ACFI Optimisation: Ensure you receive the right funding entitlements

| 04 Oct 2013
ACFI optimisation

It’s been almost three months since changes to the Aged Care Funding Instrument (ACFI) – the tool used to calculate funding for aged care facility residents – came into effect on 1 July, 2013. The most recent changes specified tougher requirements around supporting documentation to substantiate claims for certain ACFI questions. These include the Behaviour Domain – Questions 7 (Wandering), 8 (Verbal Behaviour) and 9 (Physical Behaviour); Complex Health Care Domain – Pain Management; and Changes to the ACFI User Guide and ACFI Answer Appraisal pack to prevent incongruent claiming in ACFI 2 (Mobility) and ACFI 7 (Wandering).

We expect these changes to be the start of many evidence-based requirements the Government will introduce within ACFI, in an attempt to prevent unsuitable claiming. It is reasonable to assume that over the coming years, the ACFI model will become progressively more complex and lift the pressure on aged care providers.

The whole point of moving from the former RCS classification system to the ACFI model was to reduce the amount of documentation and administration required for funding. Despite the fact, aged care providers are under more pressure than ever to provide sufficient evidence to comply with the constant revisions to ACFI. As staff are forced to allocate more time diligently maintaining records for the purposes of funding, it reduces the time they have available to provide the essential services that enhance quality of life and care of residents.

It’s no surprise then, one of the most common questions we receive from aged care providers is: How can we ensure that we receive the right funding entitlements without having to find extra time, resources and expertise to make it happen?

ACFI Optimisation

It is well documented that between 70 and 80 percent of an aged care provider’s revenue is subsidised by the Government, via ACFI. For many aged care providers, this can equate to millions of dollars’ worth of funding each year, and for the larger providers, up to tens of millions of dollars. Therefore, it’s essential for all providers to review and optimise their subsidy revenues to ensure they receive the correct amount of funding entitlements. Fortunately, there are a variety of tools for aged care providers to streamline the optimisation process.

Clinical documentation management
As part of the care and support they deliver to residents on a daily basis, care and nursing staff monitor and record continuous details pertaining to residents’ care requirements via care plans, progress notes, observation charts, assessment forms and other essential information.

For those providers relying on a paper-based system, the process of managing resident records – and maintaining the information contained within each record – can be very time-consuming and frankly, far from ideal for the purposes of meeting the stringent evidence requirements within the ACFI. Due to the structure of the ACFI model, any inefficiencies can also have negative implications on funding entitlements and subsequently, the bottom line. Therefore, it is essential that providers continually look for ways to consistently improve efficiency while preserving the quality of their care services.

Conversely, an electronic care management system simplifies the management of resident information by establishing a comprehensive and accurate record that features all the details associated with a resident’s care and treatment – all within a single system. This provides staff with a single point of data entry, as well as instant, electronic access to vital resident information necessary to improve care delivery outcomes. It is also possible for providers to collect and aggregate this information from within their own organisation, and automatically utilise these insights to identify opportunities for an uplift in funding.

ACFI reporting
The ACFI model consists of a very complex and diverse set of business rules. So without ACFI-specific reporting tools, it is incredibly challenging to highlight the myriad opportunities for increased funding – regardless of how diligently staff are documenting residents’ behaviours and conditions.

ACFI reporting tools are designed to integrate with the latest information from within a centralised care management system, in order to reduce duplication of documentation. As care and nursing staff monitor and record new resident information on a day-to-day basis, this data can also be projected into specialised optimisation reports. Any clinical change that has the potential to effect ACFI is highlighted, along with an indication of potential increases in scores and any gains in funding that may be available to an organisation. One action achieves multiple results.

Proactive prompting, via reporting tools, provides staff with a highly efficient way to manage, review, validate and audit both mandatory and voluntary appraisals for residents. These tools also make it possible to easily identify the gaps within a particular funding category, as well as the exact amount of the potential uplift available, if the gap was to be reviewed.

All supporting clinical evidence and documentation relating to appraisals can also automatically link directly from your own electronic platform, with prompts that help staff select the most relevant attachment to accompany the appraisal.

ACFI calculations
Electronic ACFI calculators are widely available and assist in determining the levels of funding a provider should expect to receive for a resident, based on the resident’s unique care requirements. These calculations are complex and without an electronic system, it is common for human errors or oversights to occur. Any miscalculations could be costing your facility significantly and an electronic system reduces the risk of these occurring.

Staff education
Having an electronic care management system that centralises resident information and integrates with calculation and optimisation tools for ACFI, is the best way to ensure that your organisation is receiving the right funding entitlements without having to rely on surplus time, resources and expertise. Our final tip would be to ensure that your staff are well versed in capturing the right resident information for the purpose of an ACFI appraisal. Continue to educate your staff as revisions arise to ensure they have a clear understanding of ACFI and how they can play their part in optimising funding.

What are your own experiences with ACFI optimisation? In what ways does your organisation ensure that it receives the correct funding entitlements?  

(Image credit: Graur Razvan Ionut)

Tags: ACFI, ACFI optimisation, clinical and care management, funding, reporting

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The iCareHealth Team


Comments

  1. Dennis

    I see this as two areas to approach first is governance and the second is the ACFI calculations
    For the first area I think that we can look towards other sectors for guidance and ideas on how to do this. Take the Superannuation industry for example, this is one of the most highly regulated financial areas around, they have a range of evidence based protocols and governance to ensure compliance for a range of statutory organisations such as ASIC, ASFA, ATO etc. On top of this are things like KAPLAN training and continuous professional improvement and government legislated changes such as mysuper and superstream. This industry has been heavily governed and has managed to do it at reasonable cost.
    However it does appear to lack consistency in approaches and has not been furnished with one tool provider. If we look at the legal industry it has understood that there is a need for consistency in approach and that most of what they do is the same, there are a number of providers that facilitate data exchange and common information tools to assist law professionals to do the job with ease, the legal arena has also understood the value equation that these tools bring in terms of SME approaches, best practices, alignment to legislative changes, current law and error reduction. This approach allows the legal area to move away from documentation and focus itself on what it does best, the provision of quality legal services.
    If we look at both of these sectors we can see that what is needed is an SME that understands the legislation, identifies ways to best maximise funding and can assist in audits. Engaging a provider to supply SME services and tools that automate reporting, training, data collection and that are aligned with changing regulations will ensure that the organisation is compliant in the nominated areas, provide a view on the growth of compliance, identify areas that require review, assist in audits and are validated, will ensure maximum entitlements are applied for and that that they remain compliant. But most of all, it will allow the care provider to do what they do best, care.

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