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The HOPE Assessment Tool: Information You Need to Know

On October 16, 2024, we hosted a webinar on the upcoming implementation of the HOPE Assessment Tool, which will catalyze hospice care starting in 2025. The webinar provided valuable insights into the tool’s implementation, content highlights, and its anticipated impact on hospice program operations. During the session, participants asked numerous important questions, many of which we’ve compiled into this FAQ for further clarification.

Access the recorded session and handouts if you missed it or would like to review the presentation.

  • Will the entire HOPE document need to be completed for Timely Reassessments? 

The HOPE Guidance Manual states the following:

 Hospices are required to submit up to four records for each patient admitted to their organization. This includes a minimum of a HOPE-Admission record, a HOPE-Discharge record, and up to two HOPE Update Visits (HUVs). Depending on the patient’s length of stay (LOS), up to two HUV records may be required for every hospice admission, each at specified timeframes. HOPE data are collected during the hospice’s routine clinical assessments and are based on unique patient assessment visits. However, not all HOPE items are completed at every time point.  Please refer to the HOPE Guidance Manual, starting at page 116, for guidance about which HOPE items need to be completed at a specific time point. 

  • What sections of the HOPE need to be completed for: HOPE ADM, HOPE HUV, HOPE SFV, and HOPE DC?

Please refer to the HOPE Guidance Manual, starting at page 116 for guidance about which HOPE items need to be completed at a specific timepoint. 

  • Will the submission of HOPE data now be entertained by iQIES instead of just QIES? 

Yes, It looks like it will be through QIES.  Please see this link for record submission information – https://qtso.cms.gov/ 

  • Is there a standard scoring process for patient impact from symptoms?

No, the symptom impact 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.  It is coded based on the clinician’s assessment and judgment after considering all the information provided by the patient, family/caregiver, and/or facility staff in addition to their own assessment. 

  • When will the HOPE Validation Tool be released by QIES/iQIES? 

There is no information about that release at this time.

  • Will there be different timelines for different levels of care, such as GIP or CC?

The patient’s level of care does not appear to be a factor or exclusion for the outlined timepoint visits.

  • Would a change in the level of care be captured on the HUV or SFV?

A need for a change in level of care could be a possible outcome of an HUV or SFV visit.  If an LPN/LVN is completing the SFV visit and notes a pain or non-pain issue, an RN should immediately assess the patient to determine if  change to the plan of care is needed.  

  • Will the pain assessment SFV accept PAINAD or FLACC in lieu of rating pain?

The HOPE assessment tool does not dictate what symptom management tool a hospice provider should use, but it does require that you specify which standardized tool for pain assessment you used.  Page 54 of the Hospice Guidance Manual v.1.0 offers examples of standardized tools for pain assessment. 

  • Are any HUVs required after the patient has been on service for more than 60 days?

There is no instruction related to completing HUV’s beyond 30 days.  This does not mean that the hospice team ceases to update the comprehensive assessment and plan of care minimally every 15 days or as often as the patient’s status requires 

  • Is there a data item for non-visit discharge with patient death if the family refuses a home visit?
  • The HOPE assessment requires the completion of discharge record at the time of discharge with reason code for the discharge. 
  • Per the CMS HOPE User Manual v1.0,  Table 1: HOPE Timepoint Definitions and Timeframes HOPE discharge assessments are not specified to be in-person, although it would be expected the HOPE assessment will be completed during a home visit if a visit is made at the time of discharge.   (Note that the Admission, HUV and SFV assessments are specifically required to be conducted in-person). For the purposes of completing HOPE, a patient is considered discharged when the patient is no longer receiving services from the hospice, or there is an interruption in care/services related to one of the reasons listed in Item A2115. Reason for Discharge (expired, revoked, no longer terminally ill, moved out of hospice service area, transferred to another hospice, discharged for cause).  
  • In the case of a non-visit discharge (family refusal, hospice not informed by facility of patient death, etc.) the hospice would complete the HOPE discharge assessment based on documentation in the hospice clinical record from which the responses to HOPE data elements can be obtained.  
  • It is recommended that hospices continue to monitor the CMS HOPE webpage for updates, FAQs and updates to the user manual for additional guidance. HOPE | CMS 
  • When will CMS meet with EMR vendors?

CMS will host a Hospice technical informational call for Software Vendors and Developers on Thursday, November 21, 2024. 

Call-in information is: 

  • If a patient has a HIS Admission and crosses over into October 2025, will that have a transitional translation of data?

In accordance with CMS training 2.2 HOPE Go-Live Date – Introducing the Hospice Outcomes and Patient Evaluation (HOPE) Tool (rainmakerssolutions.com)  HOPE data collection will begin on October 1, 2025 (FY 2026), with all newly admitted and existing hospice patients. After October 1, 2025, hospices will only use HOPE for the collection of data. The HIS will no longer be accepted for new patients. For existing patients admitted prior to October 1, 2025, using the HIS data set, the only timepoint required is the HOPE-Discharge. CMS NOTE: Patients on service at the start of HOPE data collection should not be discharged and readmitted using the HOPE tool. 

CMS has not provided information at this time about transitional translation of data for patients who are admitted prior to Oct 1, 2024.  Please watch the CMS HQRP webpage for more information – https://www.cms.gov/medicare/quality/hospice/hospice-qrp-announcements-spotlight 

  • Can an NP be used in place of an RN for the HUV?

An NP who is functioning in the role of a nurse can complete an HUV.