Addressing New HOPE Tool Requirements in Hospice

Background

Starting October 1, 2025 the Hospice Outcomes and Patient Evaluation (HOPE) tool replaced the Hospice Item Set (HIS) as the system to collect patient-specific data in hospice patients. The HOPE tool was designed and implemented by the Centers for Medicare and Medicare Services (CMS) as a way to help hospices better understand patient care needs. The tool was built with the intention of adding to the patient’s overall plan of care, not just addressing issues at admission and discharge.

The goals of the tool are to provide standardized data collection requirements for the Hospice Quality Reporting Program (HQRP). This data will help to inform and support hospice surveys and certification processes. In addition, it is intended to help to determine payment and quality improvement initiatives.

Requirements

The new HOPE tool will require hospices to submit up to 4 records for each patient admitted to the program. These records include at the time of admission (within 5 days), the time of discharge, and 2 HOPE update visits (HUVs) between days 6-15 of admission and days 16-30 of admission. If a symptom is identified with a severity rated by the patient as moderate or severe, additional follow-up is needed. This Symptom Follow-up Visit (SFV) is expected to occur in-person within 2 calendar days and must be separate from the admission and HUVs.

 The HOPE assessment includes identification and rating of 8 symptoms associated with patients admitted to hospice. 

In addition, documentation of the patient’s pain regimen including whether they are taking a scheduled or as needed opioid as well as their bowel regimen is required. Submissions for these visits must be completed within 30 days of each visit.

Utilization of Pharmacists

Pharmacists are uniquely positioned to assist the hospice care team in addressing and managing the symptoms associated with the HOPE tool. GalenusCare utilizes Precision Pharmacists who specialize in the care of older adults to participate in the care of hospice patients.

One proposed solution to help ease the burden of these additional requirements for the hospice care team is to establish collaborative practice efficiencies that help to manage these symptoms. GalenusCare has developed protocols for addressing the 8 symptoms in the HOPE tool that can be developed into collaborative practice agreements (CPAs) in agreement with the hospice provider. These CPAs would allow the Precision Pharmacist to perform interventions for symptoms per protocol, without the need for provider signature on every order. These protocols will help to streamline workflows and optimize timely delivery of patient care.

 In addition to CPAs, GalenusCare utilizes proprietary Symptom Management Pack for Timely Optimized Medications (SyMPTOM) kits to not only address the 8 HOPE symptoms, but also common comorbidities including heart failure and seizures. These kits include common medications available as an order set to be sent to the patient’s home or place of care. This eliminates the waiting time for receiving these acutely needed medications because they are available on-hand before the symptoms occur. Under a CPA, the medications in the SyMPTOM kit are available for use by the nurse and/or patient with a call to the pharmacist. 

 Precision Pharmacists are trained on the GalenusCare safety analytics tool which helps to identify high risk multi-drug interactions as well as medications associated with an increased risk of falls and cognitive impairment. The tool helps to guide recommendations including changing the time of administration, adjusting doses, and therapeutic substitution or discontinuation. All recommendations and interventions are documented and available for viewing by the entire care team to maintain continuity of care. 

Summary

The new HOPE tool will help to guide patient care as well as quality improvement. This new tool presents opportunities and challenges for hospice organizations nationwide. GalenusCare is proactively addressing challenges by providing efficient pharmacy workflow practices while maintaining patient-centered care.

The combination of the GalenusCare safety analytics, collaborative practice efficiencies, and on-hand medication availability helps to improve overall care of hospice patients. Interventions focused on safety and patient-centered care help to save time, medical costs, and improve satisfaction for all involved including the patients, their caregivers, and the entire hospice care team.