The landscape of hospice care quality assessment is evolving, and at the forefront of this transformation is HOPE, which stands for Time, Education, Assessment, Tools and Palliative care. While this acronym might seem unusual, understanding what HOPE represents is crucial for healthcare professionals and anyone involved in hospice services. This article delves into the Hospice Outcomes and Patient Evaluation (HOPE) tool, a significant development by the Centers for Medicare & Medicaid Services (CMS) designed to enhance the quality of hospice care. Replacing the Hospice Item Set (HIS), HOPE is set to redefine how hospices assess patient needs and report quality data.
The Genesis of HOPE: Addressing the Need for Enhanced Hospice Assessment
CMS introduced HOPE as a crucial component of the Hospice Quality Reporting Program (HQRP). This initiative, formalized in the FY 2025 Hospice Wage Index Final Rule (CMS-1810-F), marks a shift towards more robust and patient-centered data collection in hospice care. The full details of this ruling can be found on the CMS website under Hospice Regulations and Notices. The primary driver behind HOPE’s creation is the need for assessment-based quality data that goes beyond the limitations of the previous HIS.
The limitations of HIS were significant. While HIS served as a mechanism for abstracting medical record data, it wasn’t a real-time patient assessment tool. HIS retrospectively focused on whether hospices performed specific care processes using chart abstractions. CMS recognized the necessity for a more dynamic and comprehensive approach to capture patient and family care needs effectively. This is where HOPE comes in, aiming to capture these needs in real-time and at multiple points during a hospice stay, offering the flexibility to adapt to diverse patient conditions.
HOPE’s Objectives: Driving Improvements in Hospice Quality
HOPE is designed with several key objectives in mind, all centered around improving the quality and delivery of hospice care. These objectives include:
- Enhancing the HQRP through Standardized Data Collection: HOPE provides a structured framework for collecting consistent and comparable data across hospice agencies. This standardization is essential for accurate quality measurement and reporting.
- Gaining a Deeper Understanding of Patient Care Needs: Unlike HIS, HOPE is designed to be a patient assessment tool. This means it directly evaluates patient needs, allowing hospices to gain a clearer picture of the challenges and requirements of those under their care.
- Contributing to Personalized Care Planning: The data gathered through HOPE is intended to directly inform and improve the patient’s plan of care. By providing real-time assessment data, HOPE enables hospices to tailor their services more effectively to individual patient needs.
- Providing Clinical Data for Future Payment Refinements: The rich clinical data collected by HOPE can be used to inform future adjustments and refinements in hospice payment models, ensuring that funding mechanisms align with the actual costs of providing high-quality care.
- Development of HOPE-Based Quality Measures: CMS has already finalized two quality measures based on HOPE data. This is just the beginning, as the framework is designed to support the development of additional quality measures in the future, continually pushing for higher standards in hospice care.
Ultimately, HOPE aims to empower hospices with actionable information. This information can guide them in identifying areas for practice adjustments and improving decision-making at both the patient and agency levels. Furthermore, public reporting of HOPE assessment-based quality measures will empower patients and families to make more informed choices when selecting a hospice provider.
HOPE vs. HIS: Key Differences in Approach
While both HIS and HOPE serve the purpose of quality data collection in hospice care, their methodologies and scope differ significantly. Until September 30, 2025, HIS remains in use for data collection at admission and discharge. However, it’s crucial to understand the fundamental shift HOPE represents.
The most significant difference lies in HOPE’s proactive and real-time assessment approach. HOPE introduces “HOPE Update Visits” (HUVs), which are additional data collection timepoints within the first 30 days of a patient’s hospice election. Depending on the length of stay, hospices will be required to submit up to two HUVs. This addition of interim assessments allows for a dynamic understanding of the patient’s condition and needs as they evolve during their hospice journey.
Here’s a table summarizing the key distinctions:
| Feature | Hospice Item Set (HIS) | Hospice Outcomes and Patient Evaluation (HOPE) |
|---|---|---|
| Type | Retrospective data abstraction tool | Real-time patient assessment tool |
| Data Collection | Admission and Discharge only | Admission, Discharge, and HOPE Update Visits (HUVs) within 30 days |
| Focus | Care processes performed (retrospective) | Patient and family care needs (real-time and longitudinal) |
| Purpose | Calculate HQRP measures based on chart abstraction | Inform care planning, HQRP measures, and quality improvement |
| Timeframe | Data collected after care delivery | Data collected during care delivery |
HOPE’s forward-looking approach ensures that data collection is integrated into the hospice workflow and aligns with Medicare Conditions of Participation. The data gathered, reflecting patients’ baseline status and outcome changes, becomes a valuable asset for care planning, quality measurement, and providers’ ongoing quality improvement efforts. For a visual explanation of HOPE data collection timepoints, resources are available at the HQRP Training and Education Library.
The Development Journey of HOPE: A Collaborative Process
The creation of HOPE was a meticulous and collaborative process, emphasizing input from various stakeholders and experts. The development journey encompassed several key phases:
- Information Gathering: Initial stages involved comprehensive research and information gathering to understand the current landscape of hospice care assessment and identify areas for improvement.
- Stakeholder and Technical Expert Panel (TEP) Engagement: CMS actively engaged with stakeholders, including hospice providers, clinicians, and patient advocates. Technical Expert Panels (TEPs) were convened to provide specialized input and guidance throughout the development process. Summaries of TEP reports are accessible on the Provider and Stakeholder Engagement webpage.
- Testing and Refinement: HOPE underwent rigorous testing phases, including cognitive testing, pilot testing, alpha testing, and national beta field testing. The national beta testing, completed in October 2022, was particularly crucial, allowing hospice teams to provide feedback on the assessment instrument and data collection timepoints. This feedback directly informed the refinement of HOPE into its final form. More details on the development and testing phases can be found in the HOPE Development and Testing Report (PDF).
- Rulemaking and Public Comment: CMS proposed the HOPE tool through rulemaking, actively seeking public comments to ensure transparency and gather further insights before final implementation.
This thorough and inclusive development process underscores CMS’s commitment to creating a robust and effective assessment tool that truly serves the needs of hospice patients, their families, and providers.
Ongoing Stakeholder Engagement: Shaping the Future of Hospice Quality
CMS recognizes the importance of continued collaboration with stakeholders in the ongoing development and refinement of quality measures, including those derived from HOPE data. Opportunities for engagement, information gathering reports, and TEP reports are regularly updated on the Provider and Stakeholder Engagement page. The HQRP Forum materials are also available on this platform, providing further avenues for stakeholder participation.
For any inquiries or communication regarding HOPE or quality measures, the Hospice Quality Help Desk is available via email at [email protected].
HOPE represents a significant advancement in hospice care quality assessment. By focusing on Time-sensitive assessments, Education-driven improvements, utilizing effective Assessment Tools, and ultimately enhancing Palliative care, HOPE is poised to drive positive changes in the hospice landscape, benefiting patients, families, and providers alike. As HOPE is implemented in FY 2026 (starting October 1, 2025), its impact on quality reporting and patient care will be closely monitored and is expected to bring about a new era of enhanced hospice services.
