The Future of Hospice Care Assessment

---

The landscape of hospice care is evolving, and October 1, 2025, marks a major milestone for all Medicare-certified hospices across the United States. The Centers for Medicare & Medicaid Services (CMS) is introducing CMS HOPE, or Hospice Outcomes & Patient Evaluation, a comprehensive new tool designed to standardize patient-level data collection and replace the current Hospice Item Set (HIS).

This change represents a major step forward in improving the quality of hospice care, streamlining reporting requirements, and enhancing how hospices evaluate and respond to patient needs.

In this article, we’ll explore what CMS HOPE is, why it matters, and how your hospice can prepare for a smooth transition.

CMS HOPE is a standardized patient assessment tool developed to collect real-time, patient-specific data throughout a hospice patient’s care journey.

Its purpose is to:

• Improve quality reporting
   
• Provide insights for future payment updates
   
• Enhance patient care plans through timely and accurate data
   
• Create a more holistic view of patient needs, emphasizing overall well-being rather than isolated symptoms
   

By replacing HIS, CMS HOPE will move hospices from static, after-the-fact reporting to dynamic, actionable assessments.

The transition to HOPE begins October 1, 2025, and will affect all Medicare-certified hospices.

• October 1, 2025: All hospices are required to begin using HOPE for data collection.
   
• 3rd Quarter of 2025: Hospices should have fully trained staff, updated policies and procedures, and adjusted staffing strategies to prepare for the rollout.
   

All HOPE data will be submitted through the Internet Quality Improvement and Evaluation System (iQIES) — replacing the previous QIES system.

During the first month of care, the HOPE assessment will take place at several critical points:

1. At Admission – within the first five days
    
2. HOPE Update Visit 1 (HUV1): Days 6–15
    
3. HOPE Update Visit 2 (HUV2): Days 16–30
    
4. At Discharge: if the patient meets length-of-stay criteria
    

Depending on the patient’s length of stay, up to four assessments may be required.

With HOPE, CMS introduces new quality measures that focus on timely follow-up and symptom management.

• Measures whether a follow-up visit occurred within two days after an assessment identified moderate or severe pain.
   

• Focuses on timely responses to other moderate or severe symptoms, such as:
   
  • Shortness of breath (dyspnea)
     
  • Anxiety or nervousness
     
  • Nausea or vomiting
     
  • Diarrhea or constipation
     
  • Agitation
     

Unlike HIS, which focused primarily on symptom presence and severity, HOPE takes a holistic approach, evaluating how symptoms affect a patient’s quality of life.

When conducting a Symptom Impact Assessment, clinicians consider how symptoms impact the patient’s:

• Sleep quality
   
• Ability to concentrate
   
• Day-to-day activities
   
• Interactions with others
   

This approach reflects the true mission of hospice care: supporting the patient’s physical, emotional, and spiritual well-being.

The implementation of HOPE brings several key benefits to hospice care:

HOPE provides a more complete picture of the patient’s needs, ensuring care plans are personalized and compassionate.

By tracking patient progress dynamically, teams can communicate effectively, ensuring timely interventions and better outcomes.

The standardized data gathered through HOPE will help hospices identify trends, address gaps, and continuously enhance care quality.

HOPE helps hospices stay in compliance with CMS rules, protecting them from penalties and survey deficiencies.

The shift from HIS to HOPE represents a move toward a more dynamic, patient-centered approach to hospice care.

Under HIS, reporting was static and after-the-fact, meaning assessments were done at admission and discharge without ongoing updates. With HOPE, assessments are real-time and continuous, allowing clinicians to monitor patients more closely and respond quickly to changes in their condition.

HIS collected limited data, focusing mainly on basic patient information and outcomes. In contrast, HOPE gathers holistic, patient-centered data, looking at physical, emotional, spiritual, and social needs to create a full picture of the patient’s well-being.

Another major difference is the emphasis on follow-up care. HIS did not prioritize tracking timely interventions, while HOPE introduces quality measures that ensure follow-up visits occur within 48 hours when a patient experiences moderate or severe pain or other symptoms.

Lastly, HIS required only one-time reporting at admission and discharge. HOPE, on the other hand, involves two to four assessments per patient, depending on their length of stay, ensuring care is continuously evaluated and adjusted as needed.

To ensure a smooth transition, hospices should take these practical steps before October 1, 2025:

1. Train Staff Thoroughly
    
   • All clinical and administrative staff should be fully trained on HOPE data collection and reporting.
      

         2. Update Policies and Procedures
 

• Align internal processes with HOPE requirements.
   

         3. Adjust Staffing Strategies
 

• Account for the additional visits and documentation required for compliance.
   

         4. Implement Mock Assessments
 

• Practice using HOPE to identify potential challenges before the go-live date.
   

HOPE evaluates the patient’s needs in four key areas, providing a holistic view of their condition:

1. Physical – Pain, mobility, symptom management
    
2. Emotional – Anxiety, depression, agitation
    
3. Spiritual – Support for end-of-life spiritual needs
    
4. Social – Family dynamics, relationships, support systems
    

The transition from HIS to HOPE is a significant change for hospices, but one that ultimately brings great opportunity.

By shifting to a dynamic, patient-centered system, CMS HOPE ensures hospices can deliver more responsive, compassionate care, while also meeting regulatory and quality standards.

Hospice Consultant Partners is here to guide your organization through this transition, ensuring your team is prepared, compliant, and confident every step of the way.

Ready to prepare your hospice for HOPE?

Sources: CMS.gov