HOPE Hospice Quality Reporting: What Agencies Must Do

What HOPE is, and what changed on October 1, 2025

HOPE, the Hospice Outcomes and Patient Evaluation, is the standardized patient assessment instrument that Medicare-certified hospices must use for patients admitted on or after October 1, 2025. It replaced the Hospice Item Set (HIS), the instrument hospices had submitted since 2014. The hospice program's requirements sit within 42 CFR Part 418, and HOPE is the current vehicle for the quality data those requirements depend on.

The substantive change is not the acronym. HIS captured a snapshot at admission and another at discharge. HOPE keeps those bookends but adds structured assessment during the patient's stay, so the record now reflects the patient's status at more than two moments in care.

The assessment timepoints HOPE introduced

HOPE is organized around three kinds of assessment: an admission assessment, one or more HOPE Update Visits (HUVs) during the stay, and a discharge assessment. The update visits are the genuinely new obligation. They require the hospice to collect standardized data at defined windows after admission rather than waiting for discharge, which means the care team has to recognize when a window opens and complete the visit inside it.

Each timepoint has its own items and its own timing, and a window that passes without the required assessment cannot be reopened later. That is what makes HOPE a scheduling problem as much as a clinical one: the assessment has to be done, documented, and captured while the window is live.

How HOPE connects to the Hospice Quality Reporting Program

The data a hospice collects on HOPE is submitted to CMS and counts toward the Hospice Quality Reporting Program. HQRP sets expectations for how completely and how promptly hospices report, and compliance with those expectations is tied to the agency's annual Medicare payment update — the yearly adjustment to its base payment rates.

A hospice that does not meet HQRP reporting requirements can see that annual payment update reduced. The reduction is applied to a future payment year, so the financial effect of a reporting shortfall shows up after the records that caused it are already closed.

Why timely and complete submission is the whole job

Hospice already runs on deadlines — the Notice of Election has a five-calendar-day timely-filing window, and benefit periods move through two 90-day periods followed by unlimited 60-day periods — so agencies are used to timing driving payment. HOPE adds another timing surface, and like the others it is unforgiving after the fact: a missed assessment window or a late submission cannot be repaired once it is past.

The practical consequence is that completeness and timeliness have to be managed during the stay, not reconstructed at reporting time. By the point a reporting shortfall would otherwise surface, the window to fix it has usually closed, which is why agencies that stay current treat HOPE as an ongoing check rather than an end-of-stay task.

How ClinicalCore helps hospices stay on top of HOPE

ClinicalCore is AI-assisted clinical documentation and coding review for home health and hospice. It reads the clinical record and checks it against the information HOPE assessments and quality reporting depend on, surfacing gaps — a missing element, an assessment that does not line up with the timepoints HOPE expects — so the team can address them before data goes to CMS rather than after a reporting shortfall is already locked in.

It is EHR-agnostic and works from uploaded documents alongside any EMR, so an agency does not have to change systems to use it. ClinicalCore supports and flags; it does not replace clinician or coder judgment, and it does not guarantee compliance. The point is to make the gaps visible while they can still be fixed, and to leave the clinical and coding decisions with the people qualified to make them.

Frequently asked questions

How do hospices meet HOPE reporting requirements and avoid the quality-reporting penalty?

Complete each required HOPE assessment — admission, the HOPE Update Visits during the stay, and discharge — within its window, and submit the data to CMS within the Hospice Quality Reporting Program's deadlines and completion expectations. Falling short of those requirements can reduce the agency's annual payment update, so the practical safeguard is catching missing or late data before submission. ClinicalCore reviews the record against HOPE's assessment requirements and flags gaps while there is still time to correct them.

What assessment timepoints does HOPE require?

HOPE requires an admission assessment, one or more HOPE Update Visits (HUVs) at defined windows during the patient's stay, and a discharge assessment. The update visits are the main addition over the old Hospice Item Set, which collected data only at admission and discharge. Each window has its own timing, and a window that passes without the required assessment cannot be reopened later.

What happens if a hospice submits HOPE data late or incomplete?

A hospice that does not meet the Hospice Quality Reporting Program's completeness and timeliness requirements can have its annual Medicare payment update reduced. That reduction is applied to a later payment year, so the financial effect arrives after the records that caused it are already closed, which is why late or incomplete data usually cannot be fixed once it is noticed.

Does HOPE or a tool like ClinicalCore replace clinician and coder judgment?

No. HOPE is a standardized data instrument, and the assessments still depend on the clinical team's evaluation of the patient. ClinicalCore assists that work by reviewing the record and surfacing gaps against HOPE's requirements, but it supports and flags rather than deciding — it does not replace clinician or coder judgment or guarantee compliance.