The introduction of HOPE assessment documentation is set to change hospice reporting. It will replace the current Hospice Item Set (HIS) on October 1, 2025. This shift fundamentally changes how hospice providers assess, document and report patient care. Unlike HIS, which only required data collection at admission and discharge, the HOPE tool demands ongoing assessments throughout a patient’s hospice journey.
Hospice providers must now rethink their data collection strategies to prevent documentation gaps, compliance risks and payment reductions. The Centers for Medicare and Medicaid Services (CMS) has clarified that accurate and timely documentation will directly impact reimbursement models. Hospices that fail to submit 90% of HOPE data within 30 days of an event could see a 4% reduction in Medicare payments.
Beyond compliance, this transition has a direct impact on care quality. Frequent assessments create a clearer picture of patient needs, allowing providers to deliver better, more responsive care.
However, without easier workflows, the additional documentation could overwhelm staff and lead to delays or inaccuracies in reporting. To prepare, hospice teams must focus on refining their documentation processes, improving data accuracy and training staff for real-time data collection.
Strengthening HOPE Assessment Documentation for Compliance and Accuracy
The shift to HOPE assessment documentation requires a significant change in how hospice teams capture and report data. Unlike HIS, which served primarily as a data collection tool, HOPE functions as an assessment tool similar to the Outcome and Assessment Information Set (OASIS) used in home health. This means that data collected through HOPE will support quality reporting and could also influence future reimbursement structures.
With the introduction of HOPE, hospice providers must conduct up to four structured assessments per patient:
- Admission assessment (within the first five days)
- Update visit (between days 6-15)
- Update visit (between days 16-30, if applicable)
- Discharge assessment
This schedule means clinicians must document patient needs and symptoms more frequently. The shift from two assessments under HIS to as many as four under HOPE increases documentation requirements. Agencies must create efficient workflows to handle this added burden without disrupting patient care.
Beyond increasing the number of assessments, HOPE also introduces two new process measures that hospices must meet. These measures require the timely reassessment of pain impact and the timely reassessment of non-pain symptom impact, ensuring that patient care remains responsive and effective throughout the course of treatment.
Providers must reassess if a patient reports moderate or severe symptoms within two calendar days. Missing this window could result in compliance issues, affecting patient care and reimbursement. Hospice teams need a structured documentation strategy to meet these new standards. This strategy should prioritize real-time data collection, accurate record-keeping and automated alerts for reassessments.
Restructuring Workflows for Better Hospice Care Documentation
Improving hospice care documentation under HOPE starts with an evaluation of current workflows. Hospices must assess whether their teams collect and enter data efficiently or if delays lead to incomplete records. If HIS documentation has been a challenge in the past, those same inefficiencies will be magnified under HOPE. The increased assessment frequency means minor documentation gaps can quickly escalate into significant compliance risks.
One key factor is the timing of documentation. Data accuracy suffers if staff members are waiting hours or even days to complete assessments. Document delays can lead to compliance issues, billing problems and gaps in patient care. Encouraging real-time data entry at the point of care is the most effective way to prevent these issues.
Agencies should also examine incomplete or late documentation trends to identify problem areas. If many HIS reports have historically been missing key information, those gaps will likely persist with HOPE unless processes are revised. An internal audit of past documentation can help pinpoint common errors and determine where additional training or process changes are needed.
Eliminating Documentation Bottlenecks for Timely HOPE Assessments
With HOPE requiring up to four assessments per patient, agencies need to assess whether their current workflows can handle the increased documentation demands. The primary challenge is avoiding bottlenecks that delay documentation. Data integrity is at risk if clinicians rely on manual processes that push documentation to the end of the shift or even the next day.
Hospice leaders should start by evaluating the time it takes for staff to complete assessments and identify where delays typically occur. For example, the risk of missing critical details increases if most documentation happens after patient visits rather than during them. Implementing structured workflows prioritizing documentation at the point of care maintains accuracy. It also helps staff adapt to the faster reporting cycle required under HOPE.
Aligning Staff Workflows with the HOPE Assessment Structure
The HOPE tool introduces a structured approach to patient evaluations, meaning documentation workflows must align with the new reporting schedule. Unlike HIS, which only requires assessments at admission and discharge, HOPE demands a rolling evaluation model that requires consistency in data collection. Compliance penalties and data discrepancies become real concerns if assessment updates are not completed within the required timeframes.
Hospices should consider implementing structured check-ins with clinicians to complete assessments within the designated timeframes. Leadership should also identify gaps in documentation timing and adjust schedules to accommodate the additional workload. If staff are overwhelmed with backlogged assessments, agencies should review whether workloads need redistribution or additional training is necessary.
Standardizing Quality Audits to Improve Data Accuracy
Incomplete or inaccurate data will have a more significant impact under HOPE than it did under HIS. The more frequent assessments mean that missing or inconsistent data can create a ripple effect throughout a patient’s care plan. Agencies must implement quality audits to detect and correct documentation errors before they lead to compliance issues.
Quality audits should focus on common documentation errors. This includes incomplete assessments, missing symptom reassessments and inconsistencies in reported patient needs. Reviewing trends in the previous HIS documentation can highlight weak spots that need to be addressed before HOPE goes live.
To make audits more effective, hospices should consider utilizing EHR software platforms that allow real-time monitoring of documentation accuracy. Built-in reporting tools can help flag missing data and help complete required assessments on time.
Integrating Change Management Strategies for HOPE Compliance
The transition to HOPE is an operational change affecting every hospice provider. Managing this change effectively is key to avoiding disruptions in care and documentation. Without structured change management strategies, staff may struggle to adapt to the new reporting structure, leading to workflow inefficiencies and compliance risks.
Hospices should prioritize developing structured training and onboarding processes to help staff transition smoothly to HOPE. Leaders must emphasize the importance of the new documentation requirements and offer ongoing support as teams adapt.
Effective change management requires leadership involvement, with supervisors actively monitoring compliance and guiding staff through the transition. Hands-on training is essential, so staff can practice using HOPE documentation workflows in real-world scenarios before the official implementation date.
Additionally, continuous feedback loops should be established, allowing clinicians to share documentation challenges so workflows can be refined in real-time.
Preparing Hospice Teams for HOPE Implementation
A smooth transition to HOPE depends on well-trained staff understanding the new documentation requirements. However, practical training must equip teams with strategies to integrate HOPE into daily workflows without disrupting patient care.
One of the biggest challenges will be adapting to more frequent assessments. If clinicians are accustomed to HIS reporting, adjusting to HOPE’s structured documentation will take time. Leadership should start by analyzing how staff currently complete documentation. If many HIS reports are delayed by 24 to 48 hours, the same delays will carry over to HOPE and create compliance risks. Training should emphasize the importance of completing assessments at the point of care rather than waiting until later.
Utilizing Technology for Better Documentation Efficiency
Hospice agencies can minimize the burden of HOPE documentation by adopting advanced technology solutions. A reliable EHR software platform simplifies data entry, automates compliance tracking and improves reporting accuracy. Instead of relying on manual documentation, providers can use digital tools to simplify assessment workflows and integrate real-time updates into patient records.
Using technology to track reassessment deadlines, flag incomplete documentation and organize data submission timelines helps agencies stay ahead of compliance requirements. Automating reminders for pain reassessments allows providers to meet HOPE’s two-day reassessment rule without missing critical deadlines.
How Homecare Homebase Supports Hospice Providers
At Homecare Homebase, we provide industry-leading solutions to help hospice providers transition smoothly to HOPE. Our HCHB hospice software supports accurate documentation and maintains compliance with CMS regulations. Our technology helps agencies manage assessments efficiently by integrating real-time data capture and automated alerts.
As hospices prepare for HOPE, refining documentation processes is necessary. Stronger workflows, better training and advanced technology solutions will make the transition smoother and position providers for long-term success.
The move to structured, frequent assessments under HOPE may be challenging. However, the right approach also presents an opportunity to enhance care quality and improve patient outcomes. As the transition to HOPE approaches, now is the time to strengthen your documentation strategy. Contact us to learn how we can help you stay ahead.
