The Discharge Function Score Quality Measure is one of the newer measures CMS has put in place. This measure impacts the SNF Quality Reporting Program (QRP), the Value Based Purchasing Program (VBP), and Five Star on Care Compare.
The Discharge Function Score looks at when observed discharge scores exceed the expected discharge scores for Medicare Part A stays within a 12-month target period.
This measure uses only Type 1 SNF stays. Exclusions for this measure include:
· Incomplete Medicare Part A SNF stays (unplanned discharges, discharges to a hospital, a stay less than 3 days, or death)
· Medical conditions including coma, persistent vegetative state, complete tetraplegia, severe brain damage, locked-in syndrome, severe anoxic brain damage, cerebral edema, or compression of the brain
· Younger than 18 years old
· Discharge to hospice or received hospice while a resident
To calculate the Total Discharge Function Score, 10 Section GG items are utilized. The first 8 items used are the same for each patient:
The last two items used for the calculation may vary depending on if the patient is able to walk or if they utilize a wheelchair. The determination is based on item GG0170I3 – Walk 10 feet and how it is coded.
Based on the scoring of these 10Section GG items, the Discharge Function Score would range from 10 to 60. Statistical imputations are used to score items skipped, dashed, or coded as activity not attempted.
For this measure, the Total Observed Discharge Function Score is the sum of the coding for each of the items, using statistical imputation as described. The Expected Discharge Function Score is calculated by using a regression equation based on risk adjustment to each SNF stay.
Risk adjustment for this measure is based on the following covariates:
· Age
· Admission function score (calculated with same items and in same way as Discharge Function Score)
· Primary medical category
· Prior surgery
· Prior function (self-care, indoor mobility, stairs, functional cognition)
· Prior mobility device use
· Pressure ulcers (Stage 2, 3, and/or 4)
· Cognitive function
· Communication impairment
· Bowel and Urinary Incontinence
· Nutritional approaches
· BMI
· History of falls
· Comorbidities
· No Physical or Occupational Therapy at time of admission
The higher the percentage for this measure the better. This would indicate observed patient outcomes are exceeding expected outcomes.
Given the complexity of this measure’s calculation, the key to managing this measure is to ensure accurate and thorough coding of Section GG as well as the other sections of the MDS affecting the covariates. Collaboration amongst the interdisciplinary team, particularly therapy and nursing, is crucial to capture this information and to track a patient’s functional progress during their SNF Part A stay.
To learn more regarding this Quality Measure and the Quality Reporting Program, go to Skilled Nursing Facility (SNF) Quality Reporting Program (QRP) Measures and Technical Information | CMS