Hospices Preparing for HOPE Quality Tool Coming from CMS

The forthcoming Hospice Outcomes & Patient Evaluation (HOPE) tool is currently in the first stage of pilot testing. The tool will replace the Hospice Item Set (HIS) quality reporting system when completed, but providers have growing concerns about the ramifications, with many stretched thin after a tough year during the coronavirus pandemic.

The U.S. Centers for Medicare & Medicaid Services (CMS) is rolling out pilot testing of the new HOPE tool among a mix of hospice providers of varied sizes and geographical settings. Working in collaboration with the contractor Abt Associates, the agency indicated that the tool’s dual objectives are to provide data for the Hospice Quality Reporting Program through standardized data collection and provide clinical data that may inform potential future changes to Medicare hospice payments. CMS is working to develop measures for the HOPE reporting program that are compliant with the agency’s Meaningful Measures Initiative.

In contrast to the HIS system which extracts item set data from a patient’s medical record using a standardized mechanism, the HOPE tool will measure aspects of hospice care at different points in the patient’s experience.


“Providers are concerned about what data will be collected at a specific care time point, and if the data collection will be burdensome to the patient, their family and the provider,” Jennifer Kennedy, senior director of regulatory and quality for the National Hospice & Palliative Care Organization (NHPCO), told Hospice News. “The HOPE assessment is just entering the beta test stage this spring, so it will be a while until it makes it to implementation. The burden to the provider remains to be seen.”

Many financial and operational pressures have pummeled hospices during the ongoing coronavirus outbreak, with several taking hits to their bottom lines as they struggle to support a strained workforce bogged down by added weight as COVID-19 continues to take a heavy toll on hospice and palliative care staff nationwide.

The HOPE tool is designed to use outcome measures rather than the process measures used in the HIS system. 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.


Among the questions being raised is what data measures will carry over from the previous HIS quality reporting system into the new HOPE tool. According to Cindy Masuda, director of the hospice quality reporting program for CMS, the agency is aiming to make the transition into a new quality reporting system “seamless” for hospice providers.

“What we’re trying to clarify in the language is that we intend that HOPE will include everything from the Hospice Item Set, so that providers only have one tool to work with,” said Masuda during NHPCO’s recent Leadership and Advocacy Conference. “Obviously, there’s going to be a transition, and we have to work through all those pieces. We’re working very hard with our IT folks, with vendors, and with the provider community as we get closer to rulemaking with the implementation of HOPE and the ability to appreciate how we will transition.”

According to Masuda, CMS intends to provide training to providers on HOPE implementation and training closer prior to the tool taking effect.

Abt will work with CMS to update the tool based on findings from the findings from the current pilot stage before proceeding with national testing. Following the national test phase and associated revisions, the agency will make a request for public comment. If finalized, providers would be required to use HOPE in order to continue their participation in Medicare.

CMS indicated that the HOPE tool is anticipated to stimulate quality improvement activities and be a less demanding method than HIS. Yet, there may be a “significant learning curve” for the hospice community at large when it comes to implementing processes around a new reporting system, according to Kennedy.

The draft HOPE tool is not yet available for public viewing, and hospices are not clear on how difficult it may be to implement. That may largely depend on their organizations’ electronic medical record system vendor and their product, Kennedy indicated.

“Projection impact is hard to predict at this time,” Kennedy told Hospice News. “We envision that the mechanism and/or logistics of submitting the HOPE assessment data to CMS will be similar to the OASIS tool. We are looking forward to the HOPE assessment leading to the development of meaningful end-of-life outcome measures.”

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