Navigating the Future of Hospice Care

Hospice providers are facing a period of significant change—driven by new quality reporting requirements, evolving reimbursement models, increased regulatory scrutiny and heightened expectations for patient-centered care. During our recent McBee webinar, our team of hospice experts outlined the most pressing topics that providers must prepare for in 2025 and beyond. Here’s what every hospice organization should have on its radar.

HOPE is Coming: Prepare for Data-Driven Accountability 

The Hospice Outcomes and Patient Evaluation (HOPE) tool is set to replace the Hospice Item Set (HIS) on October 1, 2025. HOPE collects detailed, real-time clinical data throughout the patient’s care journey. This shift will place a much greater emphasis on interdisciplinary documentation, timely symptom reassessment and accurate coding of all diagnoses—not just those considered related. 

Hospices must act now to: 

• Train staff on the HOPE assessment structure and timepoints (e.g., HUVs and SFVs) 
• Implement workflows for timely symptom follow-up visits 
• Monitor new HOPE-based quality measures tied to pain and symptom reassessments 

Survey Readiness: Constant, Not Episodic 

Survey expectations are evolving—especially in light of CMS’ now-paused Hospice Special Focus Program (SFP). Even with the suspension of the program, surveys criteria remain active, including the use of condition-level deficiencies, complaint history and CAHPS scores to identify underperforming agencies. 

Survey readiness should be a constant discipline, not a last-minute scramble. Key strategies include: 

• Conducting mock surveys with a focus on documentation and interdisciplinary communication 
• Ensuring policies are up-to-date and accessible 
• Designating a primary and back-up survey manager with clear roles during survey events 

Accurate Coding: Precision Impacts Reimbursement & Quality 

Coding under hospice is more than a billing function—it’s a clinical representation of the patient’s terminal condition and comorbidities. With CMS emphasizing reporting of all diagnoses, hospices must ensure that the principal diagnosis clearly supports a prognosis of six months or less, and that related conditions are coded appropriately. 

Key coding takeaways: 

• Use the most specific, clinically accurate terminal diagnosis to support eligibility 
• Ensure comorbidities that impact the plan of care are included, even if not related to the terminal condition 
• Work closely with medical directors to ensure documentation aligns with coding selections, particularly for unrelated conditions, which must be explicitly justified 

Inaccurate or vague coding not only risks denial—it also weakens your agency’s data integrity under HOPE and other CMS initiatives. 

Documentation: Paint the Full Clinical Picture 

Accurate, timely and interdisciplinary documentation is critical in justifying hospice eligibility, care decisions and ongoing recertification. While coding captures diagnostic detail, narrative documentation provides the context that validates why hospice services are needed and appropriate. 

Examples of effective documentation practices: 

• Clearly outline the primary illness trajectory, showing functional or cognitive decline over time (e.g., decreased ADL performance, increasing symptom burden, weight loss or reduced oral intake) 
• Use objective and subjective findings to support terminal status—such as increased falls, fatigue or inability to recover from infections 
• Document family or caregiver insights when they reveal important changes in condition or unmet needs 
• Ensure each discipline contributes meaningfully to the plan of care, reflecting coordination across nursing, social work, spiritual care and therapy when applicable 

Documentation should reflect why hospice is the right level of care, not just what care was delivered. This clarity strengthens your compliance posture and improves survey outcomes. 

Data-Driven Strategy: Not Just Reporting—Improving 

Data transparency isn’t just a CMS expectation—it’s a leadership imperative. Metrics like HVLDL scores, length of stay, live discharge rate and coding patterns should be routinely reviewed to inform quality improvement efforts. 

Leaders should empower their teams to: 

• Use dashboards to monitor trends in near real-time 
• Align team goals with publicly reported measures 
• Make coding, compliance and quality discussions part of routine IDG meetings 

 Final Thought: Success is Proactive, Not Reactive 

The future of hospice care is complex—but manageable for agencies that act early, stay informed, and keep compliance and quality at the center of everything they do. Whether it’s preparing for HOPE, strengthening documentation or shoring up survey readiness, the most successful providers will be those who embed regulatory readiness into their daily operations.

McBee experts discussed strategies to navigate upcoming changes in hospice care in a recent webinar. Click here to listen to the full webinar.

About the Author

Michelle Horner, Manager of Clinical Consulting & Education

Michelle Horner, BSN, RN, HCS-O, HCS-D, HCS-H, COS-S is the Clinical Consulting and Education Manager for McBee. With over 30 years of healthcare experience, Michelle Horner is a leading expert in home health and hospice. As Manager of Clinical Consulting & Education at McBee, she excels in Quality, Clinical, and Regulatory Consulting, designing innovative training programs that elevate care standards. A sought-after speaker at industry events, Michelle captivates audiences with her expertise and passion. She serves on the AHCC’s Board of Medical Specialty Coding and Compliance Certification HCS-D and HCS-O Committees, shaping industry standards. Renowned for driving impactful financial and clinical outcomes, Michelle is dedicated to advancing the quality of care in the home care sector.