The aged care industry recognises that physiotherapy is an important and crucial service.  Physiotherapy services satisfy the clinical care needs of residential service providers.  Physiotherapy initiatives can both support the care needs of residents and assist the occupational health and safety needs of staff.

However, physiotherapy services must also be economically viable!

The aged care industry is a heavily regulated environment. It relies on government subsidies to survive. Physiotherapy services can assist residential providers to maximise these subsidies both in high and low care.

The purpose of the following information is to provide residential service providers with detailed information on the feasibility of using W&L more frequently to satisfy the requirements of ACFI Question 12, Complex Health Care Procedure 4b.

W&L can satisfy both your care and economic needs. We will show you how.

Let us consider four elements:

1. Hours: The number of hours of physiotherapy treatments required per week for all residents for whom the facility is claiming a 4b in Question 12.
2. Revenue generated via the Complex Health Care Matrix: An increase in rating provides greater revenue for the residential service provider.
3. Additionally generated profit: The increase in profit per annum after the deduction of the cost of the physiotherapy service.
4. Sustainability: Preventing ACFI Question 12 downgrade.

Hours

a. W&L advocates the following number of hours:

i. 1 hour per week for every four ACFI treatments required under question 12, 4b.

b. The rationale for the aforementioned hours is as follows:

i. Complex Health Care item 4a requires the complex pain management treatment to be done at least weekly and for at least twenty minutes.
ii. As these treatments will be performed four times per week and the client is getting reviewed regularly, the treatment time can be less, i.e. 15 minutes.  W&L has already calculated the recommended number of hours per week per resident if the W&L physiotherapy directives only included 3, 4a, 5 & 12. This was calculated at 0.2 hours per resident per week.  In this calculation, we have included one treatment per person.

d. For the purposes of Complex Health Care procedure 4b, the complex pain management must be performed by an allied health professional and of frequency at least four times per week.

e. If one treatment has been included in (c) and the resident requires at least three more treatments per week (mentioned in (d)), then we can expect an extra 45 minutes per resident spread out over three days to satisfy 4b.

f. Table 1 below shows three scenarios of the increased number of physiotherapy hours required to perform 4x weekly treatments of residents for whom the facility is claiming a 4b based on a 100-bed facility.

  Assumptions:

• A site which currently utilises 15-16 hrs/wk of physiotherapy service (prior to claiming ACFI, Question 12, 4b), will be able to be broken down into four days at 3.75–4 hrs/day.
• A site which currently utilises 8 hrs/wk of physiotherapy service (prior to claiming ACFI, Question 12, 4b) will be able to be broken down into four days at 2 hrs/day.
• The therapist is available and willing to comply with this breakdown and is happy to increase the number of contracted hours to these sites to complete the treatments.

Revenue Generated via the Complex Health Care Matrix

a. W&L is able to provide physiotherapy treatments to sustain a score of 6 points in Question 12, Complex Health Care.  Tables 2 & 3 dictate the category rating for Question 12 Complex Health Care.

b. If W&L physiotherapists can sustain a score of 6 points in Question 12 via 4b, this gives the resident a minimum rating of a C and therefore guarantees a Medium or High level of funding in the Complex Health Care Supplement.  See blow in Tables 4 & 5.

An analysis by the Department of Health & Ageing of the first 33,000 ACFI claims shows that for nearly half of all appraisals a Low Rating was claimed and a High Rating was only claimed for 13%!

c. W&L submits that the extra 6 points scored in Question 12 will at a minimum cause a two category jump in funding per day.

d. Let us now calculate the average additional income stream per resident per annum based on Table 6 figures.  The average additional revenue stream is the sum of all the annual increases divided by three.  Hence the average additional revenue per resident is indicated in Table 7:

e. We will now outline the overall increase in revenue for a residential service provider using the three scenarios in Table 1 (see below in Table 8). 

Profit

a. In order to establish the profitability of engaging W&L we must look at the following variables:

i. The extra time per resident required to complete three more treatments (total four).
ii. The additional revenue generated established in section 2.
iii. The cost of the physiotherapy service.  For the purposes of this section the fee for service shall be $65.00 per hour (please note the fee may not represent the true cost which may be higher or lower).

b. Table 9 below demonstrates the data for the 3 scenarios:

 c. Table 10 below demonstrates the revenue and profit generate in the 3 scenarios:

Sustainability/avoiding downgrades

a. It is important that systems are robust, systematic and audit proof. Currently this is even more important with the Australian Department of Health and Ageing agenda to ‘claw back’ funds through the new ACFI tool.

b. Downgrades in ACFI Question 12 could mean two things:

i. Firstly, Question 12 is being handled poorly.
ii. Secondly, residential aged care facilities are losing significant revenue causing cash flow problems and potentially leading to insolvency.

c. ‘Why should we use your service when we are already claiming a ‘D’ rating for Question 12?’ W&L knows they will be presented with this question and therefore have compiled a list of potential problems that may occur at aged care facilities that rarely occur with W&L due to our Quality Management system.

i. Inadequate documentation.
ii. Poor compliance.
iii. Omission of designation, signature, name, date and time from documentation.
iv. Neglect of monitoring currency of practicing certificates and professional indemnity insurance.
v. Lack of validation evidence to support implementation of directives.
vi. Irregular evaluations/reviews.
vii. Lack of objective quantifiable information on evaluation.
viii. Poor linkage of progress notes to assessment and care directives.
ix. Use of jargon and physiotherapy specific terminology on care directives to be implemented by carers.

d. W&L is proud to have developed a physiotherapy revenue stream from Question 12.  W&L will minimise the likelihood of the aforementioned problems via regular documentation checks by our team of managers.

e. W&L is committed to continuous improvement. We regularly review our documentation system to maximise compliance. In the event the ACFI auditors and the accreditation assessors change their focus then we will adapt to keep our system up to date, robust and audit proof. Obsolete tired systems will expose your organisation to risk.

f. The residential aged care sector is highly competitive.  Providers are finding it more and more difficult to remain viable. Providers have three physiotherapy options: 1. employ; 2. subcontract a single provider; 3. subcontract a service company. In these uncertain times, why take the risk of compromising your financial viability if the aforementioned options cannot swiftly adapt to regulatory change? W&L has been strategically planning the ACFI funding transition for 12 months. We can adapt, maximise your funding and reduce your risk.

W&L’s Proposal

Using the Wellness & Lifestyles’ ACFI Documentation System© we are confident that we can maximise your ratings for Question 12 of the ACFI.

Previously, ACFI Question 12, part 4b has been considered not viable due to logistical constraints.  There are very few facilities that have a physiotherapist on site four days per week.

W&L believes that with the introduction of this directive, the residents of the facility and the facility itself may benefit significantly.  The resident will receive more regular treatment and the facility can generate substantially more funding as seen in Table 10.

W&L would like to begin providing services to all facilities 4x weekly to allow these benefits to be achieved.  We propose that we breakdown the current number of hours that we service your site (must be greater than 8 hours) to four days and then for every resident we are able to put on a 4b claim we increase the hours by 15 minutes.  This will allow for a gradual increase in hours and not financially burden the facility in any way.  The facility will lodge its ACFI claim with the Department of Health and Aging and then we increase the hours.

W&L would be happy to process your current data in order to provide an exact indication of the financial benefit from maximising ACFI Question 12.  Please contact Nick Heywood-Smith or Michael Peachey at Head Office on (08) 8331 3000 to discuss your individual position.