HOPE Is Here: Your Guide to Navigating the New Hospice Assessment Tool

The hospice industry just went through one of its biggest changes in years. On October 1, 2025, the new HOPE (Hospice Outcomes and Patient Evaluation) assessment tool officially launched, and let me tell you, it's been quite the adjustment period for hospice providers everywhere.

If you're still trying to wrap your head around what HOPE means for your daily operations, you're definitely not alone. After working with countless hospice providers through this transition, I've seen the same questions come up again and again. So let's break down everything you need to know about navigating this new landscape.

What Exactly Is HOPE?

HOPE is CMS's brand-new clinical assessment tool that completely replaces the old Hospice Item Set (HIS). But this isn't just a simple swap-out situation. We're talking about a fundamental shift in how hospice providers collect and report patient data.

The biggest change? We've moved from retrospective chart reviews to real-time assessments conducted during actual patient care visits. That means no more scrambling through charts after the fact, you're collecting this data as part of your regular patient interactions.

CMS designed HOPE with several goals in mind:

• Standardize data collection across all hospice agencies

• Provide better understanding of patient care needs

• Support individualized care planning

• Generate clinical data for potential future payment changes

How HOPE Differs From the Old HIS System

Here's where things get interesting (and a bit more complex). While HIS only required data collection at admission and discharge, HOPE requires substantially more throughout a patient's entire stay.

The new system keeps some key items from HIS but adds significant new assessment components. Plus, all HOPE data gets submitted through CMS's Internet Quality Improvement and Evaluation System (iQIES), not the old QIES platform many of you were used to.

Breaking Down HOPE's Structure

HOPE is built around a series of timed visits, and understanding this structure is crucial for proper implementation. Let me walk you through each component:

HOPE-Admission Record

This is your mandatory first assessment, but there's a specific criteria checklist before a patient is considered "admitted" for HOPE purposes:

• Signed election statement (or care agreement for non-Medicare patients)

• Patient didn't expire before the effective date

• Hospice has visited the setting where services will be initiated

HOPE-Update Visits (HUVs)

Depending on your patient's length of stay, you'll need to complete up to two HUV records for every admission. These happen during follow-up assessment visits as outlined in the patient's care plan.

Here's the key timing: if a patient stays on hospice service for at least 17 days, you'll need those two additional update visits.

HOPE-Discharge Record

This final assessment wraps up when a patient is discharged from hospice services.

So in total, you're looking at up to four visits per patient: admission, two potential updates, and discharge.

The New Symptom Impact Screening

One of the biggest additions to HOPE is the Symptom Impact Screening, and this is completely new territory for hospice providers. Unlike traditional assessments that measure symptom severity or frequency, this screening evaluates how symptoms affect the patient's daily functioning.

We're talking about impacts on:

• Sleep patterns

• Concentration ability

• Day-to-day activities

Your registered nurse completes this based on patient and caregiver interviews, clinical observation, and clinical judgment. It's more comprehensive than what you might be used to, but it provides much richer data about patient experience.

Getting Your Workflow Right

Here's where the rubber meets the road. You need robust processes for tracking and capturing optimal documentation for each timed patient visit between admission and discharge.

My recommendation? Get your key hospice team members involved in planning these processes from the start. They're your invested stakeholders, and they'll help you identify gaps before they become problems.

Essential workflow considerations:

• Staff training on new assessment requirements

• Adapting workflows for real-time data collection

• Ensuring electronic submission capabilities via iQIES

• Using HOPE data to improve clinical decision-making

Current Timeline and What's Coming

Since HOPE launched on October 1, 2025, it's now the mandatory assessment tool for all patients, regardless of payer source or age. But here's something that might give you a bit of breathing room: outcome scoring and public reporting of HOPE-based quality measures won't happen until fiscal year 2028 (starting October 1, 2027).

This transition period is your opportunity to refine processes and improve data quality before results become publicly visible.

Common Implementation Challenges

Based on what I've seen across the industry since October, here are the most common challenges hospice providers are facing:

• Staff training gaps - Make sure everyone understands the new requirements

• Workflow disruptions - Real-time data collection requires different processes

• Technology adjustments - iQIES submission can be tricky initially

• Documentation burden - More comprehensive assessments take time

Making HOPE Work for Your Organization

The key to successful HOPE implementation isn't just compliance, it's leveraging this data to genuinely improve patient care. When done right, HOPE can strengthen care coordination and help you deliver more personalized, evidence-based care.

Ready to master HOPE implementation? I've developed a comprehensive course specifically for navigating the new HOPE tool. It covers everything from workflow optimization to staff training strategies, plus real-world examples from providers who've successfully made the transition. Check out the HOPE Navigation Course here to get your team up to speed fast.

Moving Forward

HOPE represents more than just a new assessment tool, it's an opportunity to strengthen your care quality through more thorough assessments and meaningful patient conversations. Yes, there's a learning curve, but the end result should be a deeper understanding of each patient's comprehensive experience throughout their hospice journey.

The providers who are thriving with HOPE are those who've embraced it as a care enhancement tool rather than just another compliance requirement. They're using the data to have better conversations with patients and families, make more informed care decisions, and ultimately provide better outcomes.

Take Action Today

Don't wait until you're struggling with compliance issues or audit findings. The time to master HOPE is now, while you still have breathing room before public reporting begins.

Whether you need help with staff training, workflow optimization, or just want to make sure you're capturing data correctly, getting expert guidance can save you months of trial and error.

Ready to transform your HOPE implementation from a compliance headache into a care quality advantage? Let's make it happen. Your patients: and your audit results( will thank you.)