Navigating the New HOPE Tool: What Hospice Agencies and Clinicians Need to Know Before October 1st.

The Centers for Medicare & Medicaid Services (CMS) is ushering in a major shift in hospice care documentation and assessment with the launch of the HOPE (Hospice Outcomes & Patient Evaluation) tool, effective October 1, 2025. Designed to standardize data collection and improve patient outcomes, HOPE introduces new visit requirements, stricter timelines, and more detailed symptom tracking.
Hospice agencies must act now to ensure compliance, protect reimbursement, and maintain care quality.

What’s Changing Under HOPE

Expanded Visit Requirements

HOPE introduces three new required visits beyond admission and discharge:

HUV1 (Day 6–15):Initial follow-up
HUV2 (Day 16–30):Continued follow-up
Symptom-Focused Visit (SFV):Must occur within 2 days of new or worsening symptoms

These visits are mandatory and time-sensitive. Missing a window could result in compliance violations or audit exposure.

Enhanced Symptom Assessments Under the HOPE Tool

Standardized Numeric Scales (0–3)

Clinicians must now use a 0–3 numeric scale to assess and document the severity of key symptoms. This scale promotes consistency across providers and ensures that symptom intensity is captured in a quantifiable, comparable format.

Symptoms to be scored include:

Pain:From no pain (0) to severe pain (3), guiding pain management strategies.
Shortness of Breath (SOB):Helps monitor respiratory distress and adjust interventions.
Anxiety:Supports psychosocial care planning and medication titration.
Nausea: Enables timely antiemetic administration and comfort measures.

These scores must be documented during required visits and any symptom-focused encounters, forming the basis for care planning and outcome tracking.

Additional Required Assessments

Beyond symptom scoring, clinicians must also evaluate:

Skin Integrity: : Identification and staging of pressure injuries, wounds, and other skin breakdowns
Functional Status: Assessment of mobility, self-care ability, and changes in physical function
Dyspnea Monitoring: Ongoing evaluation of breathing difficulty, especially in patients with advanced disease

These assessments provide a fuller picture of patient acuity and are essential for care coordination, especially in interdisciplinary team settings.

Documentation Deadlines

Timeliness is critical under the HOPE framework. CMS has outlined strict documentation windows to ensure assessments are both relevant and actionable.

Symptom-Focused Visits (SFVs)must be documented within 48 hours of identifying new or worsening symptoms. Delays may result in non-compliance and missed opportunities for intervention.
HOPE Update Visits (HUVs)must be completed within their designated timeframes.

Failure to meet these deadlines can lead to claim denials, audit findings, and reimbursement delays. Agencies must ensure that clinicians are aware of visit windows and that EMRs are configured to support timely documentation.

What Remains the Same

While HOPE introduces new requirements, several core practices remain unchanged:

RN-led admissions continue to be the standard for initiating hospice care
LPNs may conduct SFVs when an RN is unavailable, ensuring flexibility in staffing
EMRs such as HospiceMD, Kinnser, Axxess, and Kantime will continue to:

o Auto-schedule required HUVs
o Trigger alerts for upcoming or overdue visits
o Pre-fill data fields to streamline documentation and reduce clinician burden

These systems are being updated to align with HOPE requirements, making it easier for agencies to stay compliant without overhauling their entire workflow.

Clinician and Agency Action Checklist

To stay ahead of the HOPE rollout:

Monitor EMR alerts regularly to avoid missing scheduled HOPE Update Visits (HUVs)
Document Symptom-Focused Visits (SFVs) within 48 hours of any new or worsening symptoms
Use standardized 0–3 scalesconsistently for reporting pain, anxiety, nausea, and shortness of breath
Record both interventions and outcomes—not just the presence of symptoms
Coordinate with your interdisciplinary team to ensure SFV coverage, especially when RN availability is limited

How Cliniqon Supports Your Transition to HOPE

At Cliniqon, we specialize in helping Hospice agencies navigate regulatory changes with precision and confidence. The HOPE rollout is no exception.

Coding and QA Expertise

Our certified coders are trained on HOPE-specific documentation standards
We ensure symptom assessments, interventions, and outcomes are captured accurately
Every chart undergoes thorough QA to reduce denials and audit risk

Clinician Training and Education

We offer targeted training for RNs, LPNs, and interdisciplinary teams
Staff learn how to apply numeric scales, document SFVs, and meet CMS timelines
Ongoing education keeps your team aligned with best practices

EMR Optimization

Our team works directly with platforms like HospiceMD, Kinnser, Axxess, and Kantime
Customized templates and alerts reduce clinician burden and improve data quality

Strategic Planning and Readiness

Cliniqon provides readiness assessments and implementation plans tailored to your agency
We offer proactive guidance to ensure smooth adoption and long-term compliance
Our consultants stay engaged to support your team throughout the transition

Final Thoughts

The HOPE tool marks a new era in hospice care—more structured, more timely, and more data-driven. With Cliniqon by your side, your agency can embrace this change with clarity and confidence. Let us handle the complexities of coding, documentation, and compliance so your clinicians can focus on what matters most: delivering compassionate, high-quality care.