Care minutes dip as audits expose ineligible provider practices 

Mirus Australia has reported strong occupancy rates and flattening Average Daily Subsidy activity for March with decreasing care minutes not enough to take the shine off positive performances.

Providers should be cautious, though, as auditors are using data to target providers for unannounced visits and enquiries if they pick up unexplained or ineligible care minutes in provider totals. 

Elsewhere, growing reconsiderations suggest providers are adapting to their AN-ACC management style and the Government may have realised it should introduce an application fee for an AN-ACC reconsideration. 

Key points

• There was a marginal 1% change in total care minutes delivered per resident per day, decreasing from 205.8 in February to 203.62 in March
• Registered Nurse (RN) minutes also dropped slightly but remained just below the mandated 40 minutes requirement
• Average Daily Subsidies (ADS) activity held steady at $268.02  while claiming activity increased by .5%
• Occupancy rates increased to highlight a positive long-term trend that has the aged care sector closing in on 90% occupancy rates

Care minutes fluctuation

A quick look at Mirus’ data, which reflects about 90,000 beds, shows total care minutes dropped by 1.06% in March, with similar decreases for RN minutes and Enrolled Nurse (EN)/Assistant in Nursing (AIN) minutes. 

Rather than expressing concern, Mirus Co-Founder Robert Covino told hello leaders that environmental factors are likely causes of such marginal change. 

“In terms of direct care time in the March period, there were bouts of flu and COVID-19. These little things mean staff may be ineligible or they may have unfilled shifts coming through which does impact total direct care per resident per day,” Mr Covino said.

“Providers may not always have the ability to replace that shift and those variations do add up enough to swing the needle.”

However, while a slight backward stumble in March may not be a huge concern now, he said it highlights the work required to reach the mandatory 215 care minutes total required from October. Mr Covino also hinted at the Government’s quiet nature surrounding the impact of non-compliance on star ratings. They had previously mentioned only providers with full compliance to care minute totals could achieve relevant three-star ratings. 

“There was a discussion and webinar by the Department of Health and Aged Care late last year about modifying the star rating metrics to only allow providers who achieve both their RN and their direct care minutes to receive the three stars,” he added.

“I think they’re trying to let the star ratings play out further to represent a good news story before they start tightening the screws.”

Audits tighten the screws

As part of the Government’s care time audits currently underway, auditors are out at aged care homes digging into care minutes data. One provider mentioned by Mr Covino reportedly had three finance staff members dedicated to the audit for eight days just to ensure the auditors had all relevant information. Additionally, he said the audits are catching out the ineligible practices.

“They’re scrutinising for periods in the past and asking for source files, payroll, the details behind their data submission. That’s why it’s taking so long because a lot of these things aren’t a simple report you can just run,” he said.

He said a lot of feedback is focused on providers including ineligible workers – whether intentionally or not – and small time inclusions are being picked up. 

“We have been called in to support a provider who felt their audit triggered an unannounced visit within 48 hours of what was perceived to be an audit not going well. That triggered the regulator to send somebody on-site even though that wasn’t stated.”

“There is evidence that these agencies now have a lot more information, data sharing capabilities and communication to other parties to address issues if there is a significant risk to consumers.”

New trends emerge

Mr Covino also pointed out two key trends to hello leaders: a growing number of assessment reconsiderations and a flattening of the ADS. 

As part of the new AN-ACC funding system, providers can appeal a reclassification determination made by an independent Assessment Management Organisation (AMO). Recent Government data shows growth in reconsiderations – the ability of a provider to challenge an AMO-contracted agency’s output – across the 2023-24 financial year.

“What’s occurred in the last data upload is they reported about 11,000 reconsiderations, nearly half of that alone was in February. Then you start asking yourself what’s driving that; is it AMOs, the industry being more confident in how they understand AN-ACC, is it providers just feeling like they want to have the money or a combination,” Mr Covino said.

“The next step is the Government’s going to have to take action to cull this growing trend of reconsideration because it’s now representing 8% of the total assessment type activity in the last quarter which isn’t productive.”

Meanwhile, ADS is in its second month of stability with a slight 15-cent drop. Mr Covino attributed that to providers running more processes internally, data settling due to a latency effect and retrospective allocation of claim information.

“However, with that flattening, it does show that the providers are starting to give more notice to the care minute obligations now that it’s been mandated and the first submission of this period is coming,” he added.

“That awareness is driving a different behaviour and more mindfulness around just maximise, maximise, maximise. What is giving more attention to that awareness is the Government doing care minute audits right now.”