The HOPE Tool for Hospice Agencies
HOPE replaced the Hospice Item Set on 1 October 2025, so agencies are a year into running it. It adds two things HIS never had: update visits during the first thirty days, and a follow-up visit triggered by what a nurse records. The second one is what breaks schedules, because it starts a two-day clock nobody planned for.
What changed, and what did not
The Hospice Outcomes and Patient Evaluation was finalized in the FY 2025 Hospice Wage Index Final Rule, and data collection began on 1 October 2025. CMS publishes a guidance manual for it, currently at version 1.02.
The part agencies underestimated is not the instrument. It is the shift in what an assessment is for. HIS was a record of care you had already delivered, assembled largely from the chart. HOPE requires a clinician in front of the patient at defined points in the stay, and one of those points is not scheduled in advance. It is triggered.
The timepoints
| Timepoint | When | Who completes it |
|---|---|---|
| Admission | At hospice election | Clinician completing the assessment |
| HOPE Update Visit 1 | Days 6 to 15 of the stay, not within the first five days | Clinician completing the assessment |
| HOPE Update Visit 2 | Days 16 to 30 of the stay | Clinician completing the assessment |
| Symptom Follow-Up Visit | Within two calendar days of a triggering assessment | RN, LPN, or LVN |
| Discharge | At discharge or death | Clinician completing the assessment |
The manual singles out the symptom follow-up visit as the one that may be conducted by either an RN or an LPN or LVN, in contrast to the assessments. It does not set out a separate staffing rule for the update visits. Check your own policy and your state's scope of practice rather than inferring one.
Up to two update visits are required per admission, depending on length of stay. A short stay may require neither. Up to three symptom follow-up visits can occur in a single stay.
The visit nobody scheduled
The symptom follow-up visit is the one that turns HOPE from a documentation change into an operations problem.
Here is the mechanism. At admission or at an update visit, a nurse rates the impact of a pain or non-pain symptom. If that rating is moderate or severe, a follow-up visit is required within two calendar days. Not two business days. The clock can start on a Friday afternoon at a bedside, and it does not care that the weekend on-call roster was built on Wednesday.
Three things have to happen fast, and none of them is clinical. Somebody other than the assessing nurse has to learn that the visit is now due. Somebody has to find a clinician who can take it inside the window. And the visit has to be documented as the follow-up it was, rather than as an ordinary visit that happened to occur.
Agencies that struggle with HOPE usually do not have an assessment problem. They have a message problem: the trigger fires at a kitchen table and the scheduler finds out on Monday.
What a year has exposed
Three patterns are worth checking against your own data.
The short stay. National median hospice length of stay sits low enough that a meaningful share of admissions never reach an update visit at all. The burden is not evenly spread across your census; it concentrates in the longer stays, and in the first fortnight.
The weekend trigger. A moderate or severe rating recorded Friday is the hardest version of the two-day rule. If your triggers cluster there, the fix is a routing change rather than more staff.
The definition drift. The guidance manual has moved from version 1.00 to 1.02. An agency training its nurses from a 2025 handout is training them from a superseded document.
What HOPE does not do
HOPE does not tell you a visit is due. It defines when one is required; noticing is your problem, and it is a communication problem rather than a compliance one.
It also does not change the after-hours obligation that sits underneath all of this. Nursing services still have to be routinely available on a 24-hour basis, seven days a week, and a symptom follow-up visit landing on a Saturday meets that obligation rather than replacing it. If the on-call path is the weak link, our guide to choosing a hospice answering service covers the questions to ask.
Where QliqSOFT fits
QliqSOFT does not collect HOPE data. That belongs in your EMR, and it should stay there.
What QliqCHAT carries is the part between the trigger and the visit: the nurse who recorded a moderate or severe rating can put it in front of the scheduler and the on-call team in the thread they already use, with the patient attached, so the two-day clock starts with everyone who needs to know already knowing. The IDG sees the same thread at its next meeting.
The check worth running this month is not on the instrument. Take the last ten symptom follow-up visits your agency completed and ask how each one was communicated, and how long that took.
Frequently asked questions
What is the HOPE tool in hospice?
HOPE, the Hospice Outcomes and Patient Evaluation, is the CMS patient assessment instrument that replaced the Hospice Item Set. Data collection began on 1 October 2025 under the FY 2025 Hospice Wage Index Final Rule. It collects data at admission, at up to two update visits in the first thirty days, at any triggered symptom follow-up visit, and at discharge.
When is the HOPE assessment tool completed?
At five possible points. Admission. HOPE Update Visit 1, between days 6 and 15 of the stay and not within the first five days. HOPE Update Visit 2, between days 16 and 30. A symptom follow-up visit, within two calendar days of an assessment that rates a pain or non-pain symptom as moderate or severe. And discharge. The guidance manual specifies that a symptom follow-up visit may be conducted by an RN or an LPN or LVN, in contrast to the assessments; it does not state a separate staffing rule for the update visits.
What triggers a symptom follow-up visit?
A symptom impact rating of moderate or severe for pain or a non-pain symptom, recorded at admission or at an update visit. The follow-up visit must occur within two calendar days, which may be the same day. Up to three can occur in one hospice stay.