Pain Management Programs, Are They Still Financially Viable Post Jan 2017?

Currently there is much debate and panic about whether maintaining and continuing to offer pain management therapy under a 12.4A or 12.4B program will remain financially viable after Jan 2017 changes, but from all of the details that have come to hand regarding the planned changes the simple answer is YES!!! The facts are that unless your Physio service provider is charging you excessive rates, then despite the change in weighting of the claim items under the Complex Health Care domain and the changes to the treatment duration, residents that meet the ACFI eligibility criteria will still be adequately funded to continue receiving the service.

Here’s our 3 Red Hot Tips on how to maximise your care dollars before and after the changes take place.

Tip .1. – Make Hay While the Sun Shines

• Based on what has been announced, we know that for those residents that currently have a submitted ACFI and for any resident that has an ACFI submitted prior to 31st December 2016, that their funding levels will remain unchanged, unless they require admission to hospital for greater than 30 days.
• For those of you thinking of commencing a pain management program our suggestion would be, there is no time like the present to establish one, with the aim of having all residents eligible and that would benefit from being offered the program commenced and ACFI submitted prior to 1st January to take advantage of the current funding available.
• For those with an existing program, ensuring that all eligible residents have their ACFI’s rescheduled for review and those suitable for the program are commenced on the program prior to Dec 31st 2016. This will secure them under the grandfather clause and as such secure their funding going forward, in the absence of any future ACFI resubmission.

Tip.2. – Set yourself up for ‘Success’

• Align your self with a High Quality, Cost Effective Service Provider. It is timely to review your current provider to ensure that you are locking yourself into the best rate available and a reputable provider going forward. With the marketing being super competitive right now, taking the time to ensure that you are not only getting value for money but a high quality provider that will also offer robustness in their pain management service.
• It is crucial going forward with ACFI auditing process becoming more comprehensive and higher rates of downgrades than previously before, there will be no substitute for excellent record keeping, consistency in service provision and an ethical provider that will be able to justify their pain management program service model. Beware, cheap isn’t always best, you get what you pay for, do your homework, as some larger providers aren’t always the best and may not offer value added services that can also help to reduce other service costs.

Tip.3. – Don’t throw the baby out with the bath water

• Perhaps a better question to ask ourselves is “What will the be the costs, financial, on care staff and service quality, if I don’t offer the program, particularly if my competitors still do”? Offering a program and regular access to physio services is often a keen selling point for new clients.
• Remember, despite funding, adequately managing a resident’s pain and offering choice of therapy is a key accreditation standard and central to consumer centred care. The fact is for most residents despite the change to the ACFI funding, offering a resident pain management services under the new ruling and funding arrangement will still remain a profitable option or at very worse a breakeven activity. Poorly managed pain can result in high falls rates, increased behaviours, unnecessary carer dependency and costly drugs. It is in everyone’s best interest to ensure that those residents that could and do benefit from alternate pain management therapies are continued to be offered the access to a well serviced program.

In a Nutshell……

Continuing to run and offer clients access to physio based pain management programs beyond Jan 2017 will still be cost effective and is key to ensuring that we demonstrate a commitment to meeting both aged care accreditation standards and have a focus on person centred care. Take the time to review your current provider to make sure your service requirements will continue to be meet under the new ACFI rulings and offer financial viability.

As unfortunate as it is, we all need to come to accept that whilst healthcare remains government funded, cuts to our already limited funding will continue, but as care providers we need to learn to work within the funding guidelines and actively seek out new revenue streams and become more innovative in the ways we provide care.

Written By:

Sheryl Aldcroft
Managing Director
Agestrong Physio

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