Hospice Outcomes & Patient Evaluation (HOPEand Stakeholder Engagement


About this Page

This page provides an overview of the hospice patient assessment tool and quality measures that CMS is currently developing, as well as updates from regular HQRP Forum events.

Background of the Hospice Outcomes & Patient Evaluation

As authorized by section 3004 of the Patient Protection and Affordable Care Act, the Secretary of Health and Human Services is required to establish procedures for making data available to the public and to ensure hospices have the opportunity to review that data prior to public reporting. CMS is developing a new patient assessment tool to be proposed in future rulemaking. As finalized in the Fiscal Year 2020 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements Final Rule, the hospice patient assessment instrument is identified as the Hospice Outcomes & Patient Evaluation (HOPE). This tool is intended to help hospices better understand care needs throughout the patient’s dying process and contribute to the patient’s plan of care. It will assess patients in real-time, based on interactions with the patient, as opposed to the HIS retrospective chart review. Finally, the HOPE will support quality improvement activities and calculate outcome and other types of quality measures in a way that mitigates burden on hospice providers and patients. 

Objectives of the HOPE

The HOPE will provide standardized data as all Medicare-certified hospices will be collecting the same assessment items for all patients. Standardization will allow CMS to analyze the data by patients, hospices, and recognize the differences between hospices. Through data analytic summaries and comparisons, hospice providers will have information to help them identify opportunities to adjust and improve patient- and agency-level decisions about the care they provide. Furthermore, patients and their families will be more informed about the hospice they choose based on quality measures that measure outcomes throughout the hospice stay and public reporting.

The two primary objectives of the HOPE are to:

  • Provide quality data for HQRP requirements through standardized data collection
  • Provide additional clinical data that could inform future payment refinements.

CMS seeks to develop quality measures associated with the new assessment tool that are meaningful to all stakeholders and reflect critical outcomes of care throughout the hospice stay. The measures will meet the Meaningful Measures Initiative objectives to identify high priority areas for quality measure development while reducing burden on hospice providers. They will focus on outcomes and also fit well with the hospice business model. 

Differences between HIS and the HOPE

Currently CMS collects data at admission and discharge via the Hospice Item Set (HIS) that are used to calculate measures in the Hospice QRP. However, while HIS is a standardized mechanism for extracting medical record data, it is not a patient assessment tool because the data is not collected during a patient assessment. Instead, HIS focuses on whether hospices have performed care processes using data from chart abstraction. CMS’s goal for the HOPE is to be more comprehensive than the HIS by capturing patient and family care needs in real-time and throughout the hospice stay, with the flexibility to accommodate patients with varying clinical needs. The HOPE will take into consideration hospice workflow and the Medicare Conditions of Participation. Data in patients’ baseline status and changes in their outcomes from the HOPE will contribute to care planning and inform quality measurement for the Hospice QRP, including outcome measures, and support providers’ quality improvement efforts.

Process for Developing the HOPE

The general process for the development of the HOPE includes, but is not limited to, the following calendar year 2019 activities: information gathering, stakeholder engagement, and preparing for initial testing of the HOPE. After the initial testing, the HOPE will be revised based on test findings before moving forward to national-level testing. After conducting the national-level testing of the HOPE, CMS will incorporate learnings by refining the HOPE and propose the tool in rulemaking and seek public comments. When finalized in future rulemaking, the HOPE will be implemented in the Medicare Hospice Benefit to provide value to hospice providers, patients, and families.

Stakeholder Engagement 

CMS actively seeks to engage with stakeholders as it develops new quality measures, including the new patient assessment tool. CMS aims to provide as many relevant opportunities as possible to solicit comments from the public, including but not limited to, open door forums and HQRP Forums, technical expert panels, focus groups, and expert interviews. Announcements related to these stakeholder engagement opportunities will appear on the  Spotlight & Announcement page of this website and the full list of engagements are available on this website at Provider Engagement Opportunities pageMaterials from recent HQRP Forums are available in the Downloads section below. If you would like to communicate with CMS about HOPE or quality measures, please email HospiceAssessment@cms.hhs.gov


Hospice Quality Reporting Archives


Page Last Modified:
09/22/2020 08:18 AM