Why Agencies Struggle with the Discharge Function Score – and How to Fix It

The Discharge Function Score (DFS) is now one of the most influential measures in home health, making up 20% of your Total Performance Score (TPS) under Home Health Value-Based Purchasing (HHVBP). Yet many agencies are struggling to score well—not because their patient outcomes are poor, but because their Section GG scoring practices are inconsistent or misunderstood.  Let’s unpack some of the most common challenges:

1. Misconception: GG Items Are “Just for Therapy”

Section GG is often mistakenly viewed as a therapy-only domain. In reality, all disciplines can and should contribute to GG scoring. Both nursing and therapy staff play a role in accurately capturing functional status. It is within the scope of practice for both RNs and therapist to complete section GG of the OASIS-E1.

2. Overuse of “Not Attempted” Codes

It may feel easy to mark an activity as “not attempted,” but in HHVBP, that shortcut comes at a cost. CMS imputes all “not attempted” codes to a value between 1 (dependent) and 6 (independent). That means CMS is essentially guessing your patient’s score—something no agency should want. The more you rely on “not attempted,” the less control you have over your outcomes.

3. Misunderstanding the Scoring Guidance

The GG scale is the opposite of the M1800s many clinicians are used to. In M1860, a “6” means dependent; in GG, a “6” means independent. Without education, this reversal is a recipe for errors that can dramatically alter your Discharge Function Score for HHVBP.

4. Limited Observation at Discharge

Too many agencies rely on non-billable discharges—often done by phone or as a “desk discharge”—instead of sending a clinician into the home. Without seeing the patient directly at the end of care, clinicians are left to code “not attempted” or rely on incomplete information. Remember: GG items can be completed through direct observation, patient interview or caregiver interview—but they require accurate and intentional assessment.

The Bottom Line

The Discharge Function Score is complex—it’s not just a simple “did the patient improve?” measure. Instead, it’s expectation-based, meaning your coding and documentation at start of care set the baseline for performance. Inaccuracies or shortcuts at discharge can cost your agency both quality scores and reimbursement.