Why Your Discharge Function Score Matters: A New Era in Home Health Quality

The Discharge Function Score (DFS) has officially stepped into the spotlight, now featured on Care Compare with the Centers for Medicare and Medicaid Services (CMS) January 2025 refresh. As a new quality measure in the Home Health Value-Based Purchasing (HHVBP) model, DFS plays a critical role in determining how well agencies are meeting their patients’ expected functional abilities at discharge. With DFS carrying 20% of the total performance score for HHVBP, home health agencies cannot afford to overlook its significance.

Understanding the Discharge Function Score

The DFS evaluates your agency’s ability to help patients achieve or exceed their expected functional status upon discharge. CMS calculates an expected discharge function score for each quality episode based on patient characteristics from the OASIS-E1 assessment, focusing heavily on GG items related to mobility and self-care.

Key Points to Know:

• The national average for DFS is 67.15% according to Care Compare.
• Agencies must beat the achievement threshold of 62.350 to earn points in HHVBP.
• Agencies can earn full points by surpassing the benchmark of 83.179.
• Improvement points are awarded for surpassing your agency’s own 2023 performance.

GG Items: The Core of DFS Calculation

Properly assessing and scoring GG items in the OASIS-E1 is essential. These items measure a patient’s mobility and self-care abilities and are central to the DFS calculation.

Avoid the “Activity Not Attempted” Trap:

When GG items are marked as “Activity Not Attempted,” CMS imputes a score (1–6) for the item, essentially guessing the patient’s ability. This could misrepresent your agency’s performance. Staff should use these codes only when:

• The patient truly cannot perform the activity.
• The information cannot be gathered through observation or interview of the patient and/or caregiver.

Accurate Data is Key:

DFS reflects not only the GG items but a range of other OASIS-E1 responses. Ensuring accuracy across all items is critical for calculating the expected discharge scores.

Finding and Tracking Your DFS

Before the Discharge Function Score (DFS) is publicly reported on Care Compare, agencies can access their performance data in iQIES through the “Preview Report of Quality Measures to be Posted on Care Compare.” This provides agencies with a vital opportunity to evaluate and address their DFS performance. But why should agencies actively track and trend this data?

1. Measure Improvement Efforts: Tracking DFS data allows agencies to gauge the effectiveness of their quality improvement initiatives. Whether you’ve rolled out staff education programs, implemented new assessment protocols, or focused on documentation accuracy, analyzing trends in your DFS can reveal whether your efforts are driving measurable progress.
2. Benchmark Performance: By comparing your DFS data to national averages (currently 67.15%) and HHVBP thresholds, you can understand how your agency stacks up against peers and identify how close you are to earning achievement or improvement points. Knowing where you stand helps you target specific areas for further improvement.
3. Proactive Problem Identification: Trend analysis can uncover underlying issues, such as frequent use of “Activity Not Attempted” codes or inconsistencies in OASIS documentation. By identifying these problems early, agencies can implement corrective actions before they affect performance scores and public perception.
4. Optimize HHVBP Performance: Since DFS contributes 20% of the Total Performance Score for HHVBP, tracking your data helps ensure your agency meets or exceeds the achievement threshold (62.350) and targets the benchmark (83.179) for full points.
5. Improve Public Perception: DFS is reported on Care Compare as “How often patients were at or above an expected ability to care for themselves and move around at discharge.” A higher score not only reflects well on your agency’s ability to deliver quality care but also attracts referrals and builds trust with patients and caregivers.
6. Support Strategic Planning: Regular tracking enables data-driven decisions, helping leadership allocate resources, refine care strategies, and prioritize initiatives that directly improve functional outcomes and agency success.

Strategies to Improve Your Discharge Function Score

Improving your DFS requires a holistic approach that includes staff education, accurate assessments, and ongoing performance monitoring. Here are actionable steps:

1. Educate Your Staff:
   • Train clinicians on scoring GG items accurately and avoiding unnecessary use of “Activity Not Attempted” codes.
   • Provide ongoing education on the impact of OASIS-E1 accuracy on quality measures.
2. Optimize OASIS Documentation:
   • Ensure all OASIS items are completed thoroughly and correctly, as every detail influences the expected score.
   • Conduct regular audits to identify and correct documentation errors.
3. Utilize Data-Driven Insights:
   • Monitor your DFS in iQIES and compare it to national benchmarks.
   • Analyze trends and target specific areas for improvement.
4. Leverage Expert Support:
   • Partner with McBee for tailored education programs, OASIS and coding services, and HHVBP analysis to enhance your agency’s clinical and financial outcomes.

Why It Matters

With DFS accounting for a significant portion of the HHVBP Total Performance Score, agencies must prioritize this measure. Achieving a high DFS not only boosts your HHVBP performance but also strengthens your agency’s reputation on Care Compare positioning your agency as a leader in patient outcomes and quality care.

Let McBee Help You Succeed

At McBee, we specialize in helping home health agencies turn challenges into. We can help guide your agency through the complexities of HHVBP and quality reporting. Our solutions include:

• Staff Education: Customized training to improve OASIS accuracy and GG item scoring.
• OASIS & Coding Services: Optimize clinical and financial outcomes with expert support.
• Free HHVBP Assessment: Evaluate your reports and financial performance to identify opportunities for growth.

About the Author

Lisa Selman-Holman, Vice President of Clinical Services

Lisa Selman-Holman, JD, BSN, RN, HCS-D, COS-C, is the VP of Clinical Services at McBee, bringing over 35 years of expertise in home health and hospice. As a registered nurse and home care attorney, she specializes in regulatory compliance. Lisa has held various roles, from field nurse to executive, managing accreditation surveys, acquisitions, and regulatory crises. In 2004, she founded Selman-Holman & Associates, offering consulting, coding and OASIS review services. Lisa is a renowned educator, known for turning challenges into achievements. Joining McBee in 2021, she leads education initiatives at the Post-Acute Academy, providing courses for home health and hospice staff and executives, including clinical, regulatory and onboarding requirements.

About the Author

Michelle Horner, Manager of Clinical Consulting and 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.