Welcome to the New World for Function Measures in Home Health!

by Marian Essey, RN, BSN, COS-C

In the CY 2024 Home Health Final Rule, CMS finalized the addition of a new function measure calculated using imputation and expected rates.

 

History of Home Health Functional Measures

Functional measures are not new to home health. With the launch of OASIS data collection in 1999 and the ensuing Outcome Based Quality Improvement Reports (OBQI) in 2022 (now the iQIES Outcome Reports), home health providers have been working to understand and improve functional outcome measures for over 20 years.

Historically, the functional outcome measures were focused on either improvement or stabilization with measures such as Improvement in Ambulation/Locomotion, Stabilization in Grooming, Improvement in Bathing, etc.

Many of the early “improvement” functional outcome measures stood the test of time and were included in the Home Health Quality of Patient Care Star Rating (established 2015), in the original Home Health Value-Based Purchasing (HHVBP) Model (established 2016) and were also included in the expanded HHVBP Model (established 2020).

Evolution of the New Discharge Function Score Measure

The Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 mandated a standardized cross-setting post-acute care functional outcome measure. CMS initially developed the functional process measure for all PAC (Post Acute Care) settings: Application of Percent of Long-Term Care Hospital Patients with an Admission and Discharge Functional Assessment and a Care Plan that Addresses Function.

This measure was first publicly reported on Care Compare for home health in April 2022 with a national rate of 98.2%. This high national rate prompted CMS to quickly decide that this mandated cross-setting measure was “topped out,” meaning that the rate was such that meaningful distinctions and improvement in performance can no longer be made.

In 2022, CMS convened Technical Expert Panels (TEPs) to develop a cross-setting outcome measure that could replace this topped out process measure. These TEPs laid the foundation for the new cross-setting functional outcome measure planned to replace the topped-out process measure and be publicly reported on Care Compare in January 2025.

Overview of the NEW Discharge Function Score Measure

Unlike the historic publicly reported functional outcome measures that report the improvement rate for one functional activity, the Discharge Function Score measure reports the rate for ten activities that are currently collected in OASIS (Discharge Function Score for Home Health Agencies Technical Report June 2023).

Activities included/not included in the Discharge Function Score Measure

GG0130A  Eating 
GG0130B Oral Hygiene 
GG0130C Toileting Hygiene 
GG0130E Shower/Bathe Self (not included) 
GG0130F Upper Body Dressing (not included) 
GG0130G Lower Body Dressing (not included) 
GG0110H Putting On/Taking Off Footwear (not included) 
GG0170A Roll Left and Right 
GG0170B Sit to Lying (not included) 
GG0170C Lying to Sitting on Side of Bed 
GG0170D Sit to Stand 
GG0170E Chair/Bed-to-Chair Transfer 
GG0170F Toilet Transfer 
GG0170G Car Transfer (not included) 
GG0170I Walk 10 Feet 
GG0170J Walk 50 Feet with Two Turns 
GG0170K Walk 150 Feet (not included) 
GG0170L  Walking 10 Feet Uneven Surfaces (not included) 
GG0170M 1 Step (Curb) (not included) 
GG0170N 4 Steps (not included) 
GG0170O 12 Steps (not included) 
GG0170P Picking Up Object (not included) 
GG0170Q Does Patient Use Wheelchair/Scooter (not included) 
GG0170R, RR Wheel 50 Feet with Two Turns 
GG0170S, SS Wheel 150 Feet (not included) 

CMS describes this measure as follows: “The Discharge Function Score calculates the percent of HH patients who achieve a risk-adjusted expected function score at discharge. Functional status is measured through Section GG of OASIS assessments, which evaluates a patient’s capacity to perform daily activities related to self-care (GG0130) and mobility (GG0170).

Coefficients from a risk adjustment model controlling for admission function score, age, and patient clinical characteristics are used to determine an expected discharge function score for each HH episode.”

Learn more about how this new measure is calculated in the Jan. 17, 2024 Quarterly OASIS Update webinar.

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