Don’t Let DFS Derail Your HHVBP Score: Why Getting the OASIS Right Matters More Than Ever

With the 2025 performance year now underway, one measure is carrying more weight than ever in the Home Health Value-Based Purchasing (HHVBP) model: the Discharge Function Score (DFS).

Worth a full 20% of your Total Performance Score, the DFS has become a make-or-break metric. Yet many agencies are still struggling to understand how it’s calculated—and more importantly, how to improve it.

The DFS Equation: What You Need to Know

The DFS compares each patient’s expected level of function at discharge to their actual performance. But here’s the kicker: you don’t know what the expected score is. CMS builds that expectation using patient characteristics from OASIS-E1, including the GG items AND several other non-GG functional items. CMS is essentially building a patient profile from your documentation and assigning an outcome target. If your patient doesn’t meet or exceed that expected level, you don’t get credit for the measure.

So what happens if your assessment paints the wrong picture?

When You Chart a Granny on a Motorcycle…

Let’s say your clinician documents that Ms. Mabel is independent, breezing through her GG items and able to walk 150 feet unassisted. But in reality, she’s using a walker and struggling to make it from the bed to the bathroom with a 2-person assist. CMS now expects her to improve based on that “motorcycle granny” profile. And when she doesn’t, your DFS takes the hit.

That one misstep—not out of malice, but maybe from optimism or misunderstanding the scoring guidance—can skew your DFS and ultimately hurt your HHVBP score.

What Clinicians Are Getting Wrong

• GG items are often misinterpreted or skipped using “Activity Not Attempted” when they could be scored through observation or caregiver input.
• Non-GG OASIS items like M1000 Living Situation & Availability of Assistance, M1060 BMI, M1610-20 Incontinence, and M1700 Cognitive Functioning still influence the DFS expectation but are often completed with less scrutiny since they’re not used for payment or in HHVBP scoring directly.
• Baseline accuracy is sacrificed for speed or routine, setting unrealistic expectations from the start.

DFS Success Starts with OASIS Accuracy

If your documentation doesn’t reflect reality, CMS is scoring your agency on a fantasy. That’s why OASIS accuracy is everything—from the first assessment to discharge.

• Use the GG items as intended to capture self-care and mobility performance and avoid “Activity Not Attempted” unless it truly applies.
• Ensure clinicians understand how many OASIS items contribute to the DFS, not just the obvious ones like the GGs.
• OASIS Education: Train staff to assess function based on actual ability, not hopeful projections.
• Conduct internal audits focused on consistency across functional items and alignment with clinical presentation.

You Can’t Improve What You’re Not Tracking

DFS is now publicly reported on Care Compare, agencies can monitor their performance via iQIES. You can—and should—track your DFS in your Preview Reports, benchmark against national averages and identify areas where your scores fall short of the achievement threshold (62.350) or the benchmark (83.179).

Use your data to:

• Identify patterns in OASIS scoring
• Target staff education by clinician and item
• Correct habits that lead to over- or under-documenting function

How McBee Can Help

At McBee, we work with agencies every day to help turn OASIS challenges into HHVBP achievements. From customized training on OASIS-E1 scoring to in-depth HHVBP performance reviews, we help you build a strategy for success.

Our support includes:

• Staff Education: On GG items, functional scoring, and documentation accuracy
• OASIS & Coding Services: Improve your documentation and reimbursement outcomes
• Free HHVBP Score Assessment: Know your numbers, identify risks and find opportunities for growth

Final Takeaway

Your Discharge Function Score isn’t just a number—it’s a reflection of how well your documentation matches your patient’s story. Get that story right, and your agency will not only score higher in HHVBP—you’ll deliver better, safer, more meaningful care.

About the Author

Michelle Horner, Manager of Clinical Consulting & Education

Michelle Horner, BSN, RN, HCS-O, HCS-D, HCS-H, COS-S is the Clinical Consulting and Education Manager for McBee. With over 30 years of healthcare experience, Michelle Horner is a leading expert in home health and hospice. As Manager of Clinical Consulting & Education at McBee, she excels in Quality, Clinical, and Regulatory Consulting, designing innovative training programs that elevate care standards. A sought-after speaker at industry events, Michelle captivates audiences with her expertise and passion. She serves on the AHCC’s Board of Medical Specialty Coding and Compliance Certification HCS-D and HCS-O Committees, shaping industry standards. Renowned for driving impactful financial and clinical outcomes, Michelle is dedicated to advancing the quality of care in the home care sector.