MDS Alert

Published on Thu Dec 06, 2018 PDF

Question: I’ve heard that under the Patient-Driven Payment Model (PDPM), every resident will be given a “function score.” What kind of score is this and how is it calculated?

Codify Subscriber

Answer: One of the changes coming with PDPM will be the use of Section GG (Functional Abilities and Goals) instead of Section G (Functional Status) to determine each patient’s function score — and therefore how each patient is classified.

The change “advances CMS’s goal of using standardized assessment items across payment settings,” according to a PDPM FAQ sheet released by CMS.

However, the switch to PDPM does not include any changes on how Section GG is coded, according to CMS.

As for the functional score, the patient classification is based on the following 10 components from physical therapy (PT) and occupational therapy (OT), which were all found to be “highly predictive of PT and OT costs per day”:

• “Two bed mobility items
• “Three transfer items
• “One eating item
• “One toileting item
• “One oral hygiene item
• “Two walking items.”

The adjustment is a correction in calculations meant to redistribute score calculations in order to “track functional independence rather than functional dependence,” CMS says.

“Unlike Section G, Section GG measures functional areas with more than one item. This results in substantial overlap between the two bed mobility items, the three transfer items, and the two walking items. Because of this overlap, a simple sum of all scores for each item may inappropriately overweight functional areas measured by multiple items. Therefore, to adjust for this overlap, we calculate an average score for these related items,” CMS says in its PDPM FAQs.

Find out more about PDPM and patient function scores here: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/PDPM_FAQ_Final.pdf.