ACFI Changes in 2016

ACFI Changes in 2016

The ACFI is changing… but what are the changes exactly, and what do you need to do about them?

What are the changes?

With regards to the recent changes, what we do know for a fact is that:
1) There will be changes to the scoring matrix that determines the level of funding for complex health care
2) There will be an update to the validation processes and systems to better target high risk claimants (and fines for repetitive false claims)

Although there is also speculation that there might be a reduction in the points for taking a blood pressure readings, specification of timing of pain management for Question 12.4b, and changing of items such as the tubi-grip requirements there has been no official information released regarding this. The two points above are the facts that have been released to date.

How could this impact facilities?

When combining these two changes, there are three things providers should be aware of from a complex health care perspective:

1) Increased likelihood of existing validation risk being identified: What is the risk if just one resident isn’t receiving the treatments that have been claimed? From a financial perspective one 4b downgrade can be a payback of over $9,200 (and $18,500 p.a. future loss). The biggest issue is that the residents aren’t receiving the interventions that are clinically indicated

2) There is now a deadline for you to receive the funding you’re eligible for: What is the impact if just one resident is getting the interventions they need but it isn’t being claimed? Your facility could be missing out on as much as $18,500 funding that you’re eligible for based on the care that you’re currently providing.

3) There is now a deadline for you to receive funding for providing care to residents who need it: If there are other residents in your facility who need complex pain management interventions, improving resident pain management and mobility outcomes is achievable – in every situation where complex pain management contributes to a resident’s ACFI claim the funding always covers the cost of the service.

What should a facility do?

An ACFI Complex Health Care Audit should be completed as soon as possible as this will take into consideration the combined impact of these changes. This will help your site:
1) Reduce Your Validation Downgrade Risk
2) Receive All of the Funding You’re Eligible For
3) Ensure Efficient Allocation of Resources

Most importantly, an ACFI Complex Health Care Audit can increase care for the residents that need it. By structuring services appropriately, all residents can receive the interventions they need in a way that supports accreditation, meets funding requirements, and is cost-effective for both resident and facility.

Click here for more information about an ACFI Complex Health Care Audit