Improvement in Ambulation

The measure compares the ambulation and locomotion response recorded on the OASIS at start of care or resumption of care with the response recorded at discharge. An episode counts as improved when the discharge response shows a higher level of independence than the baseline. Episodes ending in death, transfer to an inpatient facility, or certain other dispositions are excluded, since improvement cannot be fairly assessed. CMS risk-adjusts the results using baseline patient characteristics, so agencies serving more impaired populations are measured against appropriately lower expected improvement rates.

Measured improvement is the gap between two OASIS responses, which means the start of care assessment sets the ceiling. If a clinician overstates baseline ambulation, rating a patient more independent than they actually are, the episode has little room to show improvement no matter how well therapy goes. The opposite error, understating discharge function, has the same effect from the other end. The fix is convention training: clinicians should score what the patient safely does on the day of assessment, not what they can do on a good day or what they did before the acute event. Agencies that audit SOC and discharge responses side by side routinely find their outcome problem is partly a documentation problem.

• Involve physical therapy early for patients with mobility deficits rather than waiting for nursing to stall
• Write measurable ambulation goals into the plan of care and track them visit to visit
• Address fall risk and fear of falling, which suppress mobility gains even when strength improves
• Use home safety evaluation findings, such as clutter, lighting, and footwear, as part of the mobility plan
• Reassess honestly at discharge, with the discharging clinician observing ambulation directly rather than carrying forward prior responses

Improvement in ambulation is publicly reported on Care Compare and is a component of the Quality of Patient Care Star Rating, which makes it visible to discharge planners, referral platforms, and payers. Functional improvement measures also anchor the OASIS-based category of the expanded HHVBP model, which carries 40% of the Total Performance Score in the CY2026 measure set, so ambulation performance connects to both reputation and Medicare payment adjustments.