acfi love it! hate it! - hfma.org.au · pdf file• skilled acfi staff –knowing all...

ACFI – Love it! Hate it!

Presenter: Leigh Welling [email protected]

www.leighwelling.com.au

Ph. 0418577775

September 2017

mailto:[email protected]

http://www.leighwelling.com.au/

© Leading Age Services Australia - Victoria

ACFI – a Quick Overview

• 12 Questions plus 2 Diagnoses

• Essentially assessment based

• Checklists (ticks in a box) of care delivered results in an A, B, C or D rating in each question.

• All care documentation must support claim e.g. care plans and progress notes

• Based on usual, predictable and high frequency care needs

• Three ‘Domains’ determine the subsidy funding


Three Domains:

• Activities of Daily Living – Nutrition,

Mobility, Personal Hygiene, Toileting and

Continence.

• Behaviour Supplement – Cognitive Skills,

Wandering, Verbal, Physical, and

Depression

• Complex Health Care Supplement –

Medication and Complex Health Care

Procedures.


Scoring ACFI

QUESTIONS A B C D Category Points

1 Nutrition 0 6.69 13.39 20.09 High 88+

2 Mobility 0 6.88 13.76 20.65 Medium 62-87

3 Hygiene 0 6.88 13.76 20.65 Low 18-61

4 Toileting 0 6.11 12.21 18.31

5 Continence 0 5.79 11.53 17.31


ACFI Subsidy Rates

ADL’s Behaviours Complex H.C.

HIGH $110.55 $36.19 $67.32

MEDIUM $79.80 $17.36 $46.62

LOW $36.65 $8.37 $16.37

NIL $0.00 $0.00 $0.00

Optimising ACFI Claims

Made easy!!!


Optimising ACFI

• Two Key elements being;

• Admission Policy – High ACFI average

funding = High dependency residents.

• Skilled ACFI staff – knowing all the ethical

ACFI tricks and constantly reviewing

residents for increased care needs.

• Upskilling staff through ACFI Workshops

and Consultants (of course!!)


Optimising AFI claims

• Develop a system that works for your facility.

• Share the gathering of data for ACFI to all care and activity staff.

• General staff education on the elements of the care they deliver to residents that contributes to ACFI

• Gently educate the attending medical practitioners in how valuable their contribution is to ACFI claims.

• Make the best use of Medibank documentation.

• Plan ahead so that ACFI’s are not rushed at the last moment.


Optimising AFI claims

• Someone appointed to take overall

responsibility for ACFI claims. In larger

facilities this is generally not the Director of

Care. This person does not necessarily

have to be a RN.

• Do we appoint a ACFI champion??? There

are advantages and disadvantages.

Skilled support team is best.

• Appointee needs sufficient allocation of

hours to fulfill role.


Why has ACFI changed in

2017?

• The government’s Mid-Year Economic Review

stated that ACFI subsidy funding is higher than

‘Treasury’ forecasted, especially the CHC

Domain

• Many changes to the scoring in the Complex

Health Care Domain.

• Extend the recovery of overpayments from

inaccurate claims from the former six

months back to the date of submission.


Some Changed Rules

• Government plans to reduce funding to

aged care by $1.2 Billion over the next

four years.

• Department can direct a facility to lodge a

new ACFI when they suspect a significant

drop in a resident’s care needs.


More Changed Rules• At validation where there are 2 or more

downgrades with significant changes a

facility can be placed on a 2 year warning

period.

• Fines ($10,800 per offence) will be

imposed if further validation downgrades

occur in the warning period.

• Accurate ACFI claims and complete ACFI

Appraisal Packs are essential!!


Rule changes• Increased validations to target ‘areas of

risk for inaccurate claiming’. A new $10

million computer to help!

• Regular on-site and desk audit validations

will continue.

• The department is delivering webinar

workshops aimed at education to enhance

the accuracy of ACFI claims.

• Fees for ACFI appeals – but reimbursed if

claim upheld.


ACFI Compliance - Webinar

• “False claims referred to the Australian

Federal Police for consideration.

• “Repeat ACFI review visits to providers

within weeks if a very high incidence of

misclaiming is discovered.”


No Indexation in 2017/8

• Indexation of ACFI rates will not increase

in the 2017 2018 financial year.

• $214.06 will remain top dollar for a

resident claimed as HHH through to June

30th 2018.

• The Complex Health Domain will only be

indexed at 50% of the increase granted in

the 2018 2019 financial year.


Future Direction of ACFI

• Wollongong University commissioned by

government to develop future options for

aged care funding.

• Objectives to include equitable stable long

term funding, recognising basic costs to

provide a service to any resident.

• Current ACFI is inefficient, duplicitous and

subject to “gaming”!



• Option One: Refinement of current ACFI

deleting rarely claimed care items, moving

Cognition and Depression out of the

Behaviour domain. Lead time to

implement 6 to 12 months.

• Option Two: ACAT’s allocate to one of four

funding bands. ACAT’s to be recalled if

care needs change or increase. Lead time

6 to 12 months.



• Option Three: Similar to option two but

with supplements for special needs.

Supplements to be approved by an

external assessor. Lead time to start 12

months.

• Option Four: Activity Based Funding with

branch like care claims. Lead time to start

2 years.


Future direction of ACFI

• Option Five: (preferred) Fixed base price

per resident per day. Plus variables to be

determined by an external assessor.

Variables like ‘chronic wound’ or Palliation

and to be time limited. One-off admission

payment covering initial costs.

• External assessors could be retrained

ACAT’s, new agency or accredited staff to

assess needs in other facilities, not their

own. Lead time 2 to 3 yrs + interim Opt.1

Preparing for an ACFI audit


ACFI Validations

• Generally 20% of approved beds will be

reviewed.

• Audits historically do not go back further

than claims lodged six months before the

visit. Though with the changes to ACFI it is

now common for some reviews to go back

to 2014.

• The bulk of files audited will have been

lodged six to eight weeks before the visit.

• “Desk audits” are being conducted too.


ACFI Validations

• Files of deceased residents have not been

routinely reviewed.

• Validators are entitled to be introduced to

the residents they are reviewing and will

stay and observe care delivered.

• Validators are clarifying ACFI questions by

interviewing staff.


ACFI Validations

• When notified of an impending ACFI audit take the time to review the contents of all ACFI Appraisal Packs in the target range of time. To ensure the contents are complete and match the claim submitted.

• On the day of the audit have a suitable staff member act as a ‘gofer’ to gather any additional evidence required.


ACFI Validations

• Choose with utmost care staff who may be

asked questions relating to the care of the

residents. Care staff are prone to

minimise or not recognise care given.

Remember the word “independent” is a

‘four-letter-word’ and best never used

within a facility!!!


ACFI Appraisal Packs

• Get the packs right!!

• Consistent order of content

• Currently, ‘more’ is better! Fat packs

means more reading time and less time to

walk around asking questions!!

• Ensure all documents are correctly signed

off and dated within 6 months of lodgment.


Free ACFI Updates

• Advanced ACFI information available at no

cost or obligation found at:

• www.leighwelling.com.au

• Newsletters

• “What’s New”

• Updated monthly.

• Leigh - Ph. 0418 577775

http://www.leighwelling.com.au/

PAIN MANAGEMENT IN AGED

CARE– Everybody wins!

Presenter: Leigh Welling

Leigh Welling and Associates

[email protected]

www.leighwelling.com.au

mailto:[email protected]


Pain Management

• Claimed in the 3rd Domain – Complex

Health Care.

• Three programs:

• 12.3 – Massage or Heat Packs

• 12.4A – Massage or Technical Equipment

undertaken by an RN or Allied Health

Professional (AHP)

• 12.4B – as per 12.4A but only by an AHP


Pain Management

• Foundation requirements include:

• Resident must have pain – supporting

diagnosis.

• Resident on regular analgesics helps!

• Pain assessment identifies pain.

• Resident agrees to treatment.

• Treatment plan must be “ongoing”


Pain Management

• 12.3 – Heat packs/massage can be

delivered by any staff member.

• Must achieve 20 minutes staff time each

week.

• Must be delivered at least weekly.

• Gathers just one (1) point in ACFI

Question 12.


Pain Management

• 12.4A – Massage or Technical equipment

designed especially for pain management.

• Can be undertaken by an Registered

Nurse or a Physiotherapist, Occupational

Therapist, Osteopath or Chiropractor.

• Must achieve 20 minutes staff time each

week and be delivered minimally weekly.

• Gathers three (3) points in Question 12.


Pain Management

• 12.4B Pain Management requirements:-

• 4 DAYS & 80 minutes 1:1 staff treatment

time weekly.

• Can only be undertaken by a

Physiotherapist, Occupational Therapist,

Osteopath or Chiropractor.

• Cannot be delivered by a ‘Therapy Aid’ or

an ‘Exercise Physiologist’ or any Nurse.

• Gathers Six (6) points for Question 12.


Pain Management

• ACFI Question 12 is all about points.

• 1 to 4 points = ‘B’

• 5 to 9 points = ‘C’

• 10 points plus = ‘D’

• ACFI 11 Medication and ACFI 12 work

together as a matrix.

• All residents will achieve a ‘B’ in Q11

Medication.


Pain Management

• Combinations and funding in Complex

Health Care Domain.

• Q11 ‘B’ + Q12 ‘A’ = LOW = $16.37/day

• Q11 ‘B’ + Q12 ‘B’ = LOW = $16.37/day

• Q11 ‘B’ + Q12 ‘C’ = MEDIUM = $46.62/day

• Q11 ‘B’ + Q12 ‘D’ = HIGH = $67.32/day

• Scenarios…


Pain Management

• Economics of Pain Management

Programs (PMP’s)!!

• Combinations with other claimable Q12

items works well. E.g. 12.5 Change of

Position (3 points) + 12.4A (3 points) =

MEDIUM $46.62/day. Cost to deliver PMP

is $25.00 per week. The 12.4A delivers a

gross increase of $211.75 less $25.00, a

nett benefit of $186.75 per week.


Pain Management• More economics.

• A resident gets 12.5 Change of position (3

points) + 12.4B (6 points) + 12.3 (1 point)

• So 11B Meds + 12D = $67.32/day. Care

staff deliver 12.3. heat pack. Physio 12.4B.

• Without Physio PMP only $16.37/day so

an increase of $50.95/day. $50.95X 7 =

$356.65 less cost of Physio service $100 a

nett increase of $256.65 per week.


Pain Management

• In all combinations a Physio 12.4B Pain

program self funds and delivers a nett

benefit to the facility.

• So everybody wins! The resident gets

heaps of 1:1 pain management, the facility

always has a positive $ balance income

over costs. And a young Physio is

employed!!!

acfi love it! hate it! - hfma.org.au · pdf file• skilled acfi staff –knowing all...

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