Discharge Function Score: Getting it Right!

Discharge Function Score: Getting it Right!

Are your Discharge Function Scores working for or against you? If you’re still treating Section GG like “just another MDS task,” you’re missing one of the most influential performance measures in the SNF Quality Reporting Program (QRP). The Discharge Function Score is not only publicly reported on Care Compare to display how effectively your team supports residents in regaining function, the measure also impacts the Five-Star Rating, QRP compliance, and may eventually tie into Value-Based Purchasing. It’s time to dig in and ensure Discharge Function Score accuracy.

Understanding the Basics

The intent of the SNF Discharge Function Score is to determine a facility’s success at helping residents achieve an expected level of functional ability at discharge, based on their unique clinical profile. This measure was implemented FY2024, replacing 1) Short Stay Quality Measure: Residents Who Made Improvements in Function; and 2) SNF QRP Measure: Application of Percent of Long-Term Care Hospital (LTCH) Patients with an Admission and Discharge Functional Assessment and a Care Plan That Addresses Function.

January 2025 brought an updated release with unfrozen QMs. While CMS recalibrated cut point scores to maintain an even distribution of scores across facilities, this measure still resulted in an overall decline in performance.

Includes 10 key Section GG self-care and mobility items:

• • Self-Care:
    • GG0130A – Eating
    • GG0130B – Oral Hygiene
    • GG0130C – Toileting hygiene
  • Mobility:
    • GG0170A – Roll Left and Right
    • GG0170C – Lying to sitting on side of bed
    • GG0170D – Sit to stand
    • GG0170E – Chair/bed-to-chair transfer
    • GG0170F – Toilet transfer
    • GG0170I – Walk 10 Feet
    • GG0170J – Walk 50 feet with 2 turns
    • or GG0170R Wheel 50 Feet with 2 Turns, if non-ambulatory

Calculation

• • CMS calculates a resident-specific expected discharge score using a complex statistical model that incorporates:
    • Exclusions for residents not appropriate for the measure (e.g., expired, hospice, <3-day stay)
    • Covariates—a set of 74 risk adjustment variables (e.g., Primary diagnosis, Prior level of function (PLOF), Cognitive function, history of falls, nutritional status, comorbidities, etc.)
  • Section GG is assessed at admission and discharge. Then, CMS compares the expected discharge function score to your actual GG discharge coding. The facility’s final performance score reflects the percentage of stays that met or exceeded CMS expectations, and are reported publicly on Care Compare.

Best Practices for Improving Your DC Function Score

Your success with this measure hinges on accuracy, consistency, and interdisciplinary collaboration. Here’s what top-performing providers are doing:

1. Educate nursing and therapy staff upon hire—and routinely—on CMS GG coding guidance. Misinterpretation of GG scoring definitions is a frequent cause of inconsistencies. Ongoing education with applied practice ensures team-wide understanding and stronger documentation alignment.
2. Identify an accurate PLOF that reflects the resident’s functional level prior to the onset of their current illness/injury: Establishing an accurate PLOF can assist with discharge planning and support setting achievable discharge goals. Providers are instructed to record the resident’s usual ability to perform self-care, indoor mobility (ambulation), stairs, and functional cognition prior to the current illness, exacerbation, or injury. The RAI (pgs. GG-2 – GG-4) includes examples for coding prior functioning in everyday activities; these emphasize the importance of coding the patient’s prior functioning based on the time immediately before their most recent condition exacerbation that required acute care.
3. Encourage staff to document per occurrence vs per shift. More documented occurrences mean more comprehensive data and more opportunities to identify the resident’s true usual performances.
4. Incorporate a GG review process into the weekly IDT Medicare/Case Management meetings: Utilize this meeting to discuss current functional status and the progress made to date toward discharge goals. Incorporate a GG IDT collaboration during your meetings, at a minimum, for admission and discharge alike.
5. Establish admission performance baseline before the patient benefits from therapy interventions. Section GG should reflect how the resident performs at the start of care, not after improvement begins. Accurate baseline scoring helps support the skilled need and proper risk adjustment. Collaboration between therapy, nursing, and MDS ensures the score reflects true performance and not just a single discipline’s perspective. Keep in mind: if the team determines that usual performance is best represented by day 2 for certain tasks, this should be clearly documented in the IDT notes to support the MDS coding.
6. Establish realistic discharge goals with the resident and family based on their current situation. Begin planning for discharge upon admission. Meet with the resident and family to paint a realistic clinical picture and avoid premature discharge, which could negatively impact both the Discharge Function Score and other quality measures as well.
7. Validate that the Discharge performance is a true reflection of the resident’s functional performance at the time of Medicare Discharge: Line staff must allow each resident to function as independently as possible at the level determined to be safe for them. Reporting under GG is a major shift from Section G, as staff were once taught to report the highest level of assistance the patient required during self-care and mobility tasks. If residents are coded as more dependent than they actually are—based on staff habits rather than the resident true abilities—it can negatively impact the facility’s discharge function score.  For example, if therapy has determined that a resident is safe to complete bed mobility and transfer tasks independently prior to discharge, but CNAs continue to provide supervision / touching assistance out of routine, the resident may be inaccurately coded as requiring assistance. This discrepancy lowers the facility’s reported discharge functional outcomes and misrepresents the residents’ true progress.
8. Limit activity not attempted codes (09, 10, 88) whenever possible. The activity not attempted codes trigger statistical imputation, meaning CMS uses modeling to guess the resident’s functional ability—which may lower your score. Ensure all disciplines contribute to capturing actual observed performance for each item. Every attempt should be made to assess the functional status.
9. Utilize SNF Review & Correct Reports. Take this opportunity to ensure accuracy before data is publicly reported. The next window for correcting SNF QRP data will be related to the data collected between January 1, 2025 and March 31, 2025, which has a final submission deadline of August 15, 2025. Be sure to monitor CMS announcements and iQIES for the specific release date of the corresponding Provider Preview Reports and their 30-day correction window.
10. Implement consistent auditing and monitoring of Section GG coding. Regularly review MDS assessments and the supportive documentation to ensure consistency, coding accuracy, and compliance. If a patient is reported at a higher than functional performance at admission, their progress may appear minimal. Conversely, if a patient is under-scored at discharge, the facility may appear to provide ineffective therapy and other care and services that prepare them to function as independent as possible at discharge, impacting quality scores and future referrals.

Final Thoughts

The SNF Discharge Function Score is one of the most powerful performance indicators you have—and now that it’s tied to Care Compare, it’s on public display for everyone to see. Facilities that prioritize realistic goal setting, interdisciplinary communication, and proactive monitoring will be successful demonstrating quantifiable improvements in function that are consistently reflected in their SNF Discharge Function Score.

Next Steps:

• • Schedule a documentation review and training session with Proactive
  • Implement the Proactive Section GG Training Toolkit to fast forward coding accuracy and supportive documentation compliance. This toolkit includes video scenarios with coding practice to drive success.
  • Schedule a Discharge Function Score review and training session with Proactive’s nurse and therapist consultant team to access facility specific guidance to improve outcomes
  • Engage Proactive as a Medicare meeting monitor to assist in driving IDT dialogue, documentation and coding accuracy, discharge planning and Medicare compliance.

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