by Lori Marmon PT, MBA, COS-C
The M2420- Discharge Disposition item, collected only at the Discharge from agency (RFA 9), time point has an impact on outcome measures, process measures. and within the expanded Home Health Value Based purchasing model for CY 2024. But how?
The intent of M2420 is to identify where the patient resides after discharge from the home health agency. This item is coded based on the information known at discharge regarding where the patient will reside, and the services the patient is expected to receive after discharge from the home health agency.
In first looking at the impact on an outcome measure, the response to M2420 is utilized in the OASIS-based quality measure, Discharged to Community. For a “favorable” outcome with this measure, the patient would remain in the community following the discharge from the home health agency, which would be reflected by the selection of Response 1 or 2 in M2420, that the patient remained in the community with or without skilled services from a Medicare Certified HHA.
With the OASIS-E1 draft version of the OASIS items, the item itself was updated with this language to provide greater clarity in response selection. The item response language now reflects the guidance that was in the OASIS-E manual. “Formal assistive services” has been replaced in the responses to represent the updated definition which is “skilled services from a Medicare Certified HHA”.
Additionally for this item in terms of impact on outcome measures, coding Response 3- Patient transferred to a non-institutional hospice, serves as a measure-specific exclusion for the Discharged to Community outcome measure. This “Hospice Exclusion” applies to other outcome measures as well and those details are available on the Home Health Outcome Measures Table.
While the OASIS-based Discharged to Community outcome measure is not publicly reported on Care Compare, it is in the current quality measure set for the expanded HHVBP Model for Performance Year 2024.
Beginning with the CY 2025 performance year, the OASIS-based measure, Discharged to Community will be removed from the expanded Model quality measure set, however, there are still implications for accurate coding in the other quality metrics that do impact agencies under the expanded HHVBP model.
With accurate coding of M2420, it may be appropriate for a patient to excluded from the calculation of the quality measures for Improvement in Management of Oral Medications or Improvement in Dyspnea (both measures included in the CY2025 measure set for the expanded HHVBP Model). If a patient is discharged to a non-institutional hospice, this is a measure specific exclusion for both of these quality measures in the expanded HHVBP Model measure set and they are dependent on the correct coding for M2420 to trigger the exclusion if applicable.
And then there are the process measure applications to consider as well. Correctly coding M2420- Discharge Disposition at discharge impacts which Transfer of Health measure will be applicable to a patient. If a patient is discharged to a subsequent provider (another Medicare certified HHA or a non-institutional hospice) then the patient will be in the denominator count for the Transfer of Health Information to a Subsequent Provider process measure.
Accuracy in capturing the correct response for M2420 based on the guidance provided, can assist agencies in making sure that the reconciled medication list is provided correctly. Additional information regarding the process measures is available on the Home Health Process Measures Table.
When one OASIS item can initiate the skip pattern within OASIS and those responses result in an influence on quality metrics, it behooves clinicians and agencies to focus on understanding the coding guidance for M2420- Discharge Disposition and strive for accuracy.
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