About this Page

This page provides an overview of the Hospice Outcomes and Patient Evaluation (HOPE) assessment tool and updated information about the development of HOPE.

Background of HOPE

As authorized by Section 1814(i)(5) of the Social Security 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. The Centers for Medicare & Medicaid Services (CMS) is developing a new patient assessment tool to be proposed in future rulemaking. The name of the hospice patient assessment instrument, HOPE, was finalized in the FY2020 Hospice Final Rule. This tool intends 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 Hospice Item Set (HIS) retrospective chart review. Finally, HOPE will support quality improvement activities and calculate outcomes and other types of quality measures in a way that mitigates burden on hospice providers and patients. 

Objectives of HOPE

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 patterns and trends which will help identify the differences between hospices. Through data summaries and comparisons, hospice providers will have information to help them identify opportunities to adjust their practices and improve the 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 public reporting of quality measures that measure outcomes throughout the hospice stay. .

The two primary objectives of HOPE are to:

  • Provide quality data for Hospice Quality Reporting Program (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 objectives of the Meaningful Measures Initiative  to identify high-priority areas for quality measure development while reducing burden on hospice providers. Measures will be focused on patient outcomes and will fit well with the hospice business model. Details about the measure development process can be found on the Quality Measure Development  webpage.  

Differences between Hospice Item Set (HIS) and HOPE

Currently, CMS collects data at admission and discharge from hospice via the HIS. These data are currently used to calculate measures in the HQRP. However, while the HIS is a standardized mechanism for abstracting medical record data, it is not a patient assessment tool because the HIS data are not collected during a patient assessment. Instead, HIS focuses on whether hospices have performed care processes using retrospective data from chart abstraction. CMS’ goal for 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. HOPE will take into consideration hospice workflow and the Medicare Conditions of Participation. Data on patients’ baseline status and changes in their outcomes collected via HOPE will contribute to care planning and inform quality measurement for the HQRP, and support providers’ quality improvement efforts.

Process for Developing HOPE

The general process for the development of HOPE includes but is not limited to, the following activities: information gathering, stakeholder engagement, and testing of HOPE. After the initial testing, HOPE was revised based on test findings before moving forward to national-level testing. After analysis of the national-level testing of HOPE, CMS will propose the tool in rulemaking and seek public comments. When finalized in future rulemaking, 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 HOPE. Relevant opportunities, information gathering reports, and Technical Expert Panel (TEP) reports are available on this website on the Provider and Stakeholder Engagement (PDF) page. You will also find HQRP Forum materials on this same page. If you would like to communicate with CMS about HOPE or quality measures, please email the Hospice Quality Help Desk at HospiceQualityQuestions@cms.hhs.gov.  


Page Last Modified:
09/06/2023 05:05 PM