The impending transition from ACFI to AN-ACC will be a significant change to the sector but it will not just affect your funding team and processes. We have summarised seven impact areas in your business that will be most affected.
1. Your Board
The Board needs to be across the changes that are coming and we have briefed a great deal of Boards in the last few months. From these discussions we know Boards are focused on risk management and overall business viability and performance. Such a significant change to the largest part of your income is cause for careful consideration. There is also the reputational and occupancy risk of the star ratings in the first 12 months and further accreditation and workforce risk related to mandatory care minute compliance in October 2023.
2. The CEO
Aged Care CEOs are the conduit between the Board and the business. They will face increased scrutiny and questions from the Board on performance but also star ratings. It will be important for CEOs to keep the Board’s expectations at a realistic level.
At the same time, CEOs will need better oversight of their business than just the financial and quality indicators that may have been sufficient before. AN-ACC will bring in a new era of balancing funding with care minutes and managing finer margins between them. For most organisations, this will be less in your control than ever before but once AN-ACC operations have been established, it should generate better comparative data on performance across facilities and across the sector.
3. Finance & Business Analytics Team
Unsurprisingly, this team will have a big job ahead. The internal data sources they have relied on will be impacted with resident classifications now being determined by an external body. They will need to define new data sets to be their source of truth and the most effective avenue for accessing this data without reinventing the wheel. Being able to forward plan will be important to manage future EBIT performance.
With the removal of the government validation model, finance will have greater certainty on funding revenue however in essence the provider now becomes the validator, and they will need to have confidence in the business’s ability to predict and validate resident classifications.
Determining new KPIs and reviewing the current budget once AN-ACC has commenced will be a focus as well as the profitability of a facility with new paths to optimal financial performance under the AN-ACC model to be defined.
The timeliness and lag in funding realisation will come under scrutiny with the government’s 28 day Service Level Agreement on assessments being completed. Tracking and reporting on assessments, their acceptance or challenge and outcomes will be part of the new reporting providers will develop.
The process for completing the Quarterly Financial Report (QFR) will be refined with further reporting requirements likely to follow. Seeking efficient ways to gather this data will be a priority.
Care minutes may not be ‘mandatory’ until 2023 however the data pulled from the first QFR due 4th November will be the information used to determine the star ratings that will be published in December. This data will allow for the true cost of care to be established.
Workforce is the biggest cost for providers. Finance teams will want to understand the impact of care minutes and rostering in as close to real time as possible and control workforce costs against care needs.
Some supplements will continue and some will be rolled into the new AN-ACC structures. Knowing which will stay and which will go will be important to get a complete comparison of pre-AN-ACC to post-AN-ACC performance.
There will need to be better connectedness between finance and facility management to determine an optimal operating model and ongoing analysis of resident admissions or re-assessments and the impact to the roster with timely collaboration needed.
The introduction of care minutes as an industry wide concept should be taking up a lot of the HR team’s time at the moment. The need to adjust to care targets whilst balancing staffing requirements to meet accreditation standards within the roster is the biggest challenge. Whilst facilities may have changed their rosters in line with occupancy and clinical requirements in the past this is now a formal process with a consistent level of care required for all residents.
The process of defining care and developing a care minute policy should be underway and will identify care minute gaps and guide recruitment decisions. Any non-clinical workforce costs will come under greater scrutiny.
Review of care models and where Enrolled Nurses fit into an organisation’s staffing models should be reviewed with a focus on the clinical risk of removing this role due to their care minutes being equal value to that of a care worker.
Review of system functionality to enable rostering and management to care minute requirements should be a priority given the time taken to identify whether current systems are able to fulfil this, evaluation of and implementation of new systems.
There may be a requirement for staff flexibility in rostering in line with occupancy and care minutes which will not suit all staff and add complexity to EBA or union negotiations. Finding staff in aged care is a tough enough gig without the added concern over job security or satisfaction.
The publication of care minutes as part of a facility’s star ratings will likely impact staff morale and could be used as a selling point as employer of choice.
Staff communication and engagement across the business and transparency in operations is vital. Cohesive collaboration across business units with differing focus may take some time to embed HR will need strategies to bring these teams together at all levels in the business.
HR’s focus is of course not only on clinical and care staff. The added administrative, training and reporting requirements will need to be considered with the option of external support that can be dialed up or down a viable alternative to recruitment of internal staff.
5. Clinical and Quality Management
The most important area for Facility and Clinical Management to focus on will be the external assessment process. It is critical to business success to have a team of clinicians who are able to consistently predict resident classifications and know when to challenge classification results.
To achieve optimal facility performance here will need to be increased collaboration between each facility’s roster, admissions and funding teams as well as finance or business analyst representation to determine the optimal timeframes of resident admissions and reclassifications (both up and down) in line with care minute availability.
The removal of the laborious ACFI packs is a welcome relief and any RN time that had previously been involved in this process may need to be absorbed back into the main roster if RN care minutes are difficult to meet.
Although adoption of AN-ACC assessments into care planning is not required, the increase of supporting information in the clinical system and care notes will be required to support the external assessment process. Key areas of cognition and behaviours will need strong supporting notes to create a more complete picture of care requirements than an external assessor may see in a short assessment window.
In addition to understanding the cadence and logistics of external assessment processes there are also new processes around admission and management of palliative care and respite residents to unpack.
A systematic review of all residents currently receiving 4b treatment should be underway and must be clinically based and consultative. Allied Health contractors are facing difficult conversations and increased scrutiny however there are acknowledged benefits and positivity on the freedom to look at alternative ways to treat pain in accordance with resident’s wishes and goals.
As your licence to operate, there is no more important function than quality and compliance. The focus that is required to implement these reforms can leave resources spread thinly however there is an enormous potential for continuous improvement and positive outcomes for residents which should be tracked and reported accordingly.
6. Admissions and Marketing
The admissions process will now need to consider a facility’s ability to provide the required care minutes. Thus the requirement for admissions teams to be in communication with rostering and finance about future residents.
Further to this new admissions will not attract care minutes until they have had an external assessment however respite and new palliative care admissions will attract care minutes from entry making this a more complex decision .
The publication of star ratings will be a focus for admissions and marketing. Likely to be updated quarterly, the reporting of consumer experience surveys, compliance with standards, care minutes and quality indicator data will be individually reported as well as an overall star rating per facility.
The government has said providers will be given access to this data prior to publishing but it is unknown exactly what these timelines will be at this point. Marketing teams will need to be ready to promote or protect organisational reputation facility by facility. Admissions staff must be prepared for questions on star ratings and know where their facility sits against nearby competitor facilities.
Your IT function will need to quickly assess the best source of truth for the increased quantity and timeliness of data needed to help run the business. They will also be faced with manual interactions and the limited data available on the My Aged Care Portal.
Defining your source of truth and the data required in what timeframe will be high priority when the reality of data gaps is clear. There may be an interim messy period during this time and internal expectations need to be set early to avoid frustration and impact on BAU.
IT will need to review data collection processes from both internal and external sources and the storage of data in a secure environment in line with Privacy Laws with multiple teams requiring access. Current software platforms will need to be reviewed to determine if they are meeting needs in the new world. If not, due diligence on new systems and their capability to solve the unique problems facing aged care providers will need to happen in a timely manner to minimise disruption of services.
Although this seems like a great deal of change to consider, many providers are well across many of these areas. Not all are required to be in place before October 1st. We are currently working our way through the transition process with nearly 60 providers. If you would like a no obligation conversation, please reach out.