What is HOPE? The Hospice Outcomes and Patient Evaluation tool

HOPE, in one sentence

HOPE — the Hospice Outcomes and Patient Evaluation tool — is a standardized patient-level data collection instrument that CMS requires every Medicare-certified hospice to complete for every admission. It replaced the older HIS (Hospice Item Set) as the primary Hospice Quality Reporting Program (HQRP) data feed [1].

HOPE captures information at admission, during two mid-stay observation windows, and at discharge or death. Its purpose is threefold:

• Quality measurement — feeds the Hospice Quality Reporting Program and drives the CAHPS Hospice star rating.
• Care planning — the data items reflect real bedside observations (pain, dyspnea, functional status, caregiver support) that should inform the interdisciplinary plan of care.
• Public reporting — HOPE-derived measures appear on Medicare’s Care Compare site and are visible to referring physicians and families.

When HOPE observations happen

HOPE is not a one-time assessment. There are four distinct observation windows per patient:

1. Admission HOPE — completed within 5 days of the hospice admission date. This is the largest observation set and drives most quality measures.
2. HOPE Update Visit 1 (HUV1) — occurs between days 6 and 15 of the hospice election. A targeted subset of items is re-observed.
3. HOPE Update Visit 2 (HUV2) — occurs between days 16 and 30. Same targeted item set as HUV1.
4. Discharge HOPE — completed within 3 days of live discharge or the date of death.

The windows are counted from the hospice admission date, not from calendar days of the month. Miss the window and the record is late; late records affect HQRP submission compliance and can trigger a quality-reporting penalty [1][2].

What HOPE actually measures

HOPE covers observations across several domains. The specific items and codes are defined in the CMS HOPE Guidance Manual [2]. At a high level:

• Pain — presence, screening, and management follow-through.
• Dyspnea — screening, treatment, and change over time.
• Functional status — activities of daily living and decline patterns.
• Cognitive status — orientation and mental-status changes.
• Skin — presence and stage of pressure injuries or wounds.
• Caregiver — presence of a primary caregiver, caregiver strain indicators.
• Symptom-management preferences — patient and family goals of care.
• Care transitions — timing and reason for changes in level of care.

Items are worded to be observed by the clinician during a visit, not extracted after the fact from a chart. Get in the habit of completing HOPE items at the bedside or immediately after the visit, not retroactively at the office.

Who completes HOPE?

HOPE data collection is the responsibility of the hospice, and specific items are typically completed by different disciplines:

• The admitting nurse completes most Admission HOPE items during or immediately after the first assessment visit.
• The RN case manager (or a designee visiting during the HUV window) completes HUV1 and HUV2.
• The social worker, chaplain, and hospice aide may contribute observations that feed HOPE items, especially caregiver and psychosocial data.
• An IDG-designated clinician completes Discharge HOPE.

Your hospice’s specific role assignments should be documented in your policy. The CMS manual specifies the data — your organization decides who collects it, provided the required credentials and training are in place [2].

A practical HOPE workflow

The single biggest predictor of clean HOPE data is a workflow that front-loads the observations into the visit itself, so the clinician isn’t reconstructing memory hours later. A repeatable rhythm:

1. Pre-visit: print or open the HOPE item checklist in the EHR for the observation window that applies to this visit.
2. During the visit: observe → speak → document, in that order. Don’t hand the family a form.
3. End of visit: complete every HOPE item before you leave the driveway. If any observation is missing, decide whether to schedule a return visit within the window or hand off to a colleague.
4. Same-day IDG note: any HOPE observation that changes the plan of care (new pain rating, functional decline, caregiver strain) triggers an addendum to the plan.
5. Weekly HOPE audit: a 15-minute review of every HOPE record submitted this week. Trend the top three missed items and coach.

Getting HOPE data to CMS

Completed HOPE records are submitted electronically through iQIES (the Internet Quality Improvement and Evaluation System), the same platform hospices use for CASPER reporting [3]. Records must be submitted within the required timeframe (currently within 30 days of the observation date) to count for HQRP compliance.

Late or missing records reduce your compliance percentage, and dropping below the annual threshold results in a 4-percentage-point reduction to the Hospice Wage Index update — real money on the line for every hospice.

HOPE vs. HIS: what changed

HOPE replaces the older Hospice Item Set (HIS), which had run since 2014. Key differences:

• Timing: HIS was admission-only + discharge. HOPE adds two mid-stay observation windows (HUV1, HUV2) so the data reflects the hospice course, not just the endpoints.
• Item design: HOPE items are structured around observations at a visit, not chart abstraction, which shifts the data-collection burden into the clinical workflow itself.
• Scope: HOPE captures a broader set of clinical, functional, and caregiver domains — closer to the actual scope of hospice practice.

If your team is transitioning from HIS to HOPE, the biggest workflow change is the two HUVs — you need a visit rhythm that reliably hits those windows.