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10 signs a facility is not receiving the correct ACFI funding

The significant variation in revenue between individual facilities is often a result of eligible funding not being accessed.

It is often reported that the aged care industry is underfunded. When it comes to the Aged Care Funding Instrument (ACFI) however, the significant variation in revenue between individual facilities is often actually as a result of eligible funding not being accessed. Many facilities are not aware they’re not receiving all of the funding they should be. The following are common indicators that a facility is under-performing from a revenue perspective:

ACFI performance is determined by comparing the facility against EXTERNAL benchmarking: Comments of “we’re averaging $160/day” or “my vitals show that we’re doing better than the industry average” provide a false sense of security. It has been shown that some facilities are in fact underfunded by over $200K p.a. based on the care they’re already providing despite their rates being above the benchmark.

Residents are reviewed based on their ACFI anniversary DATES: The ACFI tool is very sensitive to some clinical changes. Something as simple as a resident now requiring their food to be cut-up can mean an increase in ACFI funding of up to $26,000 (not just for cutting up their food, but reflecting the residents’ overall care needs which were already being addressed). Waiting to review them at their anniversary date, and then submitting them a month after this, can lead to a loss of several thousand dollars despite the care already being provided.

It takes more than 7-DAYS to complete a reappraisal once a change is identified: A facility’s ACFI subsidies are calculated daily. If it takes several days to commence an appraisal once a resident change has been identified, and then a 21-day or 28-day reappraisal period takes place, this means days of lost funding. Even if the claim is 100% accurate, this delay can mean losing close to $2,500 per resident for each month it takes.

A resident’s ACFI rate is not calculated BEFORE the appraisal process commences: Unless the actual eligible ACFI rate is known beforehand, then there’s no system in place to guarantee that the information received back ‘from the floor’ will ensure the final claim will actually match the residents’ care needs. This frequently leads to under-claiming (all ACFI clinicians are familiar with empty behaviour, pain and continence charts being completed when staff know it’s not an actual reflection of the resident). Additionally, it may not be identified that a reappraisal may not actually be submitted, leading to staff wasting time on completing unnecessary work without achieving an increase.

Appraisals completed pre and post July 2012 aren’t being treated DIFFERENTLY: If a resident had their claim submitted prior to July 2012, and they are reappraised due to an increase in care needs, the result can still be a decrease in funding of over $15,000 in the Activities of Daily Living (ADLs) domain. Even reappraising a resident whose care needs have increased significantly in the other two domains while their ADLs needs remain the same can lead to an overall decrease in funding.

Multiple reappraisals aren’t PRIORITISED in terms of the dollar-gap: If there are multiple residents with an increase in funding available, and there’s only the capacity to do some of these at any one time, it makes sense to work on those with the largest gap. Rather than focus on the lowest funded resident, the focus should be where there is the biggest dollar-per-day increase. It is illogical getting one resident from $30/day to $50/day (an increase of $7,300 p.a.) when the same resources could have been allocated getting another from $120/day to $170/day (an increase of $18,250 p.a.).

Whoever is completing the ACFI isn’t physically ASSESSING the resident themselves: Basing assessments off what is reported by staff often not only means a lack of funding, but it also often means that the true care needs are not being identified. It is only when the time is taken to actually go in and assess a resident that it’s when the real care needs are identified. One false perception by staff without formal training in the ACFI may mean under-claiming by one category – as much as $15,000 per resident.

Behaviour charts are put out WITHOUT the resident’s specific behaviours already identified and described: There are 64 different ACFI specific behaviours. Unless staff are prompted exactly what behaviours to look out for it is highly likely that they’re either not all being captured, or that staff are recording non-ACFI specific behaviours.

There are NO Directive-4b claims being made: For every resident who is receiving complex pain management interventions 4-times per week, the difference in ACFI funding is as much as $18,220 p.a. per resident. When documented appropriately, a simple cost-analysis shows that a single-category change in the ACFI Complex Health Care domain will always cover the cost of providing the service. If a facility has a fixed number of physiotherapy hours, and not all the residents who would benefit are receiving interventions, then opportunities for improved care and funding remain.

It takes more than 1-day of staff time to COMPLETE the entire ACFI Appraisal Pack: If broken down into a repeatable and systematic process, the total time taken to complete the entire claim should be 8-hours or less of staff time. This approach means that 10 appraisals should be completed in a 2-week period with no compromise in quality or unnecessary burden to staff on the floor.

Clinical staff with good assessment skills are not enough to ensure that a facility is receiving all of the funding it’s eligible for. Time may be spent completing inappropriate documentation. The appraisal process may be drawn out. When finally submitted, the claims may be inaccurate.

What’s the next best step? If only one of these criteria are not being met, a facility-wide funding gap analysis should be completed. This will identify all potential reappraisals, allow the submission of all claims in short period of time, and ensure the facility is receiving the funding that they are eligible for. Only once this is completed should the focus revert to having systems in place to trigger a funding-versus-care evaluation whenever a clinical change occurs. Only then can a facility legitimately claim that there is not enough funding.

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