Article contributed by AAPACN Solution Provider DreamPro Intelligence
By Abby Hasani, MSN, RN, QCP, DNS-CT, RAC-CTA, LNCC
As the landscape of post-acute care continues to evolve, performance metrics have become an essential component in assessing and improving the quality of care delivered in Skilled Nursing Facilities (SNFs). One of the newer quality measures gaining attention is the Discharge Function Score — a powerful tool in evaluating how effectively SNFs help residents regain function before returning to the community.
What Is the Discharge Function Score?
The Discharge Function Score is a quality measure that reflects the functional status of residents at the time of discharge from a skilled nursing facility. Specifically, it measures improvement in self-care and mobility from admission to discharge, using standardized data from the Minimum Data Set (MDS) assessments.
CMS developed this measure as part of its broader Quality Reporting Program (QRP) to ensure SNFs are not only providing custodial care but are actively facilitating rehabilitation and recovery. This aligns with the goal of reducing rehospitalizations and enabling smoother transitions back to the community or lower levels of care.
Why It Matters
The Discharge Function Score is more than just a number. It reflects the real-world outcomes of therapy and nursing care. Facilities with higher scores demonstrate better results in helping residents regain independence — a key metric for families, referral sources, and payers evaluating quality of care.
In addition, this score is publicly reported on Care Compare, meaning it directly affects a facility’s reputation and visibility to prospective residents and families.
How Is It Calculated?
The score is derived from Section GG of the MDS, which assesses residents’ ability to perform daily activities such as walking, eating, and personal hygiene. Each resident receives a functional score on admission and another on discharge. The difference between these scores indicates the level of functional improvement.
CMS then aggregates this data to calculate an average Discharge Function Score for each facility, allowing for comparisons across providers nationally.
MDS Section GG Items Included in the Discharge Function Score
To accurately assess a resident’s functional improvement, CMS uses a set of standardized self-care and mobility items from Section GG of the Minimum Data Set (MDS) 3.0. These items capture how much assistance a resident requires to complete certain activities at both admission and discharge.
The Discharge Function Score includes the following items:
Self-Care Items
These activities reflect a resident’s ability to manage personal care tasks independently:
- GG0130A1 – Eating
- GG0130B1 – Oral hygiene
- GG0130C1 – Toileting hygiene
Mobility Items
These activities assess the resident’s ability to move in and around their environment:
- GG0170A1 – Roll left and right
- GG0170C1 – Lying to sitting on side of bed
- GG0170D1 – Sit to stand
- GG0170E1 – Chair/bed-to-chair transfer
- GG0170F1 – Toilet transfer
- GG0170J1 – Walk 50 feet with 2 turns
- GG0170K1 – Walk 150 feet
If a resident is unable to walk, wheelchair items (GG0170R1 and GG0170S1) may be used instead, though walking items are generally prioritized if the resident can attempt them.
Risk Adjustment in the Discharge Function Score
To ensure that Skilled Nursing Facilities (SNFs) are evaluated fairly, the Discharge Function Score is risk-adjusted. This means that residents’ characteristics and clinical complexities are taken into account when calculating a facility’s average score, allowing comparisons to be more equitable across different patient populations.
Without risk adjustment, facilities treating residents with more complex needs or lower baseline function might appear to perform worse — even when delivering high-quality care. Risk adjustment helps mitigate that bias.
What Is Risk Adjustment?
Risk adjustment involves statistically modifying the outcome score (in this case, the average discharge function score) based on resident-level factors that are outside the facility’s control but can impact functional outcomes.
CMS uses a hierarchical linear model to adjust for these variables, allowing performance comparisons across SNFs with different case mixes.
Factors Used in Risk Adjustment
CMS adjusts the Discharge Function Score based on a range of resident characteristics and clinical factors to ensure accurate assessment. These factors include demographic details such as age and gender, as well as the individual’s functional status at admission, which is determined by their GG scores for self-care and mobility—reflecting their baseline functional abilities. Clinical characteristics also play a role, including cognitive status (measured by the Cognitive Function Scale), the presence of comorbidities like stroke, cancer, neurologic conditions, or heart failure, and any impairments in vision, hearing, or communication. Infection status is considered, particularly recent infections such as urinary tract infections or pneumonia that could impact physical functioning. The presence and severity of pain are also factored in. Additionally, CMS evaluates service utilization during the skilled nursing facility (SNF) stay, such as the use of IV medications, tube feeding, dialysis, or oxygen therapy. Lastly, the need for mobility support—such as the use of a wheelchair or the requirement for extensive assistance with mobility at admission—is taken into account.
Best Practices to Improve and Accurately Capture Discharge Function Scores
Improving your facility’s Discharge Function Score involves a strategic focus on both clinical outcomes and documentation practices. Below are evidence-based and operational best practices SNFs can adopt:
1. Standardize Functional Assessment Processes
- Train interdisciplinary staff (nursing, therapy, MDS coordinators) to consistently observe and document residents’ functional performance.
- Use a team-based approach to complete Section GG items, drawing input from therapy and nursing staff who interact with the resident in different settings and times of day.
2. Focus on Goal-Oriented Rehabilitation
- Begin discharge planning at admission. Establish realistic, personalized functional goals tied to the resident’s prior level of function and community discharge plans.
- Use restorative nursing and therapy interventions to work toward those goals in a structured, measurable way.
3. Optimize Therapy Engagement
- Ensure therapy plans are individualized and progressive, with clear functional outcomes tied to GG items.
- Monitor for therapy plateauing and adjust plans to prevent stagnation, while also involving families and caregivers in maintaining functional gains.
4. Reinforce Early and Frequent Mobility
- Encourage mobility and independence from day one. Even small gains early in the stay contribute to overall improvement by discharge.
- Involve nursing assistants and nursing staff in promoting self-care during daily activities like dressing, grooming, and ambulation.
5. Accurate and Timely Documentation
- Complete assessments during the correct windows (typically days 1–3 for admission, and days 1–3 before discharge).
- Use real, observed performance—not hypothetical or best-case scenarios—to fill out MDS GG items.
6. Use Audit Tools and Internal Reviews
- Periodically audit completed MDS Section GG assessments to ensure consistency and compliance.
- Use mock assessments or chart reviews to identify documentation gaps or opportunities for education.
7. Leverage Technology and Data Analytics
- Implement EMR alerts to remind staff of assessment timelines and GG item completion.
- Analyze facility-level and resident-level trends in GG scoring to identify high-performing interventions or resident types that benefit most from specific programs.
8. Create a Culture of Functional Recovery
- Reinforce across departments that functional improvement is a shared responsibility.
- Celebrate success stories where residents achieve significant gains — and use these narratives to build staff morale and community trust.
Strengthening Collaboration Between Therapy and MDS Teams
One of the most important — and often overlooked — drivers of success with the Discharge Function Score is the collaboration between therapy departments and MDS coordinators. Functional outcomes and the accuracy of Section GG assessments depend heavily on coordinated efforts between these two groups.
Why Collaboration Matters
Section GG items require clinical judgment based on direct observation of a resident’s usual performance, not just their best performance in therapy. Since therapy staff often spend the most structured time working with residents on mobility and self-care tasks, they are in a unique position to provide valuable insights. However, MDS staff are responsible for completing and submitting the assessments. If there’s a disconnect in communication, functional gains may be underreported — negatively impacting the facility’s score.
Best Practices for Interdisciplinary Collaboration
1. Hold Regular Interdisciplinary Meetings
- Schedule brief, focused “GG huddles” during key MDS assessment periods (e.g., admission and discharge).
- Review each resident’s observed performance across shifts and therapy sessions to ensure that Section GG coding reflects their true capabilities.
2. Share Observations in Real-Time
- Encourage therapists to document functional performance in real time and share key observations with MDS staff, especially any changes in assistance levels or task completion.
- Use shared digital notes or communication boards to flag significant changes that affect GG coding.
3. Joint Training on Section GG Scoring Guidelines
- Conduct regular in-services that include both MDS and therapy staff to review CMS guidance on scoring GG items.
- Emphasize the importance of coding based on “usual performance” and using consistent definitions of assistance levels (e.g., supervision, limited assistance).
4. Cross-Functional Documentation Standards
- Ensure that documentation templates in the EMR align across therapy and MDS workflows so that key details about mobility and self-care performance are captured in a way that supports accurate GG scoring.
- Audit for discrepancies between therapy notes and MDS entries and resolve inconsistencies through case reviews.
5. Foster a Culture of Shared Accountability
- Reinforce that therapy outcomes and functional documentation are not the sole responsibility of any one department.
- Celebrate improvements in Discharge Function Scores as a team success, and involve both MDS and therapy staff in quality improvement discussions.
Integrating these collaborative strategies helps ensure that the functional progress your residents make is fully captured and accurately reflected in your quality scores. It also fosters a team-based care environment that drives better outcomes, smoother discharges, and stronger CMS performance metrics
Final Thoughts
The Discharge Function Score measure reinforces a critical truth: success in skilled nursing care is not just about clinical stability, but also about how well residents recover their ability to function independently. As healthcare moves toward value-based models, SNFs that prioritize functional recovery and adopt best practices in care delivery and documentation will be better positioned for long-term success — and, most importantly, deliver better outcomes for those they serve.
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