Proposed HOPE tool seeks to fill hospice data gaps but needs tweaking, experts say

Although the proposed Hospice Outcome and Patient Evaluation (HOPE) tool intends to close important data gaps surrounding end-of-life care, there is more work to be done to improve hospice quality reporting.

“So much more information needs to be gathered from these patients,” Katy Barnett, director of home care and hospice operations and policy at LeadingAge, the association of nonprofit aging services providers, which include hospices, told McKnight’s Home Care Daily Pulse in an interview. “It’s just not there in the tool right now.”

The Centers for Medicare & Medicaid Services unveiled HOPE in its proposed hospice rule for 2025. At the time, industry advocates praised the tool for its potential for data collection to provide a clearer picture of the patients’ needs. But so much surrounding hospice care is still yet unknown, according to Barnett, and the HOPE tool may not do quite enough to answer stakeholders’ questions.

Part of the problem is that the HOPE tool would not require enough check-ins on hospice patients. CMS’ proposal would require HOPE data to be collected within 30 days of a patient’s admission, and depending on their length of stay, their hospice update visit and discharge. But for patients with longer stays, these checkpoints may be too few and far between, according to Barnett.

“It’s great that we’re doing this, it’s great to see more consistent reporting and information, but it stops at 30 days,” she said. “We know a lot of hospice patients — 25% — [go beyond] the first certification period. So you’re missing all of this information.”

HOPE also would include fewer quality measures than other assessment tools, such as the Outcomes and Assessment Information Set used in home health, Barnett noted.

“There’s a lot of testing and process that goes into these assessments, and that’s why they take so long, because you want to know what that patient is dealing with and how to best support them. Right now the tool doesn’t really get into that in real deep detail, so we can’t develop quality metrics that really will get outcomes.”

These concerns with the HOPE tool point to a larger problem. There is a dearth of information surrounding hospice patients and their quality of care. The HOPE tool may not solve this problem, Barnett noted, but it could represent a good first step.

“[HOPE] isn’t going to give us a deluge of new data, but it’s going to get us moving in the right direction to really understand the patient populations,” she said.