Maximising your QOF income: Osteoporosis

Indicators: 1

Points: 3

Prevalence (2017-18): 0.2%

£/patient on the register (est.): £30.61

Osteoporosis has been part of the QOF for six years, although it is now purely a register of patients.

Indicator 1: Maintain patient register (3 points)

This is essentially two registers stuck together. There are different criteria for patients for patients older than 75 and those between 50 and 74.

Patients 50-74 years old

Patients should have had a fragility fracture coded after April 2012. This is not automatic: ultimately it is a clinical decision whether any fracture is due to fragility and it will need to be specifically coded.

It is the age of the patient at the end of the QOF year that matters (at least 50), not the age when they had their fracture. However, to be included they must have had their fracture since April 2012.

They also need to have a DEXA scan result. The DEXA scan result should be osteoporotic or, alternatively, have a T value (at either hip, femoral neck or lumbar spine) of –2.5 or lower.

Finally they should have a diagnostic code for osteoporosis – the DEXA code is not enough. Most of the valid codes mention osteoporosis and a cause, or osteoporosis with a fracture.

With these three codes the patient is logged on the register and eligible for treatment.

Patients 75 and older at the end of the QOF year

Things are a little simpler in older patients. The qualifying date is later – they should have had a fragility fracture after April 2014 and again must be specifically coded as a fragility fracture. A proportion of patients will have automatically moved on from the previous part of the register.

While a DEXA scan may be appropriate, there is no requirement for this to happen before they appear on the register. There does, however, need to be a diagnostic code for osteoporosis.

There are several codes to enter and most of the activity occurs in secondary care.

This is easy to get wrong. Having an effective procedure can ensure that patients appear on the register, as follows:

1. When the practice receives notification that a patient has had a fracture there should be a review, normally by a clinician, to say if this was a fragility fracture. Major trauma is unlikely to result in a frailty fracture but trips and falls could. In some cases more information may be needed from the patient in consultation or by phone.
2. A fragility fracture code should be entered, if appropriate.
3. The patient should be offered DEXA scan if under 75 years old.
4. The result of the scan may be automatically entered by pathology messaging. If not, it will need to be done by hand.
5. If there is evidence of osteoporosis then the patient should be informed and an osteoporosis code entered.

Removed in 2019/20:

The indicators for this area requiring treatment with bone sparing agents have been removed. There were concerns about over-treatment and the small numbers of patients involved.

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

For reference:

Indicator 1: 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 2014 and a diagnosis of osteoporosis (OST004)