THE TRANSITION FROM HIS TO HOPE
The Hospice Quality Reporting Program (HQRP) authorizes the Health and Human Services Secretary to establish a quality reporting program for hospices. Data from this quality reporting program is available to the public and hospices can review that data before it’s reported publicly.
The Hospice Item Set (HIS) was created by the Centers for Medicare & Medicaid Services (CMS) as part of the HQRP in 2014. The HIS Comprehensive Assessment at Admission captures, in a single measure, the proportion of patients for whom the hospice performed all seven care processes, as applicable. Those care processes include:1
- Beliefs/values addressed (if desired by the patient)
- Treatment preferences
- Pain screening
- Pain assessment
- Dyspnea treatment
- Dyspnea screening
- Patients treated with an opioid who are given a bowel regimen
Through several years of information gathering, stakeholder and Technical Expert Panel (TEP) engagement, and testing, CMS developed a new patient assessment tool to replace the HIS structure in the HQRP. The Hospice Outcomes and Patient Evaluation (HOPE) tool was finalized in the FY 2025 Hospice Wage Index Final Rule2 and will replace HIS effective October 1, 2025.
THE HOPE TOOL
The HOPE tool is designed to collect data in a more comprehensive and standardized way, providing a more holistic view of the patient’s needs and experiences throughout their hospice stay.3-5
Overarching Goals6
- Provide quality data for Hospice Quality Reporting Program (HQRP) requirements through standardized data collection
- Provide additional clinical data that could inform future payment refinements
Additional Objectives6
- Provide information to hospices to help inform QAPI initiatives
- Include interdisciplinary efforts in the assessment process
- Assist with hospice team care planning
- Align with Conditions of Participation
Key differences between HIS and HOPE are outlined below:
| HIS | HOPE |
| Date of Use | |
| Required until September 30, 2025 | Begins October 1, 2025 |
| Measures | |
| Tracks if care processes were completed | Tracks how well care processes were implemented and if they helped the patient |
| Timing of Data Collection | |
| 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 at admission and discharge.3 | Collects patient-specific data in real-time, based on interactions with patient and caregivers. HOPE assessments occur at admission, at two update points within the first 30 days, and at discharge with the patient and family/caregiver. 3 |
| Patient Assessment | |
| Comprehensive Assessment at Admission7
Surveys the clinician about the patient retrospectively via “check all that apply” and “yes or no” prompts on the following items:
Hospice Item Set – Admission8 p. 6-10 |
Symptom Impact Assessment at Admission
Completed within the first 5 days of admission; queries the clinician on how the patient has been affected by the following symptoms over the past 2 days:
HOPE Guidance Manual4 p. 53-69 HOPE All Items5 p. 8-10 Symptom Follow-up Visit (SFV) Should occur within 2 calendar days as a follow-up for any moderate or severe pain or non-pain symptom identified during Symptom Impact Assessment at Admission or HOPE Update Visit (HUV)
HOPE Update Visits (HUVs) Enables CMS to gather patient level data during the first 30 days of hospice election. Hospice providers will be required to submit up to two HUVs, each at specified timeframes, depending on length of the hospice stay.
|
| Workflow and CoPs | |
| n/a | Considers the hospice workflow and Medicare Hospice Conditions of Participation (CoPs) within the tool’s data collection process |
| Compliance | |
| Hospices must submit at least 90% of HIS assessments on time or they will face a 2% payment penalty | Hospices must submit at least 90% of HOPE assessments on time or they will face a 4% payment penalty |
LET ENCLARA HELP YOU IMPROVE SYMPTOM IMPACT
The Hospice Outcomes and Patient Evaluation (HOPE) tool requires assessment of pain and common symptoms experienced by patients receiving hospice care. The tool intentionally prompts hospices to document patient assessments at times beyond admission and discharge to better understand patient care needs and create more opportunities to make interventions.3-5
The Symptom Impact Assessment, to be completed within the first 5 days after a patient is admitted to hospice care, queries the clinician on how the patient has been affected by the following symptoms over the past 2 days:
- Pain
- Shortness of breath
- Anxiety
- Nausea
- Vomiting
- Diarrhea
- Constipation
- Agitation
The clinician must base this on clinical assessment (including input from the patient and/or caregiver) on how symptoms impact multiple patient activities including, but not limited to, sleep, concentration, day to day activities, or ability to interact with others. An in-person Symptom Follow-up Visit (SFV) should occur within 2 calendar days as a follow-up for any moderate or severe pain or non-pain symptom identified during Symptom Impact Assessment at admission or HOPE Update Visit (HUV).3
Successfully managing pain and common hospice symptoms lessens their impact on patient activities, improves patient quality of life, and objectively quantifies what the hospice community already knows—hospice care makes a difference! Clinicians need to identify contributors to troublesome symptoms and understand non-pharmacological and pharmacological interventions to improve patient comfort and safety. The collection of select resources shared below will help support you and your team in honing pain and symptom assessment skills and management tactics. Despite being an extensive list of resources, it is not all-inclusive. You are encouraged to visit the sites described below and peruse the respective full library of offerings.
Enclara Palliative Pearls Topics and Cases (Open Access)
Inspired by real life clinical consultations between hospice clinicians and Enclara pharmacists, these clinical case studies and reviews are provided as a service to the entire hospice community. Published monthly since 2016, Enclara’s Palliative Pearls feature trending topics with evidence-based content. Explore the extensive library of topics from the basics to advanced care. Subscribe
The Enclara Learning Academy (Enclara Clients)
Provides engaging educational resources including free CE courses and online training to support hospices with onboarding and continuous professional development. This includes an expanding selection of Enclara Learning Academy™ Micro Courses, designed to be completed in 10 minutes or less on a mobile device. Access At Your Pace Learning
Educational Resources Within E3 Pro (Enclara Clients)
Enrichment resources are available on E3 Pro. Log in and expand “Clinical Education/Training” in the left-hand navigation pane and select “Overview & Orientation” for patient and caregiver resources and select “Clinical” to view the available categories for access to quick fact documents and courses. Access E3 Pro
Palliative Care Network of Wisconsin (PCNOW) Fast Facts9
Fast Facts, hosted by the Palliative Care Network of Wisconsin, provide open access to concise, practical, peer-reviewed and evidence-based summaries on key palliative care topics important to clinicians and trainees caring for patients facing serious illness. PCNOW Fast Facts Directory
GeriPal10
An open access geriatrics and palliative care podcast, hosted by Eric Widera and Alex Smith, where geriatrics, hospice, and palliative care experts are invited to talk about topics ranging from recently published research in the field to controversies. GeriPal Podcasts
Center to Advance Palliative Care (CAPC)11
CAPC provides essential tools, training, technical assistance, and connection for all clinicians caring for people with a serious illness. Although access to the full resource library requires membership, CAPC offers several resources as open access including their blog articles and select toolkits and courses. CAPC Website
PAIN RESOURCES
Enclara Palliative Pearls
- Pain Management: Back to the Basics
- A Primer on the Use of Buprenorphine for Pain Management in Hospice
- Ketamine for the Treatment of Refractory Pain
- Mucositis: A Focus on Topical Analgesia
- Topical Analgesics for Local Pain
- Comparing Prescription and Over-the-Counter Lidocaine Patches
- Fentanyl Transdermal Conversion Case Study
- Conversion from Transdermal Fentanyl Use to Oral Administration in Cachectic Patients
- Methadone Conversion: Revisiting a Prior Case
- Methadone, Beyond the Basics
- Methadone as a Coanalgesic
- Methadone and the Pediatric Patient
- Neuropathic Pain Management in Pediatrics
- Symptom Management of Brain Metastases
- Substance Abuse and Pain
- Pain Management Considerations in ESRD
- Opioid-Induced Hyperalgesia: Overview and Management Approach
Educational Resources for Clients Within E3 Pro
Clinician Fact Sheets
- Transdermal Fentanyl Fact Sheet
- Buprenorphine Fact Sheet
- Methadone for Pain Management
- Medication Management of Pain in Kidney Dz
- Ketamine for Pain
- Safely Prescribing Ketamine for Pain
- Pain Management: Quick Facts
- Neuropathic Pain
- Topical Analgesics for Localized Pain
- Opioid Induced Neurotoxicity in Hospice
- Symptom Management of Brain Metastases
Clinician Courses
- Basic Pain Management (1 hour)
- Complex Pain Management Cases (51 min)
- Methadone: A Review for Hospice Providers (44 min)
- Back to Basics: Pain Management (Micro Course)
- Back to Basics: Methadone as a Coanalgesic (Micro Course)
Patient & Caregiver Guides
- Pain at End of Life
- Understanding Opioids for Pain in Hospice
- Understanding Methadone for Pain in Hospice
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- Tramadol (Ultram)
- Opioid Myths
- Morphine Extended-Release
- Morphine Oral Concentrate
PCNOW Fast Facts
Neuropathic Pain
- Opioids for Neuropathic Pain
- Topical Capsaicin for Neuropathic Pain
- Parenteral Lidocaine for Neuropathic Pain
- Methadone for Neuropathic Pain
- Gabapentin for Neuropathic Pain
- Tricyclic Antidepressants for Pain
- Non-Tricyclic Antidepressant for Neuropathic Pain
- Anti-Epileptic Drugs for Pain
Medication-Specific
- Low-Dose Buprenorphine Patch for Pain
- Methadone for the Treatment of Pain
- Corticosteroids in the Treatment of Bone Pain
- Tramadol in Palliative Care
Pain & Opioid or Substance Use Disorder
- Treatment of Pain in Patients Taking Buprenorphine for Opioid Use Disorders
- Opioids for Chronic Pain in Patients with History of Substance Use Disorders – Part 1: Assessment and Initiation
- Opioids for Chronic Pain in Patients with History of Substance Use Disorders – Part 2: Management and Monitoring
Assessment
- Pediatric Pain Assessment Scales
- Pain Assessment in the Cognitively Impaired
- Neuroexcitatory Effects of Opioids: Patient Assessment
Other
- Why Patients Do Not Take Their Opioids
- Pain in Sickle Cell Disease
- Opioid Poorly-Responsive Cancer Pain
- Pain Management Considerations in Older Adults
- Pain Management in Nursing Homes: Analgesic Prescribing Tips
- Common Non-Malignant Causes of Low Back Pain in Patients with Serious Illness
- Cancer-Related Incident Bone Pain
- Management of Ischemic Limb Pain
- Phantom Limb Pain
- Topical Treatments for Acute and Chronic Wound Pain
- Epidural Analgesia
- Intrathecal Drug therapy For Pain
GeriPal Podcast
- Advanced Pain Management in Cancer: Janet Abrahm
- Exploring the Nature of Chronic Pain with Haider Warraich
- Buprenorphine Use in Serious Illness: A Podcast with Katie Fitzgerald Jones, Zachary Sager and Janet Ho
- Palliative Care, Chronic Pain, and the Opioid Epidemic: GeriPal Podcast with Jessie Merlin
CAPC
- Getting Pain Management Right
- Shifting Perspectives: How to Manage Chronic Pain with the Biopsychosocial Model
- Navigating Neuropathy: How to Treat Neuropathic Pain in People with Serious Illness
- Part 1: Buprenorphine as an Essential Tool for Palliative Care Clinicians
- Part 2: The Ins and Outs of Prescribing Buprenorphine
SHORTNESS OF BREATH (DYSPNEA) RESOURCES
Enclara Palliative Pearls
- Understanding Dyspnea in End-Stage COPD: Back to Basics
- Dyspnea and Opioid Use
- Fluid Retention & Effect on Dyspnea Case
- COPD Inhalation Therapy Conversion Case
Educational Resources for Clients Within E3 Pro
Clinician Fact Sheets
- Corticosteroid Use In COPD
- Inhalers, Clinician Resource
- EnsIDT QAPI Inhalers Deprescribing Plan
- Role of Roflumiflast (Daliresp®) in Hospice and Palliative Care (Revised)
- Nebulized Opioids: Any Benefit?
- Montelukast (Singulair) for Hospice Patients
Clinician Courses
- Medication Management of Advanced COPD (36 min)
- Managing Dyspnea Caused by Non-Respiratory Sources (31 min)
- Inhaler Use Skills Training (12 min)
- Back to Basics: Understanding Dyspnea in End-Stage COPD (Micro Course)
Patient & Caregiver Guides
PCNOW Fast Facts
- Dyspnea at End-of-Life
- Assessment Tools for Dyspnea and Respiratory Distress at the End of Life
- Management of Chronic Dyspnea
- COPD: Emerging Therapies Which Can Also Palliate Symptoms
GeriPal Podcast
ANXIETY RESOURCES
Educational Resources for Clients Within E3 Pro
Clinician Fact Sheets
- Managing Anxiety in Hospice & Palliative Care
- Anxiety in Pediatrics Quick Facts
- Buspirone’s Place in the Therapy of Anxiety
Clinician Courses
Patient & Caregiver Guides
PCNOW Fast Facts
- Anxiety in Palliative Care – Causes and Diagnosis
- Acute Anxiety in Seriously Ill Children and Adolescents: Management
- Anxiety in Seriously Ill Children and Adolescents: Definitions and Assessment
- Panic Disorder at the End-of-life
GeriPal Podcast
- Anxiety in Late Life and Serious Illness: A Podcast with Alex Gamble and Brianna Williamson
- Palliative Care for Mental Illness: A Podcast with Dani Chammas and Brent Kious
CAPC
NAUSEA/VOMITING RESOURCES
Enclara Palliative Pearls
- Back to Basics: Gastrointestinal Symptoms
- Nausea and Vomiting, Sources and Palliative Management
- Addressing Loss of Appetite at End-of-Life
- Gastroparesis: Patient Case and Brief Review
Educational Resources for Clients Within E3 Pro
Clinician Fact Sheets
- Olanzapine for Nausea and Vomiting
- Ondansetron’s Place in the Therapy of Nausea and Vomiting
- Nausea at the End of Life
- Nausea and Vomiting in Pediatrics Quick Facts
Clinician Courses
- Recognizing and Managing Opioid Adverse Effects (32 min)
- Back to Basics: Gastrointestinal Symptoms (Micro Course)
- Back to Basics: Addressing Loss of Appetite at End-of-Life (Micro Course)
Patient & Caregiver Guides
PCNOW Fast Facts
- Opioids and Nausea
- Chemotherapy-Induced Nausea and Vomiting
- Nausea and Vomiting: Common Etiologies and Management
CAPC
DIARRHEA RESOURCES
Enclara Palliative Pearls
Educational Resources for Clients Within E3 Pro
- Patient & Caregiver Guide: Managing Diarrhea
PCNOW Fast Facts
- Pancreatic Enzyme Supplementation for Patients with Pancreatic Cancer
- Diarrhea in Palliative Care
- Fecal Incontinence in Palliative Care Settings
CONSTIPATION RESOURCES
Enclara Palliative Pearls
Educational Resources for Clients Within E3 Pro
Clinician Fact Sheets
Clinician Courses
- Recognizing and Managing Opioid Adverse Effects (32 min)
- GI Complications in Hospice (56 min)
- Back to Basics: Gastrointestinal Symptoms (Micro Course)
Patient & Caregiver Guides
PCNOW Fast Facts
- Opioid Induced Constipation – Part 1: Established Management
- Opioid Induced Constipation – Part 2: Newer Therapies
- Constipation
- Medical Management of Bowel Obstructions
CAPC
AGITATION RESOURCES
Enclara Palliative Pearls
Educational Resources for Clients Within E3 Pro
Clinician Fact Sheets
Clinician Courses
Patient & Caregiver Guides
PCNOW Fast Facts
- Controlled Sedation for Refractory Suffering – Part 1
- Controlled Sedation for Refractory Suffering – Part 2
- Palliative Sedation in the Home Setting
- Management of Behavioral Disturbances in Dementia: Part 1 Non-Pharmacologic
- Management of Behavioral Disturbances in Dementia: Part 2 Pharmacologic
- Non-antipsychotics/Non-benzodiazepines in the Management of Agitated Delirium
GeriPal Podcast
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References
- Centers for Medicare & Medicaid Services. Hospice Quality Reporting Program Current Measures. Accessed May 16, 2025. Site link
- Federal Register. Final FY 2025 Payment Update Rule. August 6, 2024. Site link
- Centers for Medicare & Medicaid Services. Hospice Quality Reporting Program – HOPE. Accessed May 16, 2025. Site link
- Centers for Medicare & Medicaid Services. HOPE Guidance Manual, version 1. Accessed May 16, 2025. Document link.
- Centers for Medicare & Medicaid Services. HOPE All Items. Accessed May 16, 2025. Document link
- Kennedy J, Skehan K. The HOPE Assessment Tool – What You Need to Know. Community Health Accreditation Partner (CHAP). Accessed May 16, 2025. Document link
- Centers for Medicare & Medicaid Services. Hospice Quality Reporting Program. Hospice Item Set. Accessed May 16, 2025. Site link
- Centers for Medicare & Medicaid Services. The HIS Comprehensive Assessment at Admission. Accessed May 16, 2025. Document link
- Palliative Care Network of Wisconsin (PCNOW) Fast Facts. Accessed May 16, 2025. Site link
- A Geriatrics and Palliative Care Podcast. Accessed May 16, 2025. Site link
- Center to Advance Palliative Care (CAPC). Accessed May 16, 2025. Site link
