Work Advancing on CMS Hospice Outcomes & Patient Evaluation Tool

The U.S. Centers for Medicare & Medicaid Services (CMS) is currently recruiting hospice providers to participate in a pilot test of the forthcoming Hospice Outcomes & Patient Evaluation (HOPE) tool, which when completed will replace the Hospice Item Set (HIS) quality reporting system.

According to CMS, hospices will use the tool to assess patients in real-time based on their interactions rather than through the retrospective chart reviews currently used to comply with HIS requirements. The agency has indicated that it expects the tool to jumpstart quality improvement activities and be a less demanding method than HIS for measuring performance.

“The HOPE tool is going to be a standardized assessment tool for hospice specifically. In concept and content it’s not unlike the OASIS tool for home health,” said Jennifer Kennedy, senior director of regulatory and quality for the National Hospice & Palliative Care Organization. “It’s a way for CMS to collect the same type of data from everybody in the same way.” 


For the pilot stage, the agency is seeking a mix of different types of hospices in terms of business size and the types of communities they serve, such as rural areas or urban areas, Kennedy told Hospice News. The registration period ends Feb. 21. 

Hospices are eligible to participate in the pilot if they have sufficient capacity to support clinical staff time for training and data collection, as well as implementation, communication and coordination with ABT, the contractor CMS hired to complete the tool’s development.

“If [hospices] haven’t thought about applying to be a participant in at this first pilot, they should consider it. This is really where a hospice provider can make a difference in terms of giving the developers of the tool their honest feedback about what works, what doesn’t work, what’s burdensome, and what’s helpful,” Kennedy told Hospice News. “If providers don’t consider being part of the development, they it’s a missed opportunity for us all.”


The twin objectives of implementing the tool is to provide quality data for the Hospice Quality Reporting Program through standardized data collection as well as providing clinical data that may inform potential future changes to Medicare hospice payments. The agency is working to develop measures for the HOPE reporting program that are compliant with the agency’s Meaningful Measures Initiative.

Following the first pilot test, ABT will work with CMS to update the tool based on findings from the pilot before proceeding with a national test. Following the national test and associated revisions, the agency will propose a rule for public comment regarding the tool. If finalized, the tool would be required for participation in the Medicare Hospice Benefit.

Measures used in the HOPE tool are expected to be outcome measures rather than process measures. Outcome measures reflect the impact of the health care service or intervention on the health status of patients, according to the U.S. Agency for Healthcare Research & Quality, whereas process measures indicate what a provider does in caring for the patient.

“With the standardized tool, my hope is that it would help to develop some real outcome measures to measure the quality of hospice care being provided. Right now, other than the [Consumer Assessment of Healthcare Providers and Systems program], there really aren’t outcome measures to show the effect of hospice care,” Kennedy said. “That’s where your performance improvement is going to be based, on outcome measures. If somebody rates a hospice low on their response time, for example, the hospice can take that feedback and really do true performance improvement. You can’t do that to some extent with process measures. When we talk about improving actual care and the patient and family experience, we need to have outcome measures to do that.”

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