QMAS Refresher Training

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QMAS Refresher Training Update8th March
2007
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Please noteAll the QMAS screen shots used in
the presentation are for illustrative purposes
only.
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Additional Clinical Indicators QOF 06/07

• Heart Failure
• Palliative Care
• Dementia
• Depression
• Chronic Kidney Disease
• Atrial Fibrillation
• Obesity
• Learning Difficulties
• Smoking
• LVD (Now redundant from previous QOF)

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Timelines
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Roles Responsibilities Viewing and
Interpreting ReportsHeather Stephens Innove
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Obtaining a QMAS User ID Password

• The QMAS User Administrators are based in the
  three NHS regional offices.
• qmas.queries_at_psd.csa.scot.nhs.uk
• For security reasons only QMAS User
  Administrators are allowed to issue user IDs and
  passwords.
• Good practice suggests that each user should have
  a unique user ID and password these should not
  be shared with other users.
• In order for the Administrators to set up a new
  user or role you will be required to complete an
  Additional User Form available online on the
  SHOW website www.qmasweb.scot.nhs.uk/
• The practice or Health Board must agree the
  appropriate type of access to QMAS for each user
  i.e. entering and/or viewing data.

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Roles for NHS Board Users

• If you work in an NHS Board, you can be assigned
  one (or more) of three NHS Board QMAS
  roles
• NHS Board QOF Data View
• View NHS Board achievement reports.
• View practice achievement reports.
• NHS Board QOF Management
• Review and agree the practice achievement
  submissions (and aspiration where appropriate).
• Approve that an achievement payment is to be
  calculated and made, based on the practices
  submission.
• View NHS Board achievement reports.
• View practice achievement reports.
• It is recommended that this role is allocated to
  a senior member(s) of staff in the NHS Board.
• NHS Board QOF Finance
• View the practice Year End achievement reports.
• Approve a report for payment.
• It is recommended that this role is allocated to
  a senior member(s) of staff in the NHS Board.

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Supporting Manual Practices

• There are a few manual practices that do not have
  access to QMAS but are participating in the QOF.
• It is the NHS Boards responsibility to submit
  clinical and non-clinical data on behalf of the
  practice and to sign off the report.
• Someone in the NHS Board should have a Practice
  QOF Data View and Update role and a Practice
  QOF Management Role. This should be agreed with
  the practice.

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Action Points

• Do the NHS Board Users need to be updated i.e.
  who will fulfil the QOF Management and Finance
  roles?
• Who at the NHS Board will submit data on behalf
  of manual practices?
• Have you submitted the User Check Form to the RO
  QMAS Administrator (ensuring the QMAS user
  database is up to date)?

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Road Map to guide you through the Year End Process
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Practice ProcessesStandard Pathway
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Practice Processes
Practice Approval Process
Practice prepares for End-of-Year Achievement
Payment
Clinical System Submits Clinical Achievement Data
Practice submits Achievement Declaration
QMAS Determines Achievement
Practice Reviews Achievement Reports
Approved
Non-clinical Data entered by Practice via QMAS
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Practice Preparation

• Disease register sizes
• Clinical Data run interim reports
• Non-Clinical Data ensure all questions have
  been answered
• Use Connectivity Checklist to ensure Elinks is
  working

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Practice Processes
Practice Approval Process
Practice prepares for End-of-Year Achievement
Payment
Clinical System Submits Clinical Achievement Data
Practice submits Achievement Declaration
QMAS Determines Achievement
Practice Reviews Achievement Reports
Approved
Non-clinical Data entered by Practice via QMAS
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2007
This is your practices final achievement Report
for financial year 2006/07. Please check all the
details of this Report. Only this Report may be
used as the basis for making a payment. If you
are satisfied with its accuracy, click the Next
button to initiate NHS Board approval and
payment. If you are not, contact your NHS Board
and request that the Report is adjusted.
2006/07.
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Practice Processes
Practice Approval Process

Practice prepares for End-of-Year Achievement
Payment
Clinical System Submits Clinical Achievement Data
QMAS Determines Achievement
Practice Reviews Achievement Reports
Practice submits Achievement Declaration
Approved
Non-clinical Data entered by Practice via QMAS
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I declare that, to the best of my knowledge, all
the information provided in this return is
accurate and reliable, and a proper basis on
which to calculate an achievement payment. If it
is not, I understand that appropriate action will
be taken, including where appropriate a counter
fraud criminal investigation.
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You have successfully submitted your achievement
declaration to your NHS Board. The NHS Board
will now complete pre-payment verification. If
you hear nothing further, you may assume that
verification is complete and payment has been
approved.
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NHS Board Approves Achievement Standard Pathway
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NHS Board Processes
NHS Board Approves Payment via QMAS
Payment via Primary Medical Services Payment
System
NHS Board Conducts Pre-payment Verification
Approved
Approved
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Pre-Payment Verification

• The NHS Board will need to verify the practices
  achievement prior to payment being made (High
  Trust, Soft Touch).
• The NHS Board knows the practices very well and
  will have undertaken QOF assessment visits.
• The NHS Board will be monitoring QMAS Reports
  already.
• For the vast majority of practices these checks
  will be routine and there will be no need to
  contact them.

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NHS Board Reports

• NHS Boards have access to monthly reports
• Reports contain aggregate data from all the
  practices known to QMAS
• NHS Boards have the ability to drill down into
  individual practice results.

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What is Exception Reporting?

• The Quality and Outcomes Framework (QOF) includes
  the concept of Exception reporting. This has
  been introduced to allow practices to pursue the
  quality improvement agenda and not be penalised
  for something that is not within their control or
  is a patient related issue.
• Exception reporting only applies to Indicators
  that require a Numerator and Denominator i.e. all
  Clinical Indicator Groups and in the
  Organisational Domain some of the Records and
  Information about Patients Indicators.
• CS1 Will not have exception reporting figures
  manually inputted by PSD.
• The GMS Certified GP Clinical Systems now provide
  the Exception details to QMAS.
• Exception reporting on QMAS only applies to
  automated practices.

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Exception Groupings

• There are two broad Exception groupings
• In the first group the Exceptions are
  automatically created by the GP clinical system.
  For example CHD 2 (the percentage of patients
  with newly diagnosed angina (diagnosed after 1
  April) who are referred for exercise testing
  and/or specialist assessment), all the patients
  who do not have newly diagnosed angina are
  automatically excluded from this Indicator.
  Other examples include new registrations and
  diagnosis made within certain time frames.
• The second group covers Exceptions that require
  the practices to actively record something in the
  patients' records on the GP clinical system. For
  example, patient unsuitable, informed dissent,
  allergies and intolerance of drugs.

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Comparatives

• Comparatives are now provided at a practice,
  Health Board and national level.
• Comparatives are displayed on Exception Summary
  and Exception Detail reports and are always
  displayed as percentages.
• At a Practice level this enables the Practice to
  see how they compare with the local and National
  Average.
• Health Boards will be able to see the same
  Exception reports that practices see and can also
  compare the Health Boards Average Exception
  percentage against the National Average.
• Practices need to be aware that significant
  differences between the Practice and NHS Board
  averages may prompt the Health Board to discuss
  this further with the practice.

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For further Information and to view the QMAS
Exception Reporting Tutorial and User Manual

• www.qmasweb.scot.nhs.uk/

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Non-Clinical Domain Exceptions
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Average Pounds per Point

• The Average Pounds per Point values for each
  practice and the Health Board are now displayed
  on the following Health Board reports
• Health Board Domain Level Summary of Achievement
  against Aspiration Pounds Score.
• Health Board Practice Indicator Group Level
  Breakdown of Achievement Pounds Score.
• The national pound per point value for 2006/07 is
  124.60. The pound value is adjusted for each
  practice by applying that practices Prevalence
  Factor.

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Changes to How Prevalence is Displayed in QMAS

• QMAS now displays Raw Disease Prevalence and
  Square Rooted Prevalence separately on Practice
  and Health Board Indicator Group Level Summary of
  Achievement against Aspiration Achievement
  reports.
• This enables practices and Health Boards to
  distinguish between Raw Prevalence data, based on
  the clinical data submitted to QMAS, and the
  Square Rooted Prevalence values, that are applied
  to the Pounds Achieved calculations.
• There have been no changes made to the Prevalence
  calculations.
• Practice Raw Prevalence Disease Register
• Practice List Size
• Square Rooted Prevalence Factor v Practice
  Prevalence
• v National Prevalence

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Prevalence Factor

• Means of adjusting payment
• Based on the practice list size as of 1st January
  
• Disease Register sizes as of 14th February
• Square root formula applied
• Applies to pounds not points
• Only Scottish prevalence figures

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How Prevalence is Displayed at the Year End

• By the end of year, all practices should have
  submitted National Prevalence Day (NPD)
  information to QMAS. Disease registers supplied
  at this time are aligned to the National
  Prevalence Day on February 14th. These values are
  used to calculate the individual and National
  Disease Prevalence used in the Year End process.
• The text (NPD) only appears on March Year End
  reports and highlights to the user that the data
  displayed is related to National Prevalence Day
  submission.
• It is essential that 100 of practices submit
  their prevalence data.

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• Any Questions

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NHS Board Processes
NHS Board Approves Payment via QMAS
Payment via Primary Medical Services Payment
System
NHS Board Conducts Pre-payment Verification
Approved
Approved
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NHS Board Processes
NHS Board Approves Payment via QMAS
Payment via Primary Medical Services Payment
System
NHS Board Conducts Pre-payment Verification
Approved
Approved
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Making off system payments

• If practice reports are not signed off by 18th
  April, Health Boards will be required to submit a
  QMAS Interim Achievement/Aspiration Amendment
  Form.
• Available at
• http//www.qmasweb.scot.nhs.uk/Documents/Index.h
  tm
• This will advise the PSD Regional Offices of
  interim payments to be made.
• Once the QMAS report has been signed off,
  amendments will automatically be calculated
  within Primary Medical Services Payment System
  and paid to/recovered from practices accordingly.

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• Any Questions?

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Dispute Resolution Processes
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Dispute Resolution Processes (1)

• A dispute occurs when someone disagrees with the
  QMAS Year End Report.
• Dispute Resolution is mostly dealt with outside
  of QMAS.
• The NHS Board can make changes to the final
  Report on QMAS but the practice must always
  approve the changes before payment is made.
• Dispute Resolution is best dealt with locally by
  
• a simple negotiation, such as applying a local
  Lithium agreement,
• a discussion between the practice and NHS Board
  which results in agreement.

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NHS Board Amending Achievement on QMAS

• The features of these changes are
• Limited
• Causes Recalculation of Achievement
• Generates a New Adjusted Report
• Maintains Audit Trail

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What CAN be Changed?

• Numerator
• Denominator
• Boolean Value (Yes/No)
• Practice List Size (only for those list sizes NOT
  provided by Primary Medical Services Payment
  System)
• Disease Register Size
• Additional Service Target Populations

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Practice NHS Board Reviews Achievement Report

• Report not approved by either Practice or NHS
  Board
• Adjustment agreed

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This is your practices final achievement Report
for financial year 2006/07. It has been adjusted
by your NHS Board. Please check all the details
of this Report. If you are satisfied with its
accuracy, click the Next button to indicate NHS
Board approval and payment. If you are not,
contact your NHS Board.
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Practice NHS Board Reviews Achievement Report

• Not approved by either practice or NHS Board
• No agreement reached

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Dispute Resolution Summary

• Practice does not approve Report
• Practice must assemble evidence
• NHS Board does not approve Report
• NHS Board must assemble evidence
• Practice / NHS Board review and negotiate
• Adjustment agreed
• NHS Board amend
• New Report generated for practice approval
• No Adjustment agreed
• NHS Board approve payment (practice submit
  achievement declaration if not previously
  submitted)

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Any Questions?
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Maintaining an Audit TrailQMAS Management
Functions
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Negotiation Dispute Counter-Fraud Investigation
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Negotiation Dispute Counter-Fraud Investigation
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Recent QOF Workarounds
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Diabetic Retinopathy Screening Indicator DM 21

• The problem
• The new Diabetic Retinopathy Screening programme
  (DRS) is not universally available until early
  2007.
• The solution
• If any patients have been referred for screening
  but have not been able to have the screening
  completed due to unavailability of an acceptable
  service locally, they should be exception
  reported on an individual basis.

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Summarising Records Records Indicators 15, 18
20.

• The problem
• From April 2006, QMAS now searches for codes to
  calculate the achievement of records summarised
  (in previous years practices made a declaration
  of the percentage).
• This code has not been used routinely by Scottish
  practices and many practices who have achieved
  high levels of summarisation would be
  disadvantaged.
• The solution
• For 2006/07, a manual work around has been
  devised by NHS National Services Scotland,
  Practitioner Services Division (PSD).

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End of Year Issues

• Because of the tight timescales this year a few
  changes will be made to Servers.
• IM and T Leads to ensure that all GPASS
  practices snapshots are taken just after
  midnight on Sunday 1st April.
• Practices with historic long running snapshots to
  be identified and individually tweaked to fit
  in the timescales

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Any Further Questions?