Hospice Quality Reporting Program

Starting on October 1, 2025, the Centers for Medicare & Medicaid Services (CMS) developed the (HOPE) Tool as a standardized patient assessment instrument to enhance hospice quality reporting and improve the quality of care for hospice patients. It replaces the Hospice Item Set (HIS) as part of the Hospice Quality Reporting Program (HQRP). HOPE emphasizes patient-level data collection and includes several domains to provide a comprehensive assessment of a patient's condition and care needs 

1. Pain
2. Shortness of Breath
3. Anxiety
4. Nausea
5. Vomiting
6. Diarrhea
7. Constipation
8. Agitation

 The HVLDL measure assesses hospice staff visits to patients at the end of life. This measure is constructed from Medicare hospice claims records. It indicates the hospice provider’s proportion of patients who have received in-person visits from a registered nurse or medical social worker on at least two out of the final three days of the patient’s life.

Note: The last three days are defined as: (Day 1) the day of death, (Day 2) the day prior to death, and (Day 3) the day two days prior to death.

The Hospice Care Index (HCI) captures care processes occurring throughout the hospice stay, between admission and discharge. The HCI is a single measure comprising ten indicators calculated from Medicare claims data. The indicators included in the HCI are listed below this table.

The index design of the HCI simultaneously monitors all ten indicators. Collectively these indicators represent different aspects of hospice service and thereby characterize hospices comprehensively, rather than on just a single care dimension. Each indicator equally affects the single HCI score, reflecting the equal importance of each aspect of care delivered from admission to discharge.

1. Continuous Home Care (CHC) or General Inpatient (GIP) Provided
2. Gaps in Skilled Nursing Visits
3. Early Live Discharges
4. Late Live Discharges
5. Burdensome Transitions (Type 1) – Live Discharges from Hospice Followed by Hospitalization and Subsequent Hospice Readmission
6. Burdensome Transitions (Type 2) – Live Discharges from Hospice Followed by Hospitalization with the Patient Dying in the Hospital
7. Per-beneficiary Medicare Spending
8. Skilled Nursing Care Minutes per Routine Home Care (RHC) Day
9. Skilled Nursing Minutes on Weekends
10. Visits Near Death

1. Hospice team communication 
2. Getting timely care 
3. Treating family member with respect 
4. Providing emotional support
5. Support for religious and spiritual beliefs
6. Getting help for symptoms
7. Information continuity
8. Understanding the side effects of pain medication
9. Teach How to Care for the Patient at Home