Project Outline: Implementation of Hospice HOPE Measures
Implementation of the CMS Hospice HOPE (Hospice Outcomes & Patient Evaluation) measures across OSF Home Care, establishing a unified, high‑reliability approach to symptom assessment, documentation, and follow‑up care. This initiative required deep collaboration with Operational Leadership, Clinical Education, Clinical Documentation, and Clinical Practice teams to ensure consistent workflows, regulatory readiness, and improved patient outcomes. The implementation resulted in significant improvements in quality metrics, including multiple agencies achieving 99% percentile rankings on HOPE Symptom Follow‑up Visits (SFVs), demonstrating strong adherence to CMS expectations and enhanced patient care delivery.
Key Challenges Identified
Multidisciplinary leadership group including:
Operational Leadership – to align staffing, scheduling, and workflow expectations.
Clinical Education – to develop and deploy standardized training modules.
Clinical Documentation – to ensure documentation workflows matched CMS HOPE guidance.
Clinical Practice – to integrate HOPE requirements into daily clinical operations.
This ensured that every discipline understood its role in the HOPE process and that implementation was consistent across all agencies.
Working with clinical and documentation teams, we redesigned workflows to ensure:
Accurate identification of moderate or severe symptoms during Admission and HOPE Update Visits (HUVs).
Automatic triggers for required SFVs within two calendar days.
Clear separation between assessment visits and follow‑up visits, as required by CMS.
Documentation alignment with HOPE guidance, including correct use of Z0350 (Date Assessment Completed).
These workflows were reinforced through visual job aids, competency checklists, and EMR prompts.
Project Goals
Ensure full compliance with CMS HOPE requirements effective October 2025.
Standardize symptom assessment and follow‑up workflows across all hospice agencies.
Improve timely completion of Symptom Follow‑up Visits (SFVs) for pain and non‑pain symptoms.
Strengthen documentation accuracy and alignment with CMS guidance.
Enhance patient experience and clinical responsiveness at critical points in the hospice journey.
Build a sustainable, education‑driven model for ongoing HOPE competency.
1. Cross‑Functional Alignment
2. Workflow Redesign & Standardization
3. Education & Competency Validation
Clinical Education developed a comprehensive training program that included:
HOPE measure overview and regulatory requirements.
Case‑based examples of when SFVs are triggered.
Documentation expectations for both pain and non‑pain symptoms.
Reinforcement of CMS guidance that up to three SFVs may be required depending on length of stay.
Training was delivered through live sessions, recorded modules, and competency assessments to ensure systemwide readiness.
4. Performance Monitoring & Feedback Loops
Using SHP Executive Advantage reports and internal dashboards, we monitored:
Timeliness of SFVs
Percentile rankings for pain and non‑pain follow‑up
Agency‑level performance trends
Variations requiring targeted coaching
This allowed rapid identification of improvement opportunities and ensured accountability across agencies.
Outcomes & Impact
1. Significant Improvement in HOPE Symptom Follow‑Up Measures
Following implementation:
Pain SFVs: Multiple agencies achieved 99% percentile rankings, demonstrating exceptional performance.
Non‑Pain SFVs: Nearly all agencies performed at or above the SHP National Average (97.61%), with many at 99%.
These results reflect strong adherence to CMS expectations and improved responsiveness to patient needs.
2. Enhanced Clinical Responsiveness
The standardized SFV process ensured that patients experiencing moderate or severe symptoms received timely, in‑person follow‑up within two days, improving comfort, safety, and overall quality of care
3. Strengthened Documentation Accuracy
Collaboration with Clinical Documentation ensured that HOPE data elements were captured correctly and consistently, reducing compliance risk and improving data integrity for CMS reporting.
4. Improved Regulatory Readiness
The initiative positioned OSF Home Care for success in future CMS audits and reporting cycles by ensuring:
Clear workflows
Competent staff
Accurate documentation
Strong performance metrics
5. Sustainable, High‑Reliability Model
The combination of standardized workflows, education, and performance monitoring created a durable structure that supports ongoing HOPE compliance and continuous quality improvement.
Summary
Implementation of the CMS Hospice HOPE measures, aligning operational, clinical, educational, and documentation teams to build a high‑reliability model for symptom assessment and follow‑up. This work significantly improved quality metrics, with many agencies achieving 99% percentile rankings on HOPE Symptom Follow‑up Visits, and strengthened our ability to deliver timely, compassionate, and evidence‑based hospice care.
Variation in symptom assessment practices across agencies.
Inconsistent understanding of when SFVs were required.
Documentation gaps related to HOPE data elements
Need for clearer workflows to ensure SFVs occurred within the required two‑day window.
Operational differences across agencies requiring tailored support.