Final

Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: September 03, 2020

HOPE

About this Page

This page provides information and resources specific to Hospice Outcomes and Patient Evaluation (HOPE), the new assessment tool for hospices. On this page are direct links to the draft HOPE tool, the draft HOPE Guidance Manual, and related materials. News related to HOPE activities (such as OMB approval) is also posted here.

Background of HOPE

The Centers for Medicare & Medicaid Services (CMS) developed a new patient assessment tool to replace the Hospice item Set (HIS). The name HOPE, was finalized in the FY 2020 Hospice Final Rule.  This tool intends to help hospices better understand care needs throughout the patient’s dying process and contribute to the patient’s plan of care. HOPE will provide assessment-based quality data to enhance the HQRP through standardized data collection and provide additional clinical data that could inform future payment refinements. CMS intends for HOPE to include key items from the HIS and continue to collect information to inform the Comprehensive Assessment at Admission (CBE #3235) while gathering additional data to support new quality measures. 

Objectives of HOPE

CMS is proposing two HOPE-based quality measures. Additional quality measures may be developed in the future based on data elements added to future versions of the tool. More information about these proposed measures can be found on the Federal Register here: https://www.federalregister.gov/public-inspection/current.

HOPE is expected to provide hospices with information to help them identify opportunities to adjust their practices and improve patient- and agency-level decisions about the care they provide. Furthermore, patients and their families will be more informed about the hospice they choose based on potential public reporting of the HOPE assessment-based QMs.

Differences between Hospice Item Set (HIS) and HOPE

Currently, CMS collects data only at admission and discharge from hospice via the HIS. These data are currently used to calculate measures in the HQRP. However, while the HIS is a standardized mechanism for abstracting medical record data, it is not a patient assessment tool because the HIS data are not collected during a patient assessment. Instead, HIS focuses on whether hospices have performed care processes using retrospective data from chart abstraction. CMS’ goal for HOPE is to be more comprehensive than the HIS by capturing patient and family care needs in real-time and throughout the hospice stay with the flexibility to accommodate patients with varying clinical needs. 

HOPE aims to collect quality data throughout the patient’s stay by introducing an additional timepoint, the HOPE Update Visit (HUV). This additional timepoint enables CMS to gather patient level data during their hospice stay. Hospice providers will be required to submit up to two HUVs, each at specified timeframes, depending on the length of the hospice stay. HOPE will take into consideration hospice workflow and the Medicare Conditions of Participation. Data on patients’ baseline status and changes in their outcomes collected via HOPE will contribute to care planning, inform quality measurement for the HQRP, and support providers’ quality improvement efforts.

Process for Developing HOPE

The general process leading to the development of HOPE included, but was not limited to, the following activities: information gathering, stakeholder engagement, and testing of HOPE. The testing phases for HOPE included cognitive, pilot, alpha testing, and national beta field testing.  National beta testing, completed at the end of October 2022, allowed CMS to obtain input from participating hospice teams about the assessment instrument and field testing to refine and support the final draft items and time points for HOPE. CMS will propose the tool in rulemaking and seek public comments. When finalized in future rulemaking, HOPE will be implemented in the Medicare Hospice Benefit to provide value to hospice providers, patients, and families.

Stakeholder Engagement 

CMS actively seeks to engage with stakeholders as it develops new quality measures, including HOPE. Relevant opportunities, information gathering reports, and Technical Expert Panel (TEP) reports are available on this website on the Provider and Stakeholder Engagement webpage. You will also find HQRP Forum materials on this same page. If you would like to communicate with CMS about HOPE or quality measures, please email the Hospice Quality Help Desk at HospiceQualityQuestions@cms.hhs.gov.

Hospice Quality Reporting Program Archives (PDF)

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DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.