of patients with COPD with a record of FEV1 in the preceding 12 months
COPD005 (5 pts) The percentage of patients with COPD and Medical Research Council dyspnoea grade ≥3 at any time in the preceding 12 months, with a record of oxygen saturation value within the preceding 12 months, NICE 2012 menu ID: NM63
COPD006 (6 pts) The percentage of patients with COPD who have had influenza immunisation in the preceding 1 September to 31 March

Cardiovascular

Atrial Fibrillation (27 Points)
AF001 (5 pts) The contractor establishes and maintains a register of patients with atrial fibrillation
AF002 (10 pts) The percentage of patients with atrial fibrillation in whom stroke risk has been assessed using the CHADS2 risk stratification scoring system in the preceding 12 months (excluding those whose previous CHADS2 score is greater than 1), NICE 2011 menu ID: NM24
AF003 (6 pts) In those patients with atrial fibrillation in whom there is a record of a CHADS2 score of 1 (latest in the preceding 12 months), the percentage of patients who are currently treated with anti-coagulation drug therapy or anti-platelet therapy, NICE 2011 menu ID: NM45
AF004 (6 pts) In those patients with atrial fibrillation whose latest record of a CHADS2 score is greater than 1, the percentage of patients who are currently treated with anti-coagulation therapy, NICE 2011 menu ID: NM46
Heart Failure (29 Points)
HF001 (4 pts) The contractor establishes and maintains a register of patients with heart failure
HF002 (6 pts) The percentage of patients with a diagnosis of heart failure (diagnosed on or after 1 April 2006) which has been confirmed by an echocardiogram or by specialist assessment 3 months before or 12 months after entering on to the register
HF003 (10 pts) In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction, the percentage of patients who are currently treated with an ACE-I or ARB
HF004 (9 pts) In those patients with a current diagnosis of heart failure due to left ventricular systolic dysfunction who are currently treated with an ACE-I or ARB, the percentage of patients who are additionally currently treated with a beta-blocker licensed for heart failure
Hypertension (77 Points)
HYP001 (6 pts) The contractor establishes and maintains a register of patients with established hypertension
HYP002 (10 pts) The percentage of patients with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 150/90 mmHg or less
HYP003 (50 pts) The percentage of patients aged 79 or under with hypertension in whom the last blood pressure reading (measured in the preceding 9 months) is 140/90 mmHg or less, NICE 2012 menu ID: NM53
HYP004 (5 pts) The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 in whom there is an assessment of physical activity, using GPPAQ, in the preceding 12 months, NICE 2011 menu ID: NM36
HYP005 (6 pts) The percentage of patients with hypertension aged 16 or over and who have not attained the age of 75 who score ‘less than active’ on GPPAQ in the preceding 12 months, who also have a record of a brief intervention in the preceding 12 months, NICE 2011 menu ID: NM37
Peripheral Arterial Disease (9 Points)
PAD001 (2 pts) The contractor establishes and maintains a register of patients with peripheral arterial disease, NICE 2011 menu ID: NM32
PAD002 (2 pts) The percentage of patients with peripheral arterial disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, NICE 2011 menu ID: NM34
PAD003 (3 pts) The percentage of patients with peripheral arterial disease in whom the last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or less, NICE 2011 menu ID: NM35
PAD004 (2 pts) The percentage of patients with peripheral arterial disease with a record in the preceding 12 months that aspirin or an alternative anti-platelet is being taken, NICE 2011 menu ID: NM33
Secondary Prevention of Coronary Heart Disease (62 Points)
CHD001 (4 pts) The contractor establishes and maintains a register of patients with coronary heart disease
CHD002 (17 pts) The percentage of patients with coronary heart disease in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less
CHD003 (17 pts) The percentage of patients with coronary heart disease whose last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or less
CHD004 (7 pts) The percentage of patients with coronary heart disease who have had influenza immunisation in the preceding 1 September to 31 March
CHD005 (7 pts) The percentage of patients with coronary heart disease with a record in the preceding 12 months that aspirin, an alternative anti-platelet therapy, or an anti-coagulant is being taken
CHD006 (10 pts) The percentage of patients with a history of myocardial infarction (on or after 1 April 2011) currently treated with an ACE-I (or ARB if ACE-I intolerant), aspirin or an alternative anti-platelet therapy, beta-blocker and statin, NICE 2010 menu ID: NM07
Stroke and Transient Ischaemic Attack (22 Points)
STIA001 (2 pts) The contractor establishes and maintains a register of patients with stroke or TIA
STIA002 (2 pts) The percentage of patients with a stroke or TIA (diagnosed on or after 1 April 2008) who have a record of a referral for further investigation between 3 months before or 1 month after the date of the latest recorded stroke or TIA
STIA003 (5 pts) The percentage of patients with a history of stroke or TIA in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less
STIA004 (2 pts) The percentage of patients with stroke or TIA who have a record of total cholesterol in the preceding 12 months
STIA005 (5 pts) The percentage of patients with stroke shown to be non-haemorrhagic, or a history of TIA, whose last measured total cholesterol (measured in the preceding 12 months) is 5 mmol/l or less, NICE 2012 menu ID: NM60
STIA006 (2 pts) The percentage of patients with stroke or TIA who have had influenza immunisation in the preceding 1 September to 31 March
STIA007 (4 pts) The percentage of patients with a stroke shown to be non-haemorrhagic, or a history of TIA, who have a record in the preceding 12 months that an anti-platelet agent, or an anti-coagulant is being taken

High Dependency and Long-Term Conditions

Cancer (11 Points)
CAN001 (5 pts) The contractor establishes and maintains a register of all cancer patients defined as a ‘register of patients with a diagnosis of cancer excluding non-melanotic skin cancers diagnosed on or after 1 April 2003’
CAN002 (6 pts) The percentage of patients with cancer, diagnosed within the preceding 15 months, who have a patient review recorded as occurring within 3 months of the contractor receiving confirmation of the diagnosis, NICE 2012 menu ID: NM62
Chronic Kidney Disease (32 Points)
CKD001 (6 pts) The contractor establishes and maintains a register of patients aged 18 or over with CKD (US National Kidney Foundation: Stage 3 to 5 CKD)
CKD002 (11 pts) The percentage of patients on the CKD register in whom the last blood pressure reading (measured in the preceding 12 months) is 140/85 mmHg or less
CKD003 (9 pts) The percentage of patients on the CKD register with hypertension and proteinuria who are currently treated with an ACE-I or ARB
CKD004 (6 pts) The percentage of patients on the CKD register whose notes have a record of a urine albumin:creatinine ratio (or protein:creatinine ratio) test in the preceding 12 months
Diabetes Mellitus (107 Points)
DM001 (6 pts) The contractor establishes and maintains a register of all patients aged 17 or over with diabetes mellitus, which specifies the type of diabetes where a diagnosis has been confirmed, NICE 2011 menu ID: NM41
DM002 (8 pts) The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 150/90 mmHg or less, NICE 2010 menu ID: NM01
DM003 (10 pts) The percentage of patients with diabetes, on the register, in whom the last blood pressure reading (measured in the preceding 12 months) is 140/80 mmHg or less, NICE 2010 menu ID: NM02
DM004 (6 pts) The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) is 5 mmol/l or less
DM005 (3 pts) The percentage of patients with diabetes, on the register, who have a record of an albumin:creatinine ratio test in the preceding 12 months, NICE 2012 menu ID: NM59
DM006 (3 pts) The percentage of patients with diabetes, on the register, with a diagnosis of nephropathy (clinical proteinuria) or micro-albuminuria who are currently treated with an ACE-I (or ARBs)
DM007 (17 pts) The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 59 mmol/mol or less in the preceding 12 months, NICE 2010 menu ID: NM14
DM008 (8 pts) The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 64 mmol/mol or less in the preceding 12 months
DM009 (10 pts) The percentage of patients with diabetes, on the register, in whom the last IFCC-HbA1c is 75 mmol/mol or less in the preceding 12 months
DM010 (3 pts) The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 September to 31 March
DM011 (5 pts) The percentage of patients with diabetes, on the register, who have a record of retinal screening in the preceding 12 months
DM012 (4 pts) The percentage of patients with diabetes, on the register, with a record of a foot examination and risk classification: 1) low risk (normal sensation, palpable pulses), 2) increased risk (neuropathy or absent pulses), 3) high risk (neuropathy or absent pulses plus deformity or skin changes in previous ulcer) or 4) ulcerated foot within the preceding 12 months, NICE 2010 menu ID: NM13
DM013 (3 pts) The percentage of patients with diabetes, on the register, who have a record of a dietary review by a suitably competent professional in the preceding 12 months, NICE 2011 menu ID: NM28
DM014 (11 pts) The percentage of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March who have a record of being referred to a structured education programme within 9 months after entry on to the diabetes register, NICE 2011 menu ID: NM27
DM015 (4 pts) The percentage of male patients with diabetes, on the register, with a record of being asked about erectile dysfunction in the preceding 12 months, NICE 2012 menu ID: NM51
DM016 (6 pts) The percentage of male patients with diabetes, on the register, who have a record of erectile dysfunction with a record of advice and assessment of contributory factors and treatment options in the preceding 12 months, NICE 2012 menu ID: NM52
Hypothyroidism (7 Points)
THY001 (1 pt) The contractor establishes and maintains a register of patients with hypothyroidism who are currently treated with levothyroxine
THY002 (6 pts) The percentage of patients with hypothyroidism, on the register, with thyroid function tests recorded in the preceding 12 months
Palliative Care (6 Points)
PC001 (3 pts) The contractor establishes and maintains a register of all patients in need of palliative care/support irrespective of age
PC002 (3 pts) The contractor has regular (at least 3 monthly) multi-disciplinary case review meetings where all patients on the palliative care register are discussed

Mental Health and Neurology

Dementia (26 Points)
DEM001 (5 pts) The contractor establishes and maintains a register of patients diagnosed with dementia
DEM002 (15 pts) The percentage of patients diagnosed with dementia whose care has been reviewed in a face-to-face review in the preceding 12 months
DEM003 (6 pts) The percentage of patients with a new diagnosis of dementia recorded in the preceding 1 April to 31 March with a record of FBC, calcium, glucose, renal and liver function, thyroid function tests, serum vitamin B12 and folate levels recorded between 6 months before or after entering on to the register, NICE 2010 menu ID: NM09
Depression (31 Points)
DEP001 (21 pts) The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have had a bio-psychosocial assessment by the point of diagnosis. The completion of the assessment is to be recorded on the same day as the diagnosis is recorded, NICE 2012 menu ID: NM49
DEP002 (10 pts) The percentage of patients aged 18 or over with a new diagnosis of depression in the preceding 1 April to 31 March, who have been reviewed not earlier than 10 days after and not later than 35 days after the date of diagnosis, NICE 2012 menu ID: NM50
Epilepsy (10 Points)
EP001 (1 pts) The contractor establishes and maintains a register of patients aged 18 or over receiving drug treatment for epilepsy
EP002 (6 pts) The percentage of patients aged 18 or over on drug treatment for epilepsy who have been seizure free for the last 12 months recorded in the preceding 12 months
EP003 (3 pts) The percentage of women aged 18 or over and who have not attained the age of 55 who are taking antiepileptic drugs who have a record of information and counselling about contraception, conception and pregnancy in the preceding 12 months, NICE 2010 menu ID: NM03
Learning Disabilities (7 Points)
LD001 (4 pts) The contractor establishes and maintains a register of patients aged 18 or over with learning disabilities
LD002 (3 pts) The percentage of patients on the learning disability register with Down’s Syndrome aged 18 or over who have a record of blood TSH in the preceding 12 months (excluding those who are on the thyroid disease register), NICE 2010 menu ID: NM04
Mental Health (40 Points)
MH001 (4 pts) The contractor establishes and maintains a register of patients with schizophrenia, bipolar affective disorder and other psychoses and other patients on lithium therapy
MH002 (6 pts) The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate
MH003 (4 pts) The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood pressure in the preceding 12 months, NICE 2010 menu ID: NM17
MH004 (5 pts) The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of total cholesterol:hdl ratio in the preceding 12 months, NICE 2010 menu ID: NM18
MH005 (5 pts) The percentage of patients aged 40 or over with schizophrenia, bipolar affective disorder and other psychoses who have a record of blood glucose or HbA1c in the preceding 12 months, NICE 2011 menu ID: NM42
MH006 (4 pts) The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of BMI in the preceding 12 months, NICE 2010 menu ID: NM16
MH007 (4 pts) The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a record of alcohol consumption in the preceding 12 months, NICE 2010 menu ID: NM15
MH008 (5 pts) The percentage of women aged 25 or over and who have not attained the age of 65 with schizophrenia, bipolar affective disorder and other psychoses whose notes record that a cervical screening test has been performed in the preceding 5 years, NICE 2010 menu ID: NM20
MH009 (1 pts) The percentage of patients on lithium therapy with a record of serum creatinine and TSH in the preceding 9 months, NICE 2010 menu ID: NM21
MH010 (2 pts) The percentage of patients on lithium therapy with a record of lithium levels in the therapeutic range in the preceding 4 months, NICE 2010 menu ID: NM22

Musculoskeletal

Osteoporosis: Secondary Prevention of Fragility Fractures (9 Points)
OST001 (3 pts) The contractor establishes and maintains a register of patients:
1) Aged 50 or over and who have not attained the age of 75 with a record of a fragility fracture on or after 1 April 2012 and a diagnosis of osteoporosis confirmed on DXA scan, and;
2) Aged 75 or over with a record of a fragility fracture on or after 1 April 2012.
Although the register indicator OST001 defines two separate registers, the disease register for the purpose of calculating the APDF is defined as the sum of the number of patients on both registers. NICE 2011 menu ID: NM29
OST002 (3 pts) The percentage of patients aged 50 or over and who have not attained the age of 75, with a fragility fracture on or after 1 April 2012, in whom osteoporosis is confirmed on DXA scan, who are currently treated with an appropriate bone-sparing agent, NICE 2011 menu ID: NM30
OST003 (3 pts) The percentage of patients aged 75 or over with a fragility fracture on or after 1 April 2012, who are currently treated with an appropriate bone-sparing agent, NICE 2011 menu ID: NM31
Rheumatoid Arthritis (18 Points)
RA001 (1 pts) The contractor establishes and maintains a register of patients aged 16 or over with rheumatoid arthritis, NICE 2012 menu ID: NM55
RA002 (5 pts) The percentage of patients with rheumatoid arthritis, on the register, who have had a face-to-face review in the preceding 12 months, NICE 2012 menu ID: NM58
RA003 (7 pts) The percentage of patients with rheumatoid arthritis aged 30 or over and who have not attained the age of 85 who have had a cardiovascular risk assessment using a CVD risk assessment tool adjusted for RA in the preceding 12 months, NICE 2012 menu ID: NM56
RA004 (5 pts) The percentage of patients aged 50 or over and who have not attained the age of 91 with rheumatoid arthritis who have had an assessment of fracture risk using a risk assessment tool adjusted for RA in the preceding 24 months, NICE 2012 menu ID: NM57

--- QOF DOMAIN: Public Health

Cardiovascular

Blood Pressure (15 Points)
BP001 (15 pts) The percentage of patients aged 40 or over who have a record of blood pressure in the preceding 5 years, NICE 2012 menu ID: NM61
Cardiovascular Disease – Primary Prevention (15 Points)
CVD-PP001 (10 pts) In those patients with a new diagnosis of hypertension aged 30 or over and who have not attained the age of 75, recorded between the preceding 1 April to 31 March (excluding those with pre-existing CHD, diabetes, stroke and/or TIA), who have a recorded CVD risk assessment score (using an assessment tool agreed with the NHS CB) of ≥20% in the preceding 12 months: the percentage who are currently treated with statins, NICE 2011 menu ID: NM26
CVD-PP002 (5 pts) The percentage of patients diagnosed with hypertension (diagnosed on or after 1 April 2009) who are given lifestyle advice in the preceding 12 months for: smoking cessation, safe alcohol consumption and healthy diet

Lifestyle

Obesity (8 Points)
OB001 (8 pts) The contractor establishes and maintains a register of patients aged 16 or over with a BMI ≥30 in the preceding 12 months
Smoking (75 Points)
SMOK001 (11 pts) The percentage of patients aged 15 or over whose notes record smoking status in the preceding 24 months
SMOK002 (25 pts) The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses whose notes record smoking status in the preceding 12 months, NICE 2011 menu ID: NM38
SMOK003 (2 pts) The contractor supports patients who smoke in stopping smoking by a strategy which includes providing literature and offering appropriate therapy
SMOK004 (12 pts) The percentage of patients aged 15 or over who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 24 months, NICE 2011 menu ID: NM40
SMOK005 (25 pts) The percentage of patients with any or any combination of the following conditions: CHD, PAD, stroke or TIA, hypertension, diabetes, COPD, CKD, asthma, schizophrenia, bipolar affective disorder or other psychoses who are recorded as current smokers who have a record of an offer of support and treatment within the preceding 12 months, NICE 2011 menu ID: NM39

--- QOF DOMAIN: Public Health - Additional Services

Fertility, Obstetrics and Gynaecology

Cervical Screening (22 Points)
CS001 (7 pts) The contractor has a protocol that is in line with national guidance agreed with the NHS CB for the management of cervical screening, which includes staff training, management of patient call/recall, exception reporting and the regular monitoring of inadequate sample rates
CS002 (11 pts) The percentage of women aged 25 or over and who have not attained the age of 65 whose notes record that a cervical screening test has been performed in the preceding 5 years
CS003 (2 pts) The contractor ensures there is a system for informing all women of the results of cervical screening tests
CS004 (2 pts) The contractor has a policy for auditing its cervical screening service and performs an audit of inadequate cervical screening tests in relation to individual sample-takers at least every 2 years
Child Health Surveillance (6 Points)
CHS001 (6 pts) Child development checks are offered at intervals that are consistent with national guidelines and policy agreed with the NHS CB
Maternity Services (6 Points)
MAT001 (6 pts) Antenatal care and screening are offered according to current local guidelines agreed with the NHS CB
Contraception (6 Points)
CON001 (4 pts) The contractor establishes and maintains a register of women aged 54 or under who have been prescribed any method of contraception at least once in the last year, or other clinically appropriate interval e.g. last 5 years for an IUS
CON002 (3 pts) The percentage of women, on the register, prescribed an oral or patch contraceptive method in the preceding 12 months who have also received information from the contractor about long acting reversible methods of contraception in the preceding 12 months
CON003 (3 pts) The percentage of women, on the register, prescribed emergency hormonal contraception one or more times in the preceding 12 months by the contractor who have received information from the contractor about long acting reversible methods of contraception at the time of or within 1 month of the prescription

--- QOF DOMAIN: Quality and Productivity

Quality and Productivity

QP001 (5 pts) The contractor reviews data on secondary care outpatient referrals, for patients on the contractor’s registered list, provided by the NHS CB
QP002 (5 pts) The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its secondary care outpatient referral data with that of the other contractors. The contractor agrees with the group areas for commissioning or service design improvements
QP003 (11 pts) The contractor engages with the development of and follows 3 care pathways, agreed with the NHS CB, for improving the management of patients in the primary care setting (unless in individual cases they justify clinical reasons for not doing this) to avoid inappropriate outpatient referrals
QP004 (5 pts) The contractor reviews data on emergency admissions, for patients on the contractor’s registered list, provided by the NHS CB
QP005 (15 pts) The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its data on emergency admissions with that of the other contractors. The contractor agrees with the group areas for commissioning or service design improvements
QP006 (28 pts) The contractor engages with the development of and follows 3 care pathways, agreed with the NHS CB (unless in individual cases they justify clinical reasons for not doing this), in the management and treatment of patients in aiming to avoid emergency admissions
QP007 (7 pts) The contractor reviews data on accident and emergency attendances, for patients on the contractor’s registered list, provided by the NHS CB. The review will include consideration of whether access to clinicians in the contractor’s premises is appropriate, in light of the patterns on accident and emergency attendance
QP008 (9 pts) The contractor participates in an external peer review with other contractors who are members of the same clinical commissioning group to compare its data on accident and emergency attendances with that of the other contractors. The contractor agrees an improvement plan with the group. The review should include, if appropriate, proposals for improvement to access arrangements in the contractor’s premises in order to reduce avoidable accident and emergency attendances and may also include proposals for commissioning or service design improvements
QP009 (15 pts) The contractor implements the improvement plan that aims to reduce avoidable accident and emergency attendances

--- QOF DOMAIN: Patient Experience

Patient Experience

PE001 (33 pts) The contractor ensures that the length of routine booked appointments with doctors in the surgery is not less than 10 minutes. If the contractor routinely admits extra patients during booked surgeries, then the average booked consultation length should allow for the average number of extra patients seen in a surgery session such that the length of booked appointments is not less than 10 minutes. If the extra patients are seen at the end of surgery, then it is not necessary to make this adjustment. For contractors with only an open surgery system, the average face-to-face time spent by the GP with the patient is not less than 8 minutes. Contractors that routinely operate a mixed economy of booked and open surgeries should ensure that the length of booked appointments is not less than 10 minutes and the length of open surgery appointments is not less than 8 minutes.

This is a place holder for few of the US DSRIP value based payment frameworks to be added soon.