Webinar Recording: Preparing Teams for Implementation of the HOPE Assessment Tool

The clock is ticking. Starting October 1, 2025, the HOPE (Hospice Outcomes and Patient Evaluation) Assessment Tool becomes a required standard for all Medicare-certified hospices. Is your team ready? 

This webinar will walk you through what the HOPE tool is, why it matters, and what your agency needs to do now to prepare. You’ll get practical guidance from a clinical and compliance lens so you can implement HOPE without added stress or confusion. 

This isn’t just another form. HOPE is CMS’s new method for capturing patient-level data at multiple points in the hospice journey. It’s designed to improve outcomes, support accountability, and replace the HIS tool entirely. We’ll show you what’s new, what to watch out for, and how to operationalize HOPE across your team. 

You’ll Learn How To: 

• Understand the intent and structure of the HOPE assessment tool 
• Prepare for key visit timepoints and in-person data collection 
• Avoid compliance missteps that could delay submissions or impact quality metrics 
• Use QAPIplus to stay organized, audit-ready, and confident for October 1 and beyond 

WEBINAR TRANSCRIPT

We're gonna go ahead and get started. It's 12:00. Welcome to today's session. My name is Doctor Lynn Klima and I'm the Patient Safety Officer and Education Consultant for QAPIplus. So thank you for joining us today. The intention of today is to really just again kind of do a high-level overview for everybody as we.

Get closer to that HOPE implementation, which is still scheduled for October the 1st. So today we're going to go over just some key points related to that implementation and some of the resources that are available within QAPIplus to be able to help support you as we go through today's training because we have.

We have a number of folks from across the United States and we all have, you know, are approaching this in terms of different levels of readiness. We are going to do our Q&A virtually. So if you have any questions, there is a Q&A tab on your screen in teams to go ahead and write your question in.

If you have any thoughts regarding any additional resources that you might need or would be helpful to you, you can also put that information in there and then when we're finished with the webinar today, we will go ahead and compile that information and be sending it out to you as a resource.

You know, for everybody, we'll kind of collate the questions by, you know, content section and send that out as a resource for you. And then the PowerPoint materials for today as well as the recording of the lecture will also be sent to you via e-mail. So if you've signed up, you'll be able to see that there, so.

So again, you know we're gonna kind of go through and then put your questions and comments and any resources you need in that Q&A section. So again, just a little bit about myself. My name is Doctor Lynn Klima. I am working with QAPIplus as Patient Safety Officer.

Educational consultant, but I am a nurse practitioner. I have over 40 years of experience in nursing and I've worked across the entire healthcare continuum as well as in higher education and clinical roles as and also in leadership positions.

Both in acute care, primary care, home care, Hospice and palliative care. So I'm happy to be here with you today facilitating your learning and your education. So what we're going to focus on is really just kind of going through the HOPE assessment tools, purpose and its intended use, analyze any recent changes.

To the tool and explain some of their implications, particularly around the connection to assessment and reporting, looking at again those timelines, right? When are we to do these sections related to HOPE and how that aligns with our visit schedules and incorporating some practice in practical considerations and then.

Look at the resources and tools that are available not only in QAPIplus, but also that are put together by by CMS as well for for folks to be able to look at as they're getting ready to launch this work.

So if you don't know it by now, the HOPE Assessment tool is going to be live on October the 1st. So that's, you know, looming large front and center here in a couple of weeks. And it is a requirement for hospices by CMS. We've been hearing about it for a couple of years now and it's designed.

Really to enhance the quality of care and reporting inpatient outcomes, right? So they're creating some standards related to, you know, what we're going to be, you know, doing and reporting as we move forward. And the tool replaces the HIS, the Hospice Item Set, which primarily is focused on static data reporting and it's, you know, moving in towards more dynamic real-time data collection that is going to allow us to report on, you know, things that reflect the patient's condition and their individual needs as we, you know, complete these assessment visits.

So it's adding more depth to what we're collecting. Just a couple of reminders again related to the timeline. The last HIS collection will be on September 30th, right? So that will be the last data point for HIS data to go in and then data collection using the new HOPE tool will begin.

On October 1st, 2025 and then public reporting, however, won't begin until you know CY 2028. So we have a little bit of time to, you know, kind of get this right and look at data and be able to improve things. So public reporting will happen as we move forward.

With the data. So now the HOPE tool is a standardized patient level data collection tool and it's a mandatory initiative that's being, you know, implemented by CMS. And it's the idea here is again to standardize and improve the quality of care provided by hospices.

And the idea is to replace that HIS item set like we just talked about with real time data. And the difference here is that you know when we were looking at HIS, we're using you know Hospice settings and in in looking at data elements that reflect key care processes identified as best practices.

Practices in the Hospice and those were connected to that HQRP program. But HOPE is more comprehensive. It's a comprehensive assessment tool that captures A broader range of information about the patient's condition and care needs. And so unlike HIS, which focuses on specific processes, the HOPE tool is designed to capture really that whole.

Holistic view of the patient's condition and needs and that includes not only their physical condition, but also their emotional, spirit and social needs. It's also designed to be used more frequently throughout the patient's Hospice journey, allowing for ongoing evaluation and adjustment of the care plan. So when we think about HOPE, we're really looking at 30 days.

For a patient from admission and then that 30 day window if if they're still on service, we're looking at four data points that we're going to be capturing and we'll talk more about those as we go through. Care might be longer than that. You might have a patient on service longer than that, but we're looking at a 30 day period of time.

Patients that are admitted beginning October 1st. If you have patients that you have on service now and they are still there after October 1st, if they're still on your service on October one, you are not going to start a new admission with HOPE at that point. You're just going to complete the HOPE discharge requirement.

Right. So a new start is everybody who's admitted on October 1st and beyond. So those patients will be fully utilizing and data collected using the whole tool. So you know, both tools are essential when we think about, you know, what we're doing, but the idea behind.

HOPE tool is that it's a more comprehensive tool with collecting more information to inform us about how we're going to be providing patient care. So thinking about that, it is really an assessment, right? It's an assessment tool that's considered to be patient-centered and it has a broad range of information about a patient's condition and care needs. And again, it's a design to look at what is the care that we're providing, what are we finding on that assessment in those time points within that 30 days. There may be patients again that are going to be on your service longer than 30 days, but this is a snapshot of a window of those four data points when we, you know, when we admit a patient and the care that we're providing.

Starting within that first 30 days. It also allows us to capture information about the patient's goals of care and their preferences on end-of-life care. So and then again, it's a communication process, a communication tool that helps us within our team members be able to share what's happening with a patient and how do we, you know, work together.

To be able to support that patient in goals and then all of us are also you know deeply you know embedded in quality improvement in QAPI. So it's an opportunity again to really look at you know where are opportunities for improvement, how do we you know want to improve our performance so that we're supporting our patients to be able to achieve the outcome.

Outcomes that are important to them and you know, it's helping, you know, helping kind of support what the patients want as we're moving forward. So and you know the goals of the HOPE tools or the purpose of the HOPE tool is again first being able to enhance that care quality. It's focusing on providing measurable insights.

Into what happens in that patient's care by assessing, you know, different indicators such as symptom severity, pain management, how that's being managed, the quality of life, the eminent death needs. And this allows our team members to be able to tailor care more specifically or more precisely to ensure that there's a better alignment with the patient's needs throughout their journey. It also is going to improve reporting standards, right? So the implementation of HOPE ensures that there's compliance with the the quality reporting program and it's going to track care care outcomes and promote accountability. So by shifting from HIS to HOPE, the reporting process becomes more detailed with patient-centric data.

Accounts for variability or that individualization that's needed for care and then focusing on outcomes. So CMS is aiming to improve Hospice outcomes by using HOPE to pinpoint specific areas where interventions can make a significant difference for that patient and their family, and this ensures that Hospice teams are.

We're actively evaluating the care practices with reliable documentation that helps us know what you know, what's happening with that patient and reflects the progress and challenges faced by each patient and their family as they're as they're, you know, transitioning through care.

Now the HOPE tool, if you have not done so, is available in a PDF version. CMS has some resources on their site to be able to do that. Copy Plus has also has a section HOPE Resources on our website that you can download the HOPE tool and we've been also sending out weekly emails that have some.

Specific information and the tools that are available so that you have them accessible. I think it's very helpful to be able to see have a visual of all those components of each of the different sections that are available in the in the help tool. So section A is not unfamiliar to us, right? We've been collecting this data.

But there are some new additional items and we'll go through a few of those as we move forward. So that's the administrative information, kind of all that intake information that we're getting from patients. Section F is also unchanged. It's the patient preferences. Section I is also a section that we're all familiar with. It has active diagnoses, but they've.

We also expanded that list and added a section to account for comorbidities. So again, this gives us the bigger picture of that whole patient. Who are they? What are all those conditions that they have that are really a part of the complexity and the acuity level of the care and how we as a team would need to prepare and provide the best care for them. Section J has a lot of the the most changes, right? So when you're looking at health conditions, there's new items there and Section M is also new. We have, you know, always do a skin assessment as a part of our comprehensive assessment, but now we'll be reporting on those skin conditions. So we'll talk about that.

Section N, the medications have gone unchanged and then section Z, which is that record administration and sign off is essentially unchanged, although there is one new item on there.

So one of the questions that always comes up is who's who can complete the whole HOPE tool, right. So there's a lot of folks that you know once on service that are contributing to that assessment of that patient. To be clear, the comprehensive assessment must be done in person by an RN and the HOPE follow-up visits, we'll talk about those.

As we move forward also need to be completed by an RN and those visits all need to be done in person. And then we'll talk about a symptom follow-up visit and the requirements for that. But that those visits can be done by either an RN, an LPN or an LVN and that will you know help a little bit in terms of team management and.

Tools that can participate, but obviously there are other people on the team that collect that information as well. That admission data, that the demographic data, where all that is collected and informed, social workers providing information in her visits or his visits or spiritual care, spiritual care advisor, right? We're looking at.

The entire team and the data that we're all, you know, collecting. So a lot of that information is going to be able to be implemented and captured in the tool so that we can be able to know you know what are what's really happening with those patients and how do we put that all together to be able to drive that care and collaborate together to be able to help support.

Support that patient and their family. So some HOPE data elements are to be collected during routine clinical assessments, while other data may be extracted again from the clinical record by the nurse who's, you know, who's reviewing the record and kind of pulling all that information together and you know, creating that.

Comprehensive picture of who the patient is and what's happening with them, what's their story and what are we doing for them and is it helping them? Are we meeting the outcomes that are important to them? It's also important to note that you know CMS is, you know, facilitating or encouraging value-based programming that's going to be able to help.

You know, support not only better care for individuals, better health for populations and be stewards of the resources that we're using to be able to provide care. So again, you know what is the value that that we as providers are are offering to the patients and how is that measured and how is that looked at?

So again, key goals of the CMS HOPE initiative are to standardize care across providers. We want to have a uniform evaluation instrument and so that hospices nationwide can align care practices, making it easier for CMS to assess quality standards across different organizations.

We also want to promote quality assurance. So HOPE enables us to identify gaps and opportunities for improvement and in care delivery and fostering best practices and innovation through tools like the QAPI system or a QAPI approach to being able to look for performance improvement opportunities and it drives accountability, right. We want to make sure that comprehensive.

And accurate assessments required by HOPE help us be accountable for delivering high quality care consistently again to meet the needs of the patients that we're you know supporting. So the HOPE goals will allow us to provide quality data for the HQRP program. It's going to give us additional clinical data that could in the future inform or refine future payments. So how our payment structure could be could be changed based on what we're collecting and HOPE and what seems to be valuable to kind of measure and and report out on. It's also going to be able to help all of us look for performance improvement opportunities. So it's that marriage of performance improvement. We all do interdisciplinary assessment, so it's going to strengthen that and then assist with our team planning and it aligns with the conditions of participation. So we're not doing something in addition to but as a part of.

So when we think about assessing the patients and this is really the the starting point of that while HOPE data elements. So when you look at that tool, it's giving you up, you know ideas in terms of things that are going to contribute to the assessment that are required to be captured, but they aren't going to replace the thorough ongoing assessment of each patient, nor do they replace our clinical practice and clinical judgment, right. So the tool is a structure and provides all those data elements that need to be, you know, reported on during the sequence of of visits that we're going to talk about here. But as a clinician, it really is, you know, our responsibility to.

You know, capture the full picture of that patient, right. So it's not meant to be the only thing we look at. We want to look at that whole picture. And I would say that for the whole team, right. As clinicians, we're looking at that picture of that patient, that patient's story, what's happening, what's their experience and how do we bring those elements into that full scope of that assessment as well. And what do those patients need?

So when we think about what's new in the HOPE tool in Section A, in the administrative section, the new items that they've added are an assessment and documentation of the patient's race, their ethnicity, their preferred language, their living arrangements and the availability of assistance. What's what is that?

Look like in their home, right. So those are things that are often assessed, but now we're documenting it and capturing it and reporting it, right. It's a part of that reporting process under Section I, the active diagnoses we're expanding or they've expanded that diagnosis list from 3 to 10 responses.

And then under Section J, there are a number of new items that are included in the health conditions assessment and we'll talk in depth here about the symptom impact screening. But they're also one of the very first questions on Section J is your assessment of you know.

Is death eminent in the next three days with this particular patient, right. So it's not it's it's based on your clinical assessment. What are you seeing? How does the patient look compared to the last time you saw them and you're you're you know kind of identifying that this is you know death is eminent here and then other updated items are in the inclusion of neuropathic pain.

And then symptom impact screening. So it's not just if the patient is having a symptom, but how is that symptom impacting their everyday life, right. So if I'm having pain, but maybe my pain isn't severe, but I I'm having, it's moderately impacting my ability to sleep at night or maybe it's moderately impacting my ability to be engaged with my family and do things that are important to me. So we're looking at the impact of those symptoms on the patient's quality of life and then skin conditions. We're looking at this section. It has three new items and it's the, you know, the presence of the skin condition, what it is and then what treatment is being done for that particular skin problem the patient is having. So those are the new.

So the difference between HIS and HOPE is that really they're providing the opportunity here to bridge the gap, right. So from admission data, which was HIS data and discharge data, which was HIS and CAPS data, we're going to be adding to update visits in that time frame. So again thinking about.

Your patients who are admitted that 30 day, the 1st 30 days of their care when they're on your service and we're collecting data at that admission time point, at that discharge time point and then those two HOPE update visits that take place in between those visits, right. So what's happening with those patients from admission through discharge and how are we sharing that information and uploading it? Doesn't mean you're only doing 4 visits with this particular patient, but these are the four data collection points and your visit schedule with your patients that you're going to be completing. So those are the milestones really what they're called.

So when we're doing the assessment, the assessment tool details again must be collected by an RN and in person telehealth visit is not acceptable here. Multiple time points. We'll talk about that as we go through the different visit types and the HOPE update visits and then the discharge visit. So those are the time points that we're talking about and we'll talk about symptom symptom follow-up visits in here as well. So when we think about who, who do we have to send this information on? The completion of the HOPE record applies to all patient admissions.

If you're a certified Medicare certified Hospice program, regardless of your payer source of the patient, the patient's age, where they're receiving their Hospice services, or their Hospice length of stay, right? So everybody is included in this and general rules of related to the HOPE tool are that all Medicare certified hospice providers again are required to submit data on all your patient admissions. The HOPE data are collected during your routine clinical assessments that are based on the unique patient assessment visits.

Not all HOPE items are completed at every time point, right? So there's a number of, you know, data from that admission piece that isn't going to necessarily be done at every HUV visit. All HOPE records must be electronically submitted to CMS, so there's an electronic submission.

Data is collected during in-person visits, so real time. So you're collecting what's happening real now. You have to complete all data items, right, not skipping any sections and that that quality reporting is going to be done at that CCN level for when you see your report.

This is a great snippet. CMS has this. This is directly from their website, but this also just kind of talks about when these HOPE visits need to be done. So admission, the definition of that is admission data are collected as a part of the comprehensive assessment of the patient and that time frame is no later than five calendar days.

After the effective date of the Hospice election, HOPE update visit, we'll talk about that. The HOPE update visit one is the collected via in-person visit to the to the patient and it informs the updates to the plan of care and this is done by the RN, right? So what happens at that first?

Visit and HOPE update visit is required on or between days 6 and 15 of the Hospice day and should not be conducted within the first five days after the Hospice election, right? So the first five days you're not doing that update visit, the update visit takes place between days 6 and 15 and the date of the Hospice election just again would be considered day zero. So just a reminder of that HOPE update visit two is again this informs the plan of care and it's collected in person by an RN. So you're going out and doing another assessment.

Reassessment and HOPE visit two is required on or between days 16 and 30 after the Hospice election and then discharge. The data are collected at discharge for any reason and we'll go through the reasons as we go through the slides and this is done at the time of discharge. So these are the data collection time points.

Does it mean that patients getting 4 visits in that 30 days? These are the four data collection time points. Patient's visit schedule is dictated by the plan of care and what the patient needs and what the team has determined as they are, you know, putting that plan of care together for that particular patient.

This is another resource from CMS that's really helpful, talks about the HOPE admission and flow chart and when you would do that. If a patient is put on service and they you know they the patient passes away prior to the effective date, you're not going to necessarily need to do a HOPE was the Hospice.

Is it made in the setting where the hospice services will be initiated? Yes. And so it's kind of walking you through when you should be, you know, doing the HOPE admission flow chart flow. I'm sorry, the HOPE admission and using the tool. So let's start with talking about the definition of admission. So the admission visit again is collected as.

Part of the comprehensive assessment of the patient and the time frame from this is no later than five calendar days after the effective date of admission. It must be collected by an RN in person intended to form the plan of care and it could trigger a symptom follow-up visit. So we'll talk about symptom follow-up visits here. So that's the starting point. That's your first data data point for collection. Within the first five days, you're doing that admission and you're collecting that data.

The next time frame is that HOPE update visit. So this is new, right? So when you're thinking about how you're scheduling your staff, what that schedule looks like when you're building your your plan of care with that patient, maybe when you're doing your supervisory visits, you know how do you put your your visit schedule together for that first?

You know, visit the HUV one and this is again collected in person. It's an in-person assessment by the RN to update the plan of care and this is done between days 6 and 15 of the Hospice day. Remember that the date of election is day zero. You don't want to complete the HUV.

You know, on day 3-4 or five, you want to wait, make sure you're on day six. And again, it's intended to inform the plan of care. That's why you're having the arm go out there and make any adjust, you know, adjustments or changes to that plan of care based on what happens at that visit. And it also can trigger a symptom follow-up visit. So we'll talk about that.

We'll do symptom follow up all together and then HOPE visit update 2 is again a reassessment. It's on or between days 16 and 30 after the Hospice election. It's the last of the HUV visits. The date of election again is day zero. Done by an RN intended to form the plan of care and they trigger a symptom follow up visit. So let's talk about those SFVS is what they're affectionately called. So when you're doing your admission assessment and when you're doing your HUV visits, you're also assessing health conditions, right. So thinking about that health condition form.

And a part of that assessment includes not only assessing the presence of the symptoms, but also the impact of those symptoms, right? So if you have a patient who is scoring and saying pain, for example, that they it's at a moderate or severe level, so that's a score of A2.

Two or a three on those on your HOPE assessment tool. Those patients are required to have a follow-up visit within two calendar days of that symptom, not on the same day. So if you're doing an admission, you come in in the morning, patient has you know an impact score, let's say on shortness of breath at two or three you work with.

The provider to be able to come up with a treatment plan for the patient and patient was significant enough that you feel a visit is is needed to be able to evaluate those symptoms earlier. You can go back that same day and do a separate visit for symptom, you know some symptom follow-up visit and it needs to be done within the first 48 hours. So again, the idea is to assess in person, did the change in the treatment plan make any improvements in terms of that patient's outcomes? Are they more stable? Is there there the impact now less severe, right? We want to be able to see what's happening and make any changes in real time and this is also a new, a new opportunity.

Opportunity and we'll talk more about it as we go forward discharge. So all patients collected at discharge for any reason we're going to be completing that. This is again just as a reminder, all patients after October 1st, we're going to be doing all of our patients, right. So if you have patients from August and September.

That are still on service after October one, you would only be completing the HOPE tool on the discharge component. Any admissions on October one or moving forward, you're going to be doing the full HOPE assessment tool with the admission.

The HUV visits, symptom follow-up visits and the discharge. So you don't need to readmit patients, right? You're gonna close out HIS and you're gonna start with HOPE on October 1. The reasons for discharge are patient passed away, patient revoked. They're no longer terminally ill. They moved out of the area, they transferred to another Hospice and they discharged for cause. Just to let another note about transfer to another Hospice. So if you do have a patient that leaves your service, let's say September 1 and they go to another Hospice, maybe you know on the other side of town or another community, that new receiving hospice would start that HOPE tool, right? They're going to go ahead and start with that admission. And um if you're just going to be doing, you know, their discharge, so you don't need to, you know, the patient will get captured in the system at the receiver end of it, the new, the new hospice.

This is another great slide slide. This was also put by together by CMS and this is I think a great tool to make sure that you have used to educate your staff with the HOPE time points determined by their Hospice day. So again 30 days and the duration of a patient's Hospice table to determine the number of time.

Points a hospice will submit, right. So if you have a patient who is not, you know, on service, you know, by day 30, there's not going to be any data from that HUV visit too. And we'll talk about a couple of examples there. You're going to just do their discharge information. So when you think about those 30 days, it's what happens to each individual patient.

You know, if they, you know, say that they pass away on, you know, day 16, you're obviously not going to have that HUV data for, you know, for that particular patient. So there won't be anything there for them. You'll have admission, HUV one and discharge. So it's going to be based on each individual patient and what happens with them within that 30 day time point, also another great slide, right? So I always look for nice tools to have at my fingertips to be able to look at. This is again from from CMS and it talks about what happens, you know, between days zero and five, you know, let's say the patient dies or is discharged with.

As in five days after the effective date of the Hospice election. So then you're not going to do an HUV one, right? You're just going to have that admission and discharge on that particular patient. So they don't expect the HUV be done. I'm sorry, HUV to be done based on that short length of stay.

Maybe the patient is day five of Hospice, right? And it's been less than five days since the effective date of the Hospice election. You're not doing again. Remember that HUV one is not required. It's too early. You want to wait till that day six to make sure that you're you're doing that HUV one between day six and and 15. Maybe it's day 15 of the Hospice patient, right, that on your on your service and HEV1 is required and you're going to collect that data and they will accept that data, right. And again that's important. Maybe it's day 30 and the patient is still on service. So again the HEV2 is required.

You're gonna have that data updated as well. So you'll have admission, HEV1 and HEV2. What happens if the patient dies on day 10, right? Kind of in that window of time that they're in that HEV1 period. Again, you have between days 6 and 15 where that HUV visit can be done. So if they die on day 10 and you haven't done that visit yet, HUV one's not required, right? However, maybe you did do it. Maybe you did the HUV visit on day eight. You can still submit that information. They will accept it, right? But they're looking at was that HUV visit done by day 16, right? So you may not have had an opportunity to do that yet. Same thing with death discharge. Maybe the patient dies or discharged by on day 25. You would have required have been required to submit your admission and your HUV data. HUV1 data, but HUV2, maybe you didn't get to it yet, maybe you haven't completed it and you have until day 30. But if you did do it, let's say on day 16, you can still submit that data on them that they will accept it, but it is not a requirement, right? So again, depending on each individual patient.

Where they fall in this, what's happening with them, that's going to drive what what was required, what is mandated symptom follow-up visits. So again, this is I think a big opportunity in terms of, you know, looking at your schedules and resources and how do these get scheduled. These are in-person visits Required when any symptom impact is found to be moderate or severe when completing the symptom impact item for admission HUV 1 and HUV 2. So again your your assessment visits when you're admitting a patient or on those two HUV visits you're assessing.

Their health conditions and what's happening with them. And if at any of those time points the patient is rating any of their symptoms, not the presence of the symptom, but the impact of the symptom on their quality of life at A2, which is a moderate level, or a three, a severe level, you're going to need to send somebody out to evaluate that patient And how they're doing within two calendar days, right. So it depends on you know what they're what they rate those symptoms to be. I there, there are some some opportunities to not do those. We'll talk about those in a minute, but this is really something that's really important because again from a quality perspective as a patient wanting to see, you know, did what the changes that we made in the plan of care, were they effective and did they work? And these are in-person follow-ups to be able to see how how the patient's progressing and what they're doing.

So again, this is new. You're going to be assessing for them at admission and on those HUV visits. So you know if a patient you do your HUV visit and they have you know an impact score of a two or a two or three, moderate or severe then within 48 hours or two calendar days of that visit You're going to want to send an RN, LPN or LDN back out to evaluate how that's that's happening. It's a separate visit, right? It can be later that day as a separate visit, but it has to be done. Now some exemptions to this are the patient refused, the patient's unavailable, or the patient is unable to.

1. And one point here that CMS has said very, you know clearly is that if you have a refusal or an unavailable or unable to locate, you need to be able to #1 be able to track who these patients are, so having the ability to know.

Sending that you know the refusal and they're unavailable, unable to locate and you know what your plan was to try to, you know, continue to follow up with them so that we can see that progression, right. Because if it's not documented and should you be, you know, audited or looked at, you want to make sure that you have a clean documentation pattern of you know a refusal and why that took place. So again just to you know recap it, you know the symptom follow up person symptom follow up visits are in person visits there to you know to decrease the burden on teams there they've expanded who can do that from an RN to.

An RN, an LPN or an LVN. So that's a change from when this first came out a couple of years ago. And then depending on the length of stay, there may be up to three symptom follow-up visits that are required over the course of that 30 day period of time, right? So if you have a patient and you go out after the admission visit and they rate something as moderate or severe. Identify a symptom as moderate or severe. You could have a symptom follow-up visit after that admission within 48 hours or two calendar days. HEV one you go out and they might have, you know, still a moderate or severe. You might have to go back out again and do that after you know.

Two calendar days after that and then HUV 2, right. So again, though that is the requirement in terms of collecting what happened, what you know, what the impact was and was there a success rate in terms of helping the patient, you know, achieve the outcome so that they're more comfortable and there's less of an impact on their life.

So you could have up to three of those based on those visits as you go forward. So if I was a manager, one of the things I would be looking at is how am I scheduling, who's available to do those schedules and and what does that look like? And then how are my staff prepared to know what to do and communicate right that a symptom? Visits gonna be needed. If you're not documenting real time right away, how does that get communicated? And that visit gets scheduled so it doesn't get missed within that time frame. You want to capture those. So again, this is those at the time points admission, HUV 1 and HUV 2.

A key point here is that we're submitting data to CMS on those four data points, admission, discharge and those two SUV visits. There's not a separate submission, a set of data for the SFV symptom impact assessments and the visits. Those are all captured within the data assessments that you're doing.

HUV 1 and HUV 2, so you don't need to set send a separate set of data. There's no you know, like every time you SF do an SFV, you don't have to send that data point up, right? It's going to be captured in the documentation of the tool already.

So this again, another great slide, you know, is an SFV needed if a patient is scoring A moderate or severe impact. And the big take away here is it's not the presence of the symptom, it's the impact of the symptom. So if you have somebody who's saying and it's data that's collected from your assessment, right? So if the patient's saying, oh, my pain's a moderate level, but it's not, yeah, I don't really notice it bothering with the family saying or the spouse is saying he's not sleeping well at night. He's very restless. I notice that he can't get comfortable. His pain medication is not working. You're taking all that into consideration, right?

Assessing that patient and what is that impact on that patient to make that determination of moderate or severe. And then you're going to go ahead and make sure that you're doing that within two calendar days in person. And then if they aren't having those symptoms in impact at the level of moderate or severe, you're still documenting and it's giving.

You a level one, but you're not required to go out and do a symptom follow up visit. You may have additional visits for that patient depending on you know what you're seeing in your assessment, but it's not related to the symptoms and it's not data that's required to be captured. This is also another good graphic from.

That kind of is a visual display of how you would pepper those visits in within a 30 day period of time. So maybe you're admitting the patient here on the 1st, the nurse goes out and does her first initial assessment. There was an impact score of two or three. So they did the symptom follow-up visit. Then the patient already had a nurse visit scheduled on you know Friday and then there you have your HUV window. You can see that the within that HUV window you can align it with when the nurse typically goes out. Same thing with nurse visit you know here in that HUV.

You know, anywhere between there she has another visit. So you've actually done 2 visits, but there's an opportunity to collect that data for that symptom tool. And then for HUV 2, same thing, there's the HUV 2 visit patient had symptoms. You went ahead and did that symptom assessment and then a visit and assess them.

There and then the patient passed away. So you can see, you know this is a patient on service for almost 30 days and how that would fit. So you're you're not eliminating, you're not changing what your regular visit structure will be. It's an opportunity to be able to kind of look at the big picture and how do you fit it all together. And you know and and then this is focused on nurses, but there are other team members like you know, home health aide or social work, pastoral care that are potentially, you know, involved in in their treatment plan as well. So it's a a nice visual.

There are some special circumstances, right? So again, we talked about administrative discharges. You might not need to do a discharge, a record at that, you know, at that time. The CMS manual gives some very good details related to that. And then we talked about transfers earlier with a patient transfer from 1 Hospice to another, you know, the person who admit had them on service would be doing a discharge from them and then the new Hospice would be doing a new admission and the HUV time points are going to be required and expected from either Hospice depending on where the patient was at the time the visits were due, right. So if you admitted somebody they were there for you know 15 days, you're gonna need to make sure that there's an HUV visit on there. Then they leave, you're gonna discharge them, they're gonna go to a new Hospice, they're gonna do the admission, and then that new Hospice is gonna have to pick up that HUV schedule from there. They'll do their HUV 1 and HUV 2, again, depending on how long the patient is on service.

So clearly this, you know, this is a change, right? And change is challenging. It's, you know, sometimes brings some chaos. But if we think about the the impact on the patients and what we're providing to them, this is an opportunity again to really reinforce that individualization.

In our presence with them, you know, in terms of being able to support them in this end of life journey. So you know for teams this is you know and I know everybody's been working on this. This is not new hospice teams. You're going to have to look at your workflows, your training and where you're documenting, right. So your EMR vendors have been instrumental and at where in your EMR tools you have the opportunity to document and capture this information. It's really more of a dynamic process. It's not just data collection, but it's really using real-time assessments and you know, incorporating that into the measurement, right? Are are we meeting our patients needs?

And you know, between now and the 15th, it's, you know, doing whatever practices you can. How are we going to schedule these things? Where are we getting our reports from? Where are we documenting everything right? Try to do as much as you can in advance of the 1st to be able to be ready for what happens on October 1. So it involves everybody, right? Nurses, your medical directors, your physicians, your interdisciplinary team members. So everyone should know about these changes. And I would also challenge you to talk to your family and caregivers, patients, families and caregivers about this, not your family.

Because they they should know, right? This is part of their experience and their satisfaction of what we're doing and what we're why it's important for them to be honest about the symptoms that they're having and what they can expect of us, right. This is part of that patient engagement that's going to not only improve the care that they get, but also enhance the care that they get, but also improve their satisfaction with the services that we're each going to be providing. We already talked about this. The clinical assessments are completed by an RN. The LPN or LVN can do the symptom follow-up visits and can document that, but there may be other administrative data.

That's collected by, you know, you know, anybody on your team is part of your workflows there, right? So when you look at the conditions of participation and your policies and procedures and roles within your organization, there are components to that tool that might be captured by other roles, right? So your policies and job aids or job codes are going to be able to just, you know, differentiate and define that. But you also need to make sure that in that section Z, that record administration, that any person completing any portion of HOPE needs to be providing a signature and what their role was within that. So that's kind of the I on the T crossing the T dotting the I section. Here is the data set. Again, this is a good slide. I'm not going to go through each one of these individually, but it is what we've kind of talked about, what those sections are and what's been expanded and what's included in there. So it's kind of a nice snapshot so you can see.

=We've already been doing this, but maybe I need to focus on these elements for staff education and training and knowing what to do. The other note here is that acceptable sources of documentation. So your primary sources are data that are collected through those in person assessments, right when you're seeing that patient and then the clinical care processes as they are completed. So you're trying to get stuff real time, right? You're not looking at historical records. You're really trying to get things real time. Who are the team members that saw the patient this week? What's been happening with them? What do I see today? What's the family reporting? What's the patient saying? And that's really the the nature of how you're going to answer those questions in that tool. And you know, you might be extracting some information in the clinical record to be able to help with that, right? So like maybe you're looking at race, maybe you're looking at ethnicity. There are the pieces of information that are in that record that are going to be captured there.

In particular, HOPE care processes is in is, you know, it's not documented in your record at all. So again, it's not documented, it didn't get done. You want to make sure that you are, you know, cleanly documenting all those components so that you can report on all those components HOPE submission deadlines. So again, thinking about how do we send this data up to HOPE the goals? The target for HOPE is that providers must submit at least 90% of all their HOPE records by the 30 day submission deadline to be compliant.

So when you think about 30 days, it's 30 days from admission, 30 date from 30 days from each HEV completion date, and 30 days from the discharge date. So talk with within your organization who's accountable for setting that data up. Do not wait till the 30 days, right? So you want to make sure it's been submitted, accepted.

In a clean submission and there aren't any things that you have to correct and modify, right? So don't wait till the very last minute to send it and then it gets it's a rejected record. So 90% right, 90% completion, 90% accuracy and submission and having a workflow where that data is, you know, submitted routinely, maybe on a weekly basis for all admissions, you know, So what is your process? Who are the people that are going to be involved in that? Who's going to be assuring that those records are clean, signed off and ready to go? And if there's a rejection report, you know, what's the process to clean that up?

In a time, so you make that 30 day window complete. So here's again a nice slide that talks about that 30 day, you know, completion rate, I'm sorry, collection and submission date 30 days from that time frame.

So CMS recommends that it's at the discretion of each hospice to develop internal policies for completing and submitting HOPE records according to current requirements. The completion goal is neither a requirement. So when they're talking about completion here, it's the time frame for the documentation. When does that documentation? So if I'm the nurse and I'm doing the admission. What's the timeframe for me to get that documentation completed and signed off on? So that's really, you know, an organizational directive and what they're recommending is that your admission records, you know within that 14 day window that that admission is completed and signed off.

Right. So not waiting, not delaying 14 days, two weeks, the HOPE update records, they're also recommending within 14 days. So if you do your HOPE update visit, you have a 14 day window to make sure that that documentation is completed. Now obviously you know the longer you take to be able to do that, that's going to.

You know, kind of trip up the process along the way. So you know, what is your organizational standard for getting that documentation completed in a timely way as real-time as possible so that there's not this record that's outstanding there and maybe gets missed for a submission?

And then HOPE discharge, discharge documentation is recommended to be done within seven days and then you know again completed so that it it you have a clean record. And then all of this, if these timelines are completed, you know within that 14 days the the completion, the submission is within 30 days of when the visit was done. So looking at you know your opportunities within your organization about completion of records and if there are any things that could potentially trip you out there. So this is a compliance you know target in terms of HOPE submission they're looking at that you're sending.

Your records at a minimum and that you have a 90%, you know, acceptance rate. So that's a high target, right. So anything you could do now, I believe they're opening up some test file sites now through Ikeys to be able to do that. So practice, right, get that right and start monitoring right away as you're doing this beyond October 1, you know, looking at your records to assure that they're clean and all data fields are collected so that you don't have those rejections, right? And the the the challenge here is that if we don't meet that chance, the threshold that they're that they're proposing or there's no data that we're submitting, the provider is going to be subject to a 4% payment deduction, you know, in the coordinating APU year for pay for reporting. So again, this has an impact on on reimbursement back to the house.

So again, a reminder, the submission deadlines are 30 days. That's kind of easy to remember. If you're in home care, you have very similar experience with Oasis data, but we want to make sure that you are, it's accepted within that 30 days, right? You don't want to have a rejection submitted on day 30 and then you have rejections and miss that time.

So being as proactive and ahead of schedule as possible. So in terms of assuring or you know, helping support compliance, you know if you haven't already done so, make sure staff who you know are going to be completing these assessment tool items are knowledgeable about them. What's incomplete and included where in your EMR you know the the workflow is to document these things where it's going to get captured.

How they, you know, do all of those pieces and then make sure that they're completing and and getting those records finalized and submitted as quickly as possible, right. We don't want to have them held out, right. Real-time charting is issue everywhere. So it's, you know, it's definitely something to really kind of help support and and promote.

And encourage and then submitting those HOPE records and then looking at those SFV reports to make sure that those records are accepted without errors. So another great opportunity if you start to see those errors in your SFV reports, that's a PIP opportunity, right? Quality improvement, how do we correct this? Where are we maybe falling short? What do we need?

We need to do and put a a PIP in place so that we can improve that. So that's all the, you know, high-level meat of everything. We have been putting out resources through QAPIplus and will continue to do so as this rolls out. A couple of key places to look are in, you know, your emails.

We've been doing a weekly e-mail blast with resources that are there. We also have our website which has a HOPE section with not only FAQs, but just resources for HOPE in general. Those are some great places to look and then we will be putting some things in QAPIplus if you're a QAPIplus user. As well into the QAPIplus portal. So a couple of things if you have not done so I suspect most people probably have is download that full HOPE manual should become your your little Bible. We have provided that resource on our web page. We kind of went through all the CMS things and try to you know organize them so that because there's a lot there as well and prioritize them. Look at a project timeline. We're close to implementation now.

At the the launch of October 1 to, you know, not only make sure your staff understands, you know where documentation is taking place, you have tested a file, you have an Ikeys account. If you haven't already done that, that would be really important, you know, to kind of jump into and then you know, start looking at are there opportunities, do you see any gaps?

In practice and you know now early on and then once we launch, you know, how are you going to monitor week by week? Is there a way to look at your admissions, get reports, look at admissions? Are you scheduling SFV visits? You know, really be on it as you're getting launched so that you can, you know, correct, do that plan, do check, act cycle and correct and rectify right away. Here's some of the resources that we've put out there, a readiness assessment tool and a gaps analysis. There are will be some compliance audit tools forthcoming so that there'll be audit materials in copy plus to be able to help you with auditing and then some resources for education and training for staff and team members.

So again, October one, HOPE 's going to launch. We're going to be starting with all new admissions, starting with October one, starting with the full HOPE assessment tool. And you know, we're anybody who's still on service from prior to October one, you're just going to need to do the discharge visit.

Then we have a little bit of time, not much to really kind of make sure that we're getting all the I's dotted and the T's crossed over the next couple of months to get this right. We're not going to see any public scoring and outcome scoring in public reporting until fiscal year 2028. So we have a little bit of time, but you know as you all know change is hard and there's a lot of opportunities to to clean some things up. So we want to you know kind of keep keep it moving really if you will meet with your EHR group. A lot of the EHR vendors have been doing some great webinars for their customers and they have had some really you know they've been and being able to make this easier for us as we move forward. So chat with them again, touch base with them, make sure you guys are all on the same page. You know where the HOPE things are so you can reinforce that with your staff. If you have not set up an Ikeys account, please, as soon as you hang up with this call today, go and do that and engage your staff, right?

We want to make sure that they understand who's involved, who's going to complete these files, you know, who are your folks are that are going to be your officers that are going to have access to Ikeys and then you know are going to be monitoring that data submission. Now CMS had wanted folks to have that iQUES account by September 10th. They recommended one person. The preference is to have two folks be their provider security officials, their PSOs. So make sure you've done that and there's some some resource information here as well as on our website.

Right on this slide to be able to assure that you know how to do iQUES if you haven't and you know, test that all out now because everything takes time and you know we don't want to wait till the last minute to be able to do that. And again, start to look at your staffing, your scheduling, your resources, policies, right. So you know, workflows, you know, job aids, you know, what are those things that you need to be putting in place as you're doing this so that you have the tools and resources internally to your organization to be successful as you're moving forward. So I know this is a big change. It's been coming for a long time. It's still on target for October one. So it really if you think about it. A patient experience, it's really you know transform I think what patients feel from us, right. We all are there to help our patients and it's going to give us an opportunity to really capture that comprehensive patient-centered data that we're collecting and doing and submitting respond to those patient needs in a way that.

That's going to be meaningful for them. So you know, you know, try to embrace it, be positive about it and integrate it into your practice and you know, always know that we're all really trying to strive to provide our patients with the best possible care. So that's really the outcome of this and trying to encourage it in a positive way. We are nearly out of time, so I'm not going to go through these common questions, but this slide deck will be emailed to you after the call today and all of your questions will be provided with answers and we'll be submitting that out and as well as your recording of today’s session for you to share and use within your staff. And then here's some common resources as well that you can find with links to them. So that's it. I thank you for your time today. I encourage you and give you, you know, some strong uplift and support as you're, you know, ready to kind of take on this challenge and embrace it, right. So it is going to help us with, you know, improving and enhancing solid patient care. So thank you for your time today and I look forward to supporting you as we go through this journey together. Thank you.