The HOPE Assessment Tool Series: Understanding the Required Timed Visits

The HOPE Assessment Tool Series: Understanding the Required Timed Visits

Written by Jennifer Kennedy

It’s January 2025, and we are counting down to the implementation of the HOPE Assessment Tool on October 1, 2025. That date may seem far away, but there is much preparation you need to do in the coming months for a seamless launch on the “go-date”. Your staff will need consistent education about the assessment tool content and their responsibility for the administration and completion of the timed visits.  

The HOPE assessment tool aims to provide a more comprehensive understanding of patient care needs by collecting standardized data at multiple time points during a patient’s hospice stay.  Hospice providers need to develop processes for tracking and capturing optimal documentation for each timed patient visit between admission and discharge. Developing and testing processes before the designated implementation date will allow for the identification of gaps and performance improvement. Organizations should consider looping in key hospice team members to plan these processes as they are invested stakeholders in ensuring success.

Timed Visits

The HOPE tool’s timed visits are designed to collect data at key intervals in the patient’s/family’s hospice stay, which is then submitted to CMS. The Hospice Item Set (HIS) includes an admission and discharge record. The HOPE tool requires the submission of a minimum of a HOPE-Admission record, up to two HOPE Update Visits (HUVs), and a HOPE-Discharge record. It is important to understand that the timed visits are incorporated into the patient’s plan of care visits from the hospice team. The scope and frequency of visits are determined by the needs identified in the comprehensive assessment at admission and the updated comprehensive assessment throughout the patient’s length of stay. Let’s break each of these timed visits down to understand their requirements.

HOPE-Admission record

A patient is considered admitted for HOPE if the following three criteria are met: 

  1. There is a signed election statement (or other agreement for care for non-Medicare patients)
  2. The patient did not expire before the effective date of the election or agreement for care
  3. The hospice visited the setting where hospice services are to be initiated

The HOPE-Admission data are collected as part of the comprehensive assessment of the patient no later than 5 calendar days after the effective date of the hospice election. The date of the hospice election is considered “Day 0”. All items in the HOPE assessment tool are completed at admission unless otherwise specified in the HOPE Guidance Manual 1.0.

HOPE-Update Visit (HUV) record

Depending on the patient’s length of stay (LOS), up to two HUV records may be required for every hospice admission. HOPE data are collected during a patient’s follow-up assessment visits outlined in their plan of care. The HUVs are aligned with the patient’s LOS and completed by a registered nurse (RN) as follows:

  • The first HUV (HUV1) should be completed between days 6 – 15 of the patient’s stay, but not within the first five days after the date of admission 
  • The second HUV (HUV2) should be completed between days 16 – 30 of the patient’s stay. 

Not all HOPE items are completed during the HUV, and the HOPE Guidance Manual 1.0, Appendix C, page 117,  contains a version of a HUV with the  following sections for completion:

  • Section A – Administrative Information
  • Section J – Health Conditions
  • Section M – Skins Conditions
  • Section N – Medications
  • Section Z – Assessment Administration

HOPE-Discharge record

A patient is considered discharged from hospice care when they are no longer receiving services from the hospice, or there is an interruption in care/services related to one of the reasons allowable discharge reasons in the federal hospice regulations at § 418.26 Discharge from hospice care.  Discharge reasons include:

  • The patient died
  • The patient revoked their hospice care
  • The patient is no longer terminally ill
  • The patient moved out of the hospice organization’s service area
  • The patient transferred to another hospice
  • The patient is discharged for cause

Sections A-Administrative Information, and Z – Assessment Administration are completed for a HOPE-Discharge record.

Symptom Impact Screening and Follow-up Visit 

The Symptom Impact Screening is a new item for hospice providers.  CMS defines symptom impact as the effect of symptom(s) on the patient and states in the manual guidance that they may impact a patient in multiple ways, (i.e., sleep, concentration, day-to-day activities).  This screening is not an assessment of the severity, intensity, frequency, or other characteristics of the symptoms listed, but the impact these symptoms have on the patient. The hospice RN completes this item and determines the effect of each symptom on the patient based on patient/caregiver interview, observation, clinical assessment, and clinical judgment.

During the Admission or HUV, data collected for the Symptom Impact Screening item may trigger the need for the Symptom Follow-up Visit (SFV).  A Symptom Impact Follow-up Visit (SFV) is a timed visit that is required for a patient if the pain or non-pain symptom impact was rated as moderate or severe during the admission visit or a HUV (1 and/or 2).   This is not an assessment of the severity, intensity, frequency, or other characteristics of the symptoms listed, but the impact these symptoms have on the patient.  An RN or licensed practical nurse(LPN)/licensed vocational nurse (LVN) completes this visit within two calendar days as a follow-up for any pain or non-pain symptom impact rated as moderate or severe.  (Note: It may occur anytime within two calendar days or later on the same day as the assessment where an Admission or HUV was completed). Up to three SFVs may be required throughout the hospice stay, depending on a patient’s responses to the symptom impact items.

CHAP is invested in providing you with the information and resources you need to be successful.  Watch our communication for upcoming blogs, education, and resources in 2025. 

References

The Centers for Medicare and Medicaid Services. (2024, Oct 1). Hospice outcomes and patient evaluation (HOPE) guidance manual – v1.00. https://www.cms.gov/files/document/hope-guidance-manualv100.pdf