HOPE Assessment

The Hospice Outcomes and Patient Evaluation (HOPE) is the CMS standardized patient assessment instrument that every Medicare-certified hospice must complete and submit for the Hospice Quality Reporting Program (HQRP). HOPE replaced the Hospice Item Set (HIS) for all patients admitted on or after October 1, 2025 (CMS HOPE page)^[1].

HOPE moved hospice quality data collection from a two-point model to a multi-point model tied to the patient's actual course of care. Where HIS collected data only at admission and discharge, HOPE adds mid-stay assessment timepoints called HOPE Update Visits (HUVs) to capture patient-level data during the first 30 days on service (CMS HOPE page)^[1]. A hospice submits up to four records per patient: a HOPE Admission completed within 5 days of admission, HUV1 completed between days 6 and 15, HUV2 completed between days 16 and 30, and a HOPE Discharge (HOPE Guidance Manual v1.02)^[2]. The number of HUVs required depends on length of stay; a patient discharged before day 6 triggers no HUV. If any HOPE assessment identifies pain or another symptom at moderate or severe impact, an in-person Symptom Follow-Up Visit (SFV) must occur within 2 calendar days (CMS HOPE page)^[1]. HOPE combines retained HIS items, revised items, and new items, and records are submitted to the Internet Quality Improvement and Evaluation System (iQIES) within 30 days of each record's target date (HOPE Implementation FAQs)^[3]. For patients admitted on or after October 1, 2025, CMS accepts only HOPE records; corrected or late HIS records with target dates of September 30, 2025 or earlier were accepted in the legacy QIES system through February 15, 2026 (QTSO HOPE iQIES announcement)^[4].

HOPE is a materially larger operational lift than HIS because it puts the clinical team on a clock at multiple points in the stay, not just at the edges. The HUV windows and the 2-calendar-day SFV requirement mean quality compliance now depends on scheduling and documenting real visits mid-stay, which is a staffing and workflow problem, not a data-entry problem. The exposure is direct: HOPE compliance feeds the HQRP timeliness threshold, and missing it costs 4 percentage points off the Annual Payment Update (FY 2026 Hospice Final Rule fact sheet)^[5]. Because HOPE is new as of October 1, 2025, the first full annual compliance cycle is still running, so process gaps that were survivable under HIS are now live financial risk.