Hospices are preparing for an onslaught of potential operational impacts with the forthcoming implementation of the U.S. Centers for Medicare & Medicaid Services’ (CMS) new Hospice Outcomes and Patient Evaluation (HOPE) tool.

The agency’s 2025 final rule announced that the HOPE tool will take effect in October 2025, and will replace the Hospice Item Set (HIS) quality reporting system. The HOPE tool will measure aspects of hospice care at different points in the patient’s experience, which is in contrast to the HIS system that extracted item set data from a patient’s medical record using a standardized mechanism.

Hospice leaders are navigating a complex transition to an entirely new set of quality measures, according to Megan Turby Weaver, vice president of quality, compliance and health information management at Gulfside Healthcare Services. Anticipating the potential range of operational and staffing effects of the new HOPE tool will be key for balanced clinical capacity, Turby Weaver said at Hospice News’ ELEVATE conference in Orlando, Florida.

“It’s very important as directors, administrators and anybody who has their hands in operations to prepare for how this might affect the workload of your staff,” Turby Weaver told Hospice News at the conference. “It has the potential to have a huge impact. Not only from a quality perspective does this have the potential to really impact somebody who cares for our patients, [but also] from the document process, it has the potential to help you from a compliance perspective as well, in just really being sure that your implementation meets all the requirements.”

Hospice News photo by TBAR Productions

The new HOPE tool 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 compared to HIS, including:

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

The methodology also includes two new quality measures — Timely Reassessment of Pain Impact and Timely Reassessment of Non-Pain Symptom Impact. Another new process associated with the HOPE tool is the Symptom Follow-up Visit. These visits are in-person and expected to be conducted 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 four of these visits may be necessary during a patient’s time in hospice.

Field testing of the new methodology has allowed for improved understanding around the potential challenges that hospice providers may encounter on the horizon, said Patty Mathews, director of quality at Chapters Health System. These include allowing other interdisciplinary staff to participate in follow-up visit assessments amid rising demand and prolific staffing shortages, Mathews stated.

Hospices will need to ramp up staffing education across the board to ensure compliance, she indicated.

“A unique difference that [CMS is] actually recognizing due to all the feedback is that we have staffing challenges,” Mathews said at the conference. “It’s having [other staff] able to do the follow-up visits when they’re required. Before they were not allowed, but they can do some of the follow up now. It’s communication, collaboration and coordination. You better bring all your stakeholders to the table to help develop these processes. It’s not just the quality department. It’s not just the clinical team. The education is for everybody in the whole organization. We bring them all together and work together.”

Preparing staff for the HOPE tool involves training clinicians to examine and document patients’ experiences from a different perspective, according to Carlos Palomino, vice president of clinical services and development at Chapters Health System. The new quality system takes a deeper examination into the impact of patients’ terminal conditions, Palomino said.

Hospices need more time to help staff prepare not only on logistical levels, but also from a mental health perspective, he added. Ensuring compliance involves considering the added stress and anxiety of operating under different guidelines during a time of increased regulatory oversight, Palomino stated.

“Symptom impact is in a lot of the writing,” Palomino told Hospice News at the conference. “As nurses, we’re constantly looking for what we call symptom severity. But now what the HOPE tool is asking is, we need to understand how that’s impacting your day-to-day [life]. It’s almost asking for our clinicians to kind of elevate the way that we’re practicing, because we’re asking nurses don’t just look at severity, but look and ask and probe what is the impact of the symptom that they have. We have not had time to get ready, and that’s just going to cause us more anxiety than anything else.”