By Dr Colleen Morley, DNP, RN, CCM, CMAC, CMGT-BC, CMCN, ACM-RN, FCM, FAACM
Hospice care is entering a new chapter with the introduction of the HOPE Tool—Hospice Outcomes and Patient Evaluation—from the Centers for Medicare & Medicaid Services (CMS). This new assessment approach represents a thoughtful shift toward understanding patients’ needs in real time, rather than relying solely on retrospective chart review. For case managers and hospice professionals, HOPE offers the opportunity to enhance both the quality of care and the way teams communicate across the interdisciplinary team. It is designed not just as a reporting requirement, but as a tool that can meaningfully shape the hospice experience for patients and families.
Understanding the HOPE Tool
HOPE replaces the long-standing Hospice Item Set (HIS), which has been in place for years as the foundation of hospice quality reporting. Unlike HIS—which collected data only at admission and discharge—HOPE is structured to capture a more complete and dynamic picture of a patient’s journey. Beginning October 1, 2025, all hospices will transition to this new system, using HOPE assessments at several points throughout the care experience.
What makes HOPE different is its focus on what the patient is actually experiencing in the moment. Instead of asking whether documentation exists to support a care task, HOPE guides clinicians to observe and record clinical findings, changes in symptoms, patient preferences, and caregiver needs. By moving away from a snapshot approach and embracing ongoing evaluation, HOPE creates a more accurate story of the patient’s condition and the care being provided.
How HOPE Changes the Assessment Approach
The shift from HIS to HOPE introduces a more continuous and clinically grounded process. HOPE includes an admission assessment, up to two update visits during the stay, and a discharge assessment. In addition, if a patient is found to have significant pain or other concerning symptoms during any assessment, a follow-up visit is required within two calendar days. This structure reinforces the intention behind hospice care: to respond swiftly and compassionately when a patient’s condition changes.
Where HIS focused on documentation—essentially confirming whether something was done—HOPE emphasizes the patient’s lived experience. That difference sounds subtle, but it transforms the purpose of assessment. HOPE helps care teams identify trends, anticipate needs, and intervene earlier, all while grounding the process in the reality of what the patient and family are navigating.
Why CMS Developed HOPE
CMS designed the HOPE Tool to align hospice quality reporting with every team’s fundamental mission: delivering individualized, patient-centered care at the end of life. By standardizing assessments across the country, HOPE aims to elevate the overall quality of hospice services and create more meaningful quality measures for public reporting. The data gathered through HOPE is intended to support continuous quality improvement efforts, helping agencies see where they excel and where adjustments could strengthen their care.
Importantly, the goal is not merely additional documentation. Instead, CMS seeks to provide hospices with clinically useful data—information that can drive better interdisciplinary communication, more responsive symptom management, and a more accurate representation of the care experience.
The Potential Benefits for Patients, Families, and Care Providers
When used thoughtfully, the HOPE Tool can enhance hospice care in several deeply significant ways. More frequent and structured assessments allow teams to identify shifts in a patient’s condition earlier and respond more quickly, particularly when symptoms worsen. This proactive approach supports better comfort, fewer crises, and more confidence for families who want assurance that their loved one’s needs are recognized and addressed promptly.
HOPE also encourages more dynamic, evolving care planning. Instead of setting a care plan at admission and revisiting it only if something changes, teams have natural touchpoints built into the workflow that invite conversation and reassessment. This reinforces the idea that hospice care is not static—it evolves as the patient’s condition and priorities evolve.
Families may also benefit from deeper communication prompted by HOPE assessments. Each evaluation serves as a moment to pause and ask what matters most right now, how the caregiver is coping, and whether the plan of care still reflects the patient’s values, comfort needs, and personal goals. All of this contributes to a more compassionate, person-centered experience.
For hospices striving to improve performance, HOPE offers more meaningful quality data than HIS ever could. Real-time, patient-level information can help agencies understand where delays occur, where symptoms are well controlled, and how consistently care teams apply best practices. This, in turn, creates opportunities for targeted improvement that ultimately strengthen the entire organization.
Implementation Challenges to Anticipate
As with any significant change, implementing HOPE will require preparation. Hospices will need to review their workflows, determine which team members complete each assessment, and establish reliable processes for timely follow-up when symptoms trigger additional visits. Staff training will be essential—not only to learn the tool itself, but also to understand its intent, the documentation requirements, and the processes for data submission through the updated iQIES system.
Another important consideration is the patient’s comfort. While assessments serve an important purpose, hospice professionals must balance the need for data with the realities of end-of-life care. Sensitivity, timing, and clinical judgment will remain central to maintaining the dignity and comfort that define hospice philosophy.
Finally, agencies may need to update their electronic health records, develop internal dashboards, and support their teams through a period of adjustment. The transition is manageable and worthwhile, but it will require intention and leadership.
The Role of Case Managers in the HOPE Era
Case managers will play an essential role in ensuring that HOPE fulfills its promise. You help keep communication flowing among disciplines, advocate for timely symptom management, review and coordinate care plans, and guide families through the process with clarity and compassion. With HOPE’s emphasis on real-time assessment, the case manager’s ability to interpret information, mobilize the team, and maintain alignment across disciplines becomes even more valuable.
HOPE also provides case managers with stronger, more consistent data to inform care planning and quality improvement. It becomes easier to identify trends, monitor outcomes, and participate meaningfully in conversations about improving practice at both the patient and organizational level.
Looking Ahead
The introduction of the HOPE Tool signals a new phase in hospice care—one that is more attentive, more data-informed, and more aligned with the lived realities of patients and families. Over time, HOPE-based quality measures will likely expand, public reporting will evolve, and future payment models may incorporate the insights HOPE provides. The agencies that prepare early, invest in training, and embrace the spirit behind the tool will be well positioned not only for compliance, but for delivering truly exceptional care.
At its core, hospice is about presence, compassion, and honoring what matters most to patients and families. The HOPE Tool reinforces these principles by guiding care teams to pay close attention to how patients are doing in real time and respond with intention. With thoughtful implementation, HOPE can strengthen the quality of hospice care nationwide and support teams in doing what they do best: providing comfort, dignity, and connection at one of life’s most meaningful transitions.
Interested in becoming a Case Management Fellow (FCM™)? Learn more and start your application today: https://bit.ly/48zwEAX
Application period extended to February 15, 2026. Take advantage of this extra time and get started now!
References
Centers for Medicare and Medicaid. (2025). HOPE. https://www.cms.gov/medicare/quality/hospice/hope
Centers for Medicare and Medicaid. (2025). Hospice Regulations and Notices. https://www.cms.gov/medicare/payment/fee-for-service-providers/hospice/hospice-regulations-and-notices
Bio: Dr. Colleen Morley, DNP, RN, CCM, CMAC, CMCN, CMGT BC, ACM-RN, IQCI, FCM, FAACM is the Associate Chief Clinical Operations Officer, Care Continuum for University of Illinois Health System and the current Immediate Past President of the Case Management Society of America National Board of Directors and President Elect of CMSA Chicago. She has held positions in acute care as Director of Case Management at several acute care facilities and managed care entities in Illinois, overseeing Utilization Review, Case Management and Social Services for over 14 years; piloting quality improvement initiatives focused on readmission reduction, care coordination through better communication and population health management. Her current passion is in the area of improving health literacy. She is the recipient of the CMSA Foundation Practice Improvement Award (2020) and ANA Illinois Practice Improvement Award (2020) for her work in this area. Dr. Morley also received the AAMCN Managed Care Nurse Leader of the Year in 2010 and the CMSA Fellow of Case Management designation in 2022. Her 1st book, “A Practical Guide to Acute Care Case Management”, published by Blue Bayou Press was released in February, 2022. Her 2nd book, "Practical Gude to Hospital Readmission Reduction =, published by Blue Bayou Press was released in February 2024. Her 3rd book, "Practocal Guid eto Acute care Case Management Leadership" is in the works, targeting publication in 2025. Dr. Morley celebrates 25 years of nursing experience and 20 years in case management in 2024. Her clinical specialties include Med/Surg, Oncology and Pediatric Nursing. She received her ADN at South Suburban College in South Holland, IL; BSN at Jacksonville University in Jacksonville, FL, MSN from Norwich University in Northfield, VT and her DNP at Chamberlain College of Nursing.