3 Things Every Hospice Provider Should Know About HOPE (Before 2026)

The HOPE (Hospice Outcomes & Patient Evaluation) tool is now fully implemented across all hospice providers, marking the most significant change in hospice assessment and quality reporting since the introduction of Medicare hospice benefits. With the October 1, 2025 implementation date now behind us, every hospice provider must understand these three critical aspects of HOPE to maintain compliance, optimize reimbursement, and prepare for the upcoming quality reporting requirements.

1. Implementation Deadlines Are Non-Negotiable: And Some Are Still Coming

While HOPE implementation officially began on October 1, 2025, the transition timeline includes several critical deadlines that many providers may not fully understand. All hospice admissions and discharges occurring on or after October 1, 2025, must be documented using HOPE and submitted through the new iQIES (Internet Quality Improvement and Evaluation System) platform. This isn't a gradual rollout: it's an immediate requirement.

However, here's what many providers miss: the legacy HIS (Hospice Item Set) system will completely shut down on February 15, 2026. Any pre-October 1, 2025 admissions or discharges that weren't submitted through the old QIES system must be completed via iQIES using HIS forms before this final deadline. After February 15, 2026, there will be no mechanism to submit legacy HIS data.

Key Action Items:

• Ensure all staff have iQIES access and training

• Complete identity provisioning for new users

• Test submission processes before critical deadlines

• Develop backup procedures for system outages

• Create tracking systems for both HOPE and legacy HIS submissions

The financial implications of missing these deadlines are severe. Providers who fail to maintain the required 90% submission rate for HOPE assessments will face the 4% Hospice Quality Reporting Program (HQRP) penalty, which applies to all Medicare payments: not just a portion.

2. HOPE Transforms Your Clinical Workflow: Not Just Documentation

The most significant operational change HOPE brings isn't the assessment questions: it's the complete restructuring of when and how often you assess patients. Unlike HIS, which required only admission and discharge assessments, HOPE mandates up to four separate assessment types depending on patient length of stay and clinical presentation.

The Four HOPE Assessment Types:

HOPE Admission Assessment: Required for all new admissions, similar to the previous HIS admission process but with expanded clinical domains.

HOPE Update Visits (HUVs): Up to two visits required within the first 30 days after a beneficiary elects hospice care. These aren't optional: they're mandatory for patients who remain in care beyond specific timeframes.

HOPE Discharge Assessment: Required for all discharges, transfers, and deaths, with expanded symptom and care quality measures.

Symptom Follow-up Visits (SFVs): Triggered automatically when patients report moderate to severe pain, shortness of breath, or other qualifying symptoms during any HOPE assessment. These must be completed within two calendar days of the triggering assessment.

Staffing Requirements Have Changed Too:

• Registered nurses must complete all clinical assessment items

• Other qualified hospice staff can complete administrative sections

• Different staff members can complete different portions of the same assessment

• Clear documentation of which staff member completed each section is required

This workflow change requires significant operational adjustments. Many hospices are discovering they need additional nursing staff to meet the increased assessment frequency requirements, particularly for the time-sensitive SFVs.

3. Financial Stakes and Public Reporting Create New Accountability

HOPE isn't just changing documentation: it's changing how hospices will be evaluated, paid, and publicly compared. The financial and reputational implications are more significant than many providers realize.

Immediate Financial Impact: The FY 2026 hospice payment rates include a 2.6% increase across most care levels, but this comes with increased accountability. Providers who fail HQRP requirements face a 4% payment reduction on all Medicare hospice payments. With HOPE's 90% submission rate requirement and new quality measures, the risk of penalties has increased substantially.

Public Reporting Timeline: CMS has announced that HOPE-based quality measures will be publicly reported on the Care Compare website no earlier than Fall 2027. This timeline gives providers approximately 18 months to establish strong HOPE performance before their outcomes become publicly visible to patients, families, and referral sources.

What Will Be Reported: While CMS hasn't finalized all measures, early indicators suggest public reporting will include:

• Pain management effectiveness

• Shortness of breath improvement

• Treatment preference alignment

• Care coordination metrics

• Patient and family experience scores

Face-to-Face Requirements Updates: HOPE also includes updated attestation requirements for the face-to-face encounters. The clinical narrative requirements have been expanded, and the documentation must align with HOPE assessment findings: creating new opportunities for audit scrutiny.

Preparing for Success:

• Establish baseline performance metrics now using HOPE data

• Train clinical staff on the connection between assessment accuracy and quality scores

• Develop internal quality assurance processes for HOPE submissions

• Create systems to track and improve performance on future public reporting measures

Getting the Support You Need

The HOPE transition represents the most significant change in hospice operations in decades. Success requires more than understanding the technical requirements: it demands a comprehensive approach to workflow redesign, staff training, and quality management.

Many hospice providers are finding that internal training alone isn't sufficient to navigate HOPE's complexities effectively. The interconnections between assessment timing, clinical workflows, financial implications, and upcoming public reporting requirements create a web of compliance challenges that benefit from expert guidance.

Ready to master HOPE implementation? Our comprehensive HOPE for HOPE course provides the practical, step-by-step guidance hospice providers need to turn HOPE from a compliance burden into a competitive advantage. From workflow optimization to quality improvement strategies, get the tools you need to succeed in the new hospice landscape.

The HOPE era is here. The question isn't whether your hospice will adapt: it's whether you'll adapt successfully enough to thrive in this new environment of increased accountability and public transparency. Understanding these three fundamental aspects of HOPE is just the beginning. Your next step is putting that understanding into action with systems, training, and support that ensure long-term success.