Starting in 2025, the GG section will play a larger role in the functional assessment category of OASIS and will significantly impact Home Health Value-Based Purchasing (HHVBP) and Quality Reporting programs.
Effective January 1, 2025, the Total Normalized Composite Change in Mobility and Change in Self-Care measures, which are currently based on M1800 items, will be replaced by a single Discharge Function Score, a new OASIS-based outcome measure calculated using GG functional assessment items.
The new Discharge Function Score will be reported on Care Compare and will account for 20% of an agency’s Total Performance Score in HHVBP.
Completing the GG Section
There are eleven OASIS GG items that are included in calculations to measure the patient’s functional status for the Discharge Function Score:
Valid responses to these items include responses 01-06, indicating the patient’s functional status was assessed. Responses 07, 09, 10, and 88, along with skipping these items or entering a dash (-), indicate that the functional activity was not attempted/assessed.
How the Discharge Function Score Works
The Discharge Function Score calculates the percent of home health patients who achieve a risk-adjusted expected function score at discharge (Discharge Function Score Measure (Home Health) – Technical Report 2024).
When clinicians complete an OASIS at the Start of Care or Resumption of Care, the responses to GG items are used in the Discharge Function Score algorithm developed by CMS. This algorithm calculates the expected discharge status of the patient based on these initial responses.
At discharge, the responses provided on the Discharge OASIS are compared to the Expected Discharge Status calculated by the algorithm. If the Observed Discharge Status matches or exceeds the Expected Discharge Score, it results in a positive score for the agency.
The score for your agency is calculated by dividing:
- Numerator: The number of quality episodes during the reporting period where the agency’s observed discharge function score for GG items is equal to or higher than the expected discharge function score.
- Denominator: The total number of home health quality episodes with an OASIS discharge record in the reporting period that do not meet the exclusion criteria.
Remember that if any GG activity, is coded with an ‘activity not attempted’ code of 7, 9, 10, 88, or is dashed (-), or is skipped or missing, then statistical imputation is used to estimate the score for that item.
To accurately reflect a patient’s functional status, agencies are advised to reduce the use of the ‘activity not attempted’ codes when possible.
Importance of Education and Training
Ensure that your clinicians completing the OASIS and the QA team reviewing them are well-educated on the guidelines for GG item scoring and how it impacts your performance in Quality Reporting and the Value-Based Purchasing Program. Start this training as soon as possible; focus on educating clinicians about the differences between GG item scoring and M1800 scoring guidelines, as each requires distinct assessment methods and response types.
