The U.S. Centers for Medicare & Medicaid Services (CMS) has released its final guidance manual for implementing the Hospice Outcomes and Patient Evaluation (HOPE) tool.

The tool is slated for an October 2025 implementation, according to the agency’s 2025 final hospice rule. The tool will replace the Hospice Item Set (HIS) quality reporting system.

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.

“HOPE items are designed to collect patient-specific data in real-time, based on interactions with the patient and family/caregiver, and with flexibility to accommodate patients with varying clinical needs,” CMS indicated in the guidance. “While HOPE contains some original HIS items, HOPE intends to help hospices better understand patient care needs and contribute to the patient’s plan of care at additional timepoints, not just at admission and discharge.”

The new guidance manual is designed to inform providers on how to implement aspects of the tool and the associated data collection processes. The document contains introductory material data collection time points and requirements, item-specific guidance for completing all of the data elements, as well as information on the submission of HOPE records and the correction processes.

HOPE will collect data at multiple time points across the hospice stay, including admission, the HOPE Update Visit (HUV) and discharge. In addition, HOPE includes several domains that are new or expanded relative to HIS, including:

• Sociodemographic (updated)
• Diagnoses (expanded)
• Symptom Impact Assessment
• Skin Conditions
• Imminent death

Field testing of this new methodology was completed late last year. It contains two new quality measures — Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact.

Another new process associated with the tool are Symptom Follow-up Visit. These visits are an in-person visit expected within two calendar days as a follow-up for any pain or non-pain symptom impact rated as moderate or severe, according to CMS. As many as three of these visits may be necessary during a patient’s time in hospice.

“Symptom impact is coded based on the clinician’s judgment after considering all the information provided by the patient, family/caregiver, and/or facility staff in addition to their own assessment,” CMS wrote in the guidance. “Symptoms may impact multiple patient activities including, but not limited to, sleep, concentration, day-to-day activities, or ability to interact with others.”