The Hospice Outcomes and Patient Evaluation (HOPE) assessment tool is scheduled to be implemented Oct. 1, 2025, meaning the clock is ticking for hospice providers to complete internal preparations. Providers can collect and submit hospice item set (HIS) data until Sept. 30, 2025, after which only HOPE data will be accepted for all patients admitted or discharged on or after Oct. 1, 2025.
The HOPE tool is a standardized interdisciplinary assessment that aims to meet these goals from the Centers for Medicare & Medicaid Services (CMS):
- Obtainment of clinical data that informs future patient-level quality measure development and could inform future payment modification
- Provision of information to hospices to help inform quality assurance and performance improvement initiatives
- Inclusion of interdisciplinary efforts in the assessment process
- Help with hospice team care planning
- Alignment with CMS conditions of participation (CoP)
While HOPE data elements contribute to this assessment, they do not replace a thorough, ongoing evaluation of each patient or clinical practice or judgment.
CMS said the HOPE assessment will not impact the CoP, which functions as an initial and comprehensive assessment of patient requirements. The assessment content of CoP will be required in addition to the HOPE data items. CMS said it is important for providers to ensure their documentation software vendor maintains CoP content while building their HOPE content. The HOPE tool will replace the HIS content, but the core of the HIS data items will be captured in the HOPE tool. Additionally, CMS posted a change table that compares the HIS and HOPE data elements.
Real-Time Data Collection
Come October, all Medicare-certified hospice providers must submit HOPE data for all patients regardless of age, payer source, location of care or length of stay (LOS). This data will then be collected and submitted to CMS at the CMS certification number level.
The HOPE tool is designed to collect data to assess patients and families related to their interactions with their hospice team. It also adapts their clinical needs and gathers additional information to contribute to patients’ care plans throughout their hospice stays. The tool includes several domains that are new or expanded relative to the HIS, including:
- Updated socio demographics
- Expanded diagnoses
- Symptom impact assessment
- Imminent death
The tool will include data elements that represent other domains, such as:
- Administration
- Preferences for customary routine activities
- Active diagnoses
- Health conditions
- Medications
- Skin conditions
Further details, questions on coding guidance and examples about the domains and data elements are in the HOPE Guidance Manual V 1.0.
CMS will measure compliance with HOPE data submissions using the same methodology that was used for the HIS. After the HIS is phased out, hospices will continue to submit 90% of all required HOPE data records within 30 days of the completion date (patient’s admission, discharge and—based on the patient's LOS—up to two update visit time points). Providers who fail to meet at least 90% submission of all required HOPE assessments to CMS will be subject to a 4% point reduction of the annual market basket for the coordinating fiscal year.
New Data Collection Points
The HOPE assessment tool will collect data at multiple time points in the patient’s hospice stay, but not all HOPE items will be completed at every point. Data is collected at admission, HOPE update visits (HUV), symptom follow-up visits (SFV) as applicable and at discharge. HUVs and SFVs are new data collection points for hospice providers.
An HUV is collected via in-person visits to inform updates on the plan of care. Up to two HUV records may be required for every hospice admission depending on LOS (CMS will not accept more than two). The information collected from these visits will include clinical data that requires a skilled nursing assessment; it's expected that a registered nurse (RN) will complete these visits.
The first HUV should be completed between days six and 15 of a patient’s hospice stay, but not within the first five days after the hospice election. The second HUV should be completed between days 16 and 30.
During the admission or HUV, data collected for the symptom impact item may trigger the need for an SFV. The need for an SFV should be based on the symptom impact, as opposed to the severity rating of the experienced pain or non-pain symptoms. Therefore, SFVs should not be an assessment of the severity, intensity, frequency or other characteristics of symptoms, but rather, the impact these symptoms have on the patient. CMS defines symptom impact as “the effect of symptom(s) on the patient,” and these symptoms may impact a patient in multiple ways, such as disturbance to sleep, concentration or day-to-day activities.
An SFV should be completed in person within two calendar days of admission or HUV as a follow-up for any pain or non-pain symptom impact rated by the patient as moderate or severe. The SFV must be separate from the admission or the HUV and may occur anytime within two calendar days. SFVs will only be required when moderate or severe symptoms are documented at any admission or HUV time point, and up to two SFVs may be required throughout the hospice stay depending on the patient’s LOS. CMS has specified that an SFV may be completed by an RN, licensed practical nurse or vocational nurse.
The HOPE guidance manual provides details, guidance, sample calendars and scenarios regarding HUVs and SFVs.
It also contains instructions for record management, including:
- Record Administration: Items in this section contain signatures of individuals completing HOPE assessments and the individual verifying the HOPE record.
- Submission & Correction: This chapter details the electronic submission and correction process for HOPE records, and requirements for data submission.
Each provider must create electronic HOPE records and submission files using file-creating software that meets the HOPE data submission specification requirements, which are available on the CMS hospice quality reporting program (HQRP) website. Providers must register for an account in the CMS system and request a user role. Further details are available on the QIES Technical Support Office website at qtso.cms.gov.
Future Quality Measures
CMS finalized two process measures calculated from HOPE data that should be added to HQRP no sooner FY 2028. By then, CMS will have the necessary data to establish the scientific soundness of quality measures. These two measures will determine whether a follow-up visit occurs within two days of an initial assessment of moderate or severe symptom impact.
Preparing for the HOPE assessment will take time and effort for hospice providers. While CMS will provide resources and some training, it will be the responsibility of hospice organizations to ensure that:
- Staff members review and understand the HOPE guidance manual
- The organization’s electronic medical record vendor develops a plan and timeline for integrating HOPE assessment items into the comprehensive assessment and has a strategy to share updates
- The organization establishes its baseline assessment performance by identifying assessment process gaps to determine baseline performance before implementation
- Staff members receive consistent education about the HOPE tool as well as CMS-developed education
- Organizations stay updated on HOPE information that is posted by CMS on the HQRP webpage.