Big changes are coming to hospice quality reporting. Starting October 1, 2025, Medicare-certified hospices will retire the familiar Hospice Item Set (HIS). HIS will be replaced by a new tool: HOPE (Hospice Outcomes & Patient Evaluation). This shift raises questions and concerns for hospice leaders.
If you’re wondering how this will affect your staff, your workflow, or your compliance, you’re not alone.
In this article, we’ll break down:
- the differences between HOPE and HIS
- why this change is happening
- what to expect
- how to prepare
Our goal is to help you transition smoothly so you can stay compliant and keep your focus on delivering excellent end-of-life care.
What Is HIS, and Why Did It Matter?
The Hospice Item Set (HIS) has been a mandatory quality reporting tool for Medicare-certified hospices. It captured whether key care processes were completed at admission and discharge, such as pain assessments and preference discussions. Submitting timely and complete HIS data was essential to avoid a 2% payment penalty.
While HIS helped standardize care expectations, its effectiveness declined as nearly all hospices consistently met the requirements. Also, because it captured very limited data, HIS became less useful in distinguishing high performers or driving quality improvement.
What Is HOPE?
HOPE (Hospice Outcomes & Patient Evaluation) is CMS’s new standardized assessment tool. HOPE will fully replace HIS starting October 1, 2025. Here’s how it differs:
- Real-Time Assessment: Unlike HIS, which was a retrospective chart review, HOPE is done during care visits with the patient and family.
- Multiple Timepoints: HOPE assessments occur at admission, at two update points within the first 30 days, and at discharge.
- Richer Data: HOPE collects more clinical and patient-centered data, including symptom severity, goals of care, and outcomes.
- Actionable Insights: HOPE is meant to support care planning, not just data reporting.
HOPE allows CMS to gather better data on how well symptoms are managed and how care changes over time.
Why Is CMS Making This Change?
CMS is shifting from process measures to outcome measures. HIS tracked if something was done. HOPE tracks how well it was done and if it helped the patient.
Additional reasons for the change include:
- Better visibility into changing patient needs
- More meaningful quality comparisons
- Ability to create new measures (e.g., timely symptom management)
CMS also wants to modernize data collection and eventually tie quality performance more closely to reimbursement. This is similar to what they did with Value Based Purchasing in Home Health.
How is HOPE Different from HIS?
- Timeline: HIS is required until September 30, 2025. HOPE begins October 1, 2025.
- Frequency: HOPE requires assessments at up to four timepoints per patient (vs. two with HIS).
- Workflow Impact: HOPE will add tasks to clinical staff schedules, especially in the first month of care.
- Compliance Requirements: Hospices must submit at least 90% of HOPE assessments on time to avoid a 4% payment penalty (up from 2% with HIS).
- Public Reporting: HOPE data will not be publicly reported until FY 2028 at the earliest, giving time for adjustment.
How Can Hospices Prepare for HOPE?
- Learn the Tool: Read the HOPE manual from CMS. Know what data points are required.
- Talk to Your EMR Vendor: Ask when HOPE features will be available and plan training accordingly.
- Update Your Workflow: Start preparing to build HOPE assessments into your routine care visits. Plan for Day 6-15 and Day 16-30 updates.
- Monitor CMS Updates: Stay current with announcements through the CMS website & monitor email alerts.
How HOPE Will Change the Future of Hospice Quality Reporting
HOPE is replacing HIS in October 2025. It’s a more thorough, real-time assessment that supports better care and quality reporting. Change can be hard, but HOPE gives hospices a chance to improve care planning and outcomes. It brings quality reporting closer to the patient experience.
Wondering what you can do to stay ready? Start now. Prepare your team, update your processes, and stay informed. Waiting until fall 2025 will make the transition harder.
You’ve adapted before, and you will again. With planning and teamwork, HOPE can enhance how your hospice delivers care—not just add work.
Want to keep your hospice running smoothly? Learn what surveyors look for in our article below. The more your team knows, the better prepared you'll be.
*This article was written in consultation with Mariam Treystman.
*Disclaimer: The content provided in this article is not intended to be, nor should it be construed as, legal, financial, or professional advice. No consultant-client relationship is established by engaging with this content. You should seek the advice of a qualified attorney, financial advisor, or other professional regarding any legal or business matters. The consultant assumes no liability for any actions taken based on the information provided.
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