CMS Risk Adjustment for Discharge Function Scores in Expanded HHVBP

CMS employs a sophisticated risk adjustment methodology to account for differences in patient populations when evaluating home health agencies’ performance on the Discharge Function Score (DFS) measure. This adjustment ensures that HHAs are not unfairly penalized for serving patients with more complex health conditions or greater functional impairments.  

Here’s a breakdown of the key adjustment factors used by CMS:

1. Patient Demographics:

• Age: Older patients often have more complex health conditions, requiring greater care.  
• Gender: Gender can influence health outcomes and care needs.  
• Race/Ethnicity: Disparities in health outcomes exist across different racial and ethnic groups.  

2. Comorbidities:

• Chronic Conditions: The presence of chronic diseases, such as diabetes, heart failure, or respiratory conditions, can impact functional status.
• Number of Comorbidities: The number of coexisting conditions can increase the complexity of care.  

3. Functional Status at Admission:

• Baseline Function: A patient’s initial functional status, as measured by the OASIS assessment, can influence their potential for improvement.

4. Socioeconomic Factors:

• Living Situation: Factors like living alone or in a nursing home can affect functional status and care needs.
• Income: Lower income may correlate with limited access to resources and support.

5. Geographic Location:

• Rural vs. Urban: Location can influence access to healthcare services and resources.  

How these factors are used:

• Risk Adjustment Model: CMS uses a statistical model to combine these factors and calculate a risk adjustment score for each patient. ¹   
• Expected Discharge Score: Based on the risk adjustment score, CMS calculates an expected discharge function score for each patient.  
• Comparison: The HHA’s observed discharge function score is compared to the expected discharge score.  
• Adjustment: If the observed score is lower than expected, the HHA’s performance is adjusted upward to account for the patient’s increased risk. Conversely, if the observed score is higher than expected, the performance is adjusted downward.

Important Note: The specific risk factors and weighting used in the risk adjustment model may change over time as CMS updates its methodology.

By incorporating these risk adjustment factors, CMS aims to provide a more accurate and equitable assessment of home health agencies’ performance on the Discharge Function Score.