CMS Releases First Draft of HOPE Tool Guidance

BALTIMORE—The Centers for Medicare and Medicaid Services (CMS) has released the first draft of its hospice outcomes and patient evaluation (HOPE) tool, a new assessment tool for hospices. The HOPE tool was developed to replace the hospice item set (HIS) as part of the hospice quality reporting program (HQRP). 

The HOPE tool was finalized in the fiscal year 2025 hospice wage index final rule and aims to provide assessment-based quality data to enhance the HQRP through standardized data collection, provide a better understanding of patient care needs, contribute to the patient’s plan of care and provide additional clinical data that could inform future payment refinements.

Objectives of HOPE

CMS finalized 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 the development of quality measures can be found on the CMS quality measure development page. 

The HOPE tool is expected to provide hospices with information helping them identify opportunities to adjust their practices and improve patient- and agency-level decisions about the care they provide. Furthermore, the tool intends to keep patients and their families more informed about the hospice they choose based on potential public reporting of the HOPE assessment-based quality measures. 

Differences Between HIS & HOPE

Until September 30, 2025, CMS will continue to collect data only at admission and discharge from hospice via the HIS. This data is used to calculate measures for the HQRP. While the HIS is a standardized mechanism for abstracting medical record data, it is not a patient assessment tool, because HIS data is 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 at additional timepoints during the hospice stay, as well as provide flexibility to accommodate patients with varying clinical needs. 

Beginning October 1, 2025, HOPE will collect data by introducing additional timepoints, referred to as the HOPE update visits (HUVs). The HUVs will allow CMS to gather patient level data during the first 30 days after a beneficiary elects hospice. Hospice providers will be required to submit up to two HUVs, each at specified timeframes, depending on the length of the hospice stay. Additionally, HOPE takes into consideration the hospice workflow and the Medicare conditions of participation. The data on patients’ baseline status and changes in their outcomes collected via HOPE will aim to contribute to care planning, inform quality measurement for the HQRP and support providers’ quality improvement efforts. Providers can access visit the CMS HQRP training and education library page for more information on data collection timepoints for HOPE. 

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 and technical expert panel (TEP) engagement and testing of the HOPE tool. Summaries of the TEP reports can be found in the downloads section on the CMS provider and stakeholder engagement page. 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 in order to refine and support the final draft items and data collection timepoints for HOPE. CMS proposed the HOPE tool in rulemaking and sought public comments. Once implemented in fiscal year 2026 (October 1, 2025), HOPE intends to provide value to hospice providers, patients and families.

Stakeholder Engagement 

CMS seeks to engage with stakeholders as it continues to develop new quality measures, including those from HOPE. Relevant opportunities, information gathering reports and TEP reports are available on the CMS provider and stakeholder engagement page.