Hospice care is entering a new phase of accountability. CMS is driving providers toward real-time, patient-centered documentation, aiming to align reporting with actual care delivery. The HOPE (Hospice Outcomes and Patient Evaluation) Tool is the centerpiece of this transition. Unlike the Hospice Item Set (HIS), which largely served as a compliance checklist, HOPE transforms documentation into an active part of clinical care.

The shift reflects a broader evolution in post-acute care. Reporting will no longer be a retrospective exercise handled by administrators but an integrated responsibility of the clinical team. This guide outlines the structure of the HOPE Tool, the responsibilities it introduces, and the steps hospices should take to remain compliant while strengthening care quality.

What Is the HOPE Tool?

The HOPE Tool, short for Hospice Outcomes and Patient Evaluation, will become the new standard for hospice documentation starting October 1, 2025. It is designed to capture clinical accuracy and care outcomes across five major assessment events:

• Admission Visit: Establishing the patient’s baseline condition.
  
  
• Update Visits (HUV1 and HUV2): Monitoring changes and ensuring care plans evolve appropriately.
  
  
• Symptom Follow-Up Visits (SFVs): Documenting interventions and outcomes when symptoms escalate.
  
  
• Discharge Visit: Recording the patient’s final status and outcomes of care provided.
  
  

Where HIS focused primarily on compliance reporting, HOPE integrates documentation directly into care delivery. It captures real-time clinical data, creating a continuous record of patient progress that informs decision-making across the interdisciplinary team.

Who Will Be Responsible for HOPE?

The responsibility for HOPE assessments rests firmly with clinical staff. Nurses and other frontline clinicians will now complete documentation that was previously handled by back-office teams. This marks a significant operational shift, requiring staff to balance patient care with structured, time-sensitive reporting.

The emphasis on real-time data collection means that assessments must be completed at the point of care or shortly after. Timeliness is no longer a convenience; it is a compliance requirement. By design, HOPE integrates documentation into daily workflows, reinforcing that accurate records are a central component of quality hospice care.

Benefits of HOPE (Beyond Compliance)

Although HOPE is a compliance mandate, it brings clear benefits that extend beyond regulatory checkboxes.

• Improved interdisciplinary care planning: Real-time assessments keep the entire care team aligned, ensuring that updates to the plan of care are based on the latest patient data.
  
  
• Faster identification of symptom escalation: Symptom follow-up visits enable providers to act quickly, reducing unnecessary hospitalizations and improving comfort.
  
  
• Reduced post-claim audits: Detailed, real-time documentation provides stronger justification for services, minimizing the risk of denials and audit challenges.
  
  
• Alignment with home health standards: Similar to OASIS in home health, HOPE raises hospice documentation to the same standard of accuracy and timeliness expected across other CMS programs.
  
  

By embedding quality metrics into daily clinical routines, HOPE has the potential to elevate both compliance outcomes and the standard of care delivered to patients and families.

Key Readiness Areas for Providers

Hospices preparing for HOPE must focus on both people and processes. A successful transition requires attention to several readiness areas:

• Staff training: Clinicians need education on HOPE requirements, assessment timing, and proper documentation techniques.
  
  
• Documentation processes: Existing workflows must be reviewed and realigned to support real-time reporting, ensuring consistency between care delivery and recorded data.
  
  
• EHR system updates: Electronic medical record vendors should be engaged early to confirm that HOPE fields and templates are integrated into their systems.
  
  
• Internal compliance monitoring: Establish internal audit processes to check completion rates, timeliness, and accuracy before CMS submission.
  
  
• Familiarity with CMS tools: Teams must be comfortable using iQIES and the Validation Utility Tool (VUT), which will be central to submission and error-checking.
  
  

Investing in these readiness areas early helps avoid compliance gaps and ensures that new processes are well established before October 2025.

Ongoing Monitoring for HOPE Compliance

Once HOPE goes live, compliance will not be a one-time project but an ongoing operational responsibility. Each assessment event comes with its own documentation requirements and deadlines.

• Admission Assessment: Sets the foundation for the care plan, requiring comprehensive and accurate baseline data.
  
  
• Update Visits (HUV1 and HUV2): Ensure continuity by capturing the patient’s progress and adjusting care strategies accordingly.
  
  
• Symptom Follow-Up Visits (SFVs): Provide evidence of responsiveness to patient needs, supporting both quality and compliance.
  
  
• Discharge Assessment: Completes the patient’s record, offering insight into the effectiveness of hospice interventions.
  
  

Monitoring completion rates and timeliness across these events will be critical. Dashboards, audits, and staff accountability measures will need to be in place to ensure compliance is consistent.

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How Red Road Supports the Transition

For many hospices, preparing for HOPE requires more than internal planning. External support can provide clarity, bandwidth, and expertise to ease the transition.

Red Road partners with agencies to:

• Conduct end-to-end documentation audits that reveal where existing practices may not align with HOPE standards.
  
  
• Provide workflow consulting to integrate HOPE into day-to-day operations without disrupting patient care.
  
  
• Support EHR alignment, ensuring templates and fields are updated correctly.
  
  
• Deliver HOPE readiness workshops that prepare clinical teams for the demands of real-time documentation.
  
  

This tailored support helps hospice teams not only meet CMS requirements but also use the transition as an opportunity to improve care processes and outcomes.

Conclusion

The HOPE Tool marks a turning point for hospice documentation. CMS is signaling that compliance is no longer enough; documentation must now drive patient-centered care in real time. While the shift introduces new responsibilities and higher expectations, it also creates opportunities to strengthen quality, improve patient outcomes, and reduce financial risk.

Providers that begin aligning staff, systems, and workflows today will be ready to embrace HOPE as more than a mandate. With preparation, HOPE becomes a catalyst for better documentation, better care, and a stronger foundation for the future of hospice.

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