ACFI – Love it! Hate it!
Presenter: Leigh Welling [email protected]
www.leighwelling.com.au
Ph. 0418577775
September 2017
© 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
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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.
© Leading Age Services Australia - Victoria
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
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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!!!
© Leading Age Services Australia - Victoria
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!!)
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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!!
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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.
© Leading Age Services Australia - Victoria
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.”
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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”!
© Leading Age Services Australia - Victoria
Future Direction of ACFI
• 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.
© Leading Age Services Australia - Victoria
Future Direction of ACFI
• 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.
© Leading Age Services Australia - Victoria
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
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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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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!!!
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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
PAIN MANAGEMENT IN AGED
CARE– Everybody wins!
Presenter: Leigh Welling
Leigh Welling and Associates
www.leighwelling.com.au
© Leading Age Services Australia - Victoria
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
© Leading Age Services Australia - Victoria
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”
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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.
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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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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…
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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.
© Leading Age Services Australia - Victoria
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!!!