How Hospice Agencies Can Leverage Technology to Flourish Under New CMS Hospice Requirements 

Summary:

Hospice agencies face consistent headwinds, among them a shifting regulatory environment that sometimes imposes new requirements. Among the changes facing providers in 2025 will be the addition of the Hospice Outcomes and Patient Evaluation (HOPE) assessment tool. As agencies begin planning to address HOPE and related changes, Medalogix Muse provides a valuable toolbox for meeting the latest challenges head on and flourishing despite regulatory challenges and staffing scarcity.  

HOPE creates new visit and reporting requirements for hospice providers.

With the finalization of the CMS FY2025 Hospice Wage Index and Payment Rate Update Final Rule come several changes. Among these is the addition of a new assessment tool for hospices called the Hospice Outcomes and Patient Evaluation (HOPE). At its core, HOPE is intended to drive more comprehensive gathering of key patient data than is currently possible using the Hospice Item Set (HIS). It does so by capturing a picture of patient needs throughout the hospice stay instead of just at admission and discharge.

This data is collected through a new requirement for agencies to conduct two HOPE Update Visits (HUVs) and submit reports on each of these visits. Data is required at admission, at 14 days following admission, and again at 14 days after the first HUV. Symptoms generally play a greater role under the new rule, which will help agencies focus more acutely on specific impactful symptoms: pain, anxiety, agitation, dyspnea, nausea, vomiting, constipation, and diarrhea. During the HUV visits, these patient symptoms must be identified as moderate or severe, after which there must be a Symptom Follow-up Visit (SFV) within two business days.

Compliance with these requirements will ultimately feed new quality process measures based on HOPE data: “Timely Reassessment of Pain Impact” and “Timely Reassessment of Non-Pain Symptom Impact.” While these measures will not be publicly reported until 2027, they will be based on prior data, meaning the time to prepare is now.   

In reviewing these requirements, a few readily apparent issues present themselves: (i) the requirement for additional visits with limited staff, (ii) consistently meeting fixed time frames for these visits, and (iii) compliance with newly required reporting. Failure to successfully meet these requirements may have an impact on an agency’s reputation with patients and referral partners alike, once relevant measures begin to be reported. With staffing and resource allocation already a challenge in the industry, tracking, staffing, and reporting on these visits will likely place additional strain on agencies.

The challenges posed by these requirements can be remedied with the right technology.

While we expect that these changes will indeed contribute to improved patient care, the additional burdens they create for providers must be addressed. CMS will continue to collect data through the Hospice Item Set through September 30, 2025, with quality data collection under HOPE beginning on October 1, 2025. This means agencies have time to come up with a plan; Medalogix Muse can be an invaluable part of that plan. 

An essential element of solution development at Medalogix is that we’re always keeping tabs on the industry broadly and regulatory changes specifically, focusing on the resulting challenges posed to the providers we serve. We consistently adapt our solutions to ensure our clients are empowered to excel in the latest regulatory environment. With this in mind, we have developed a holistic approach to helping agencies address these new requirements. These product updates will be rolled out over the next three quarters in preparation for the first data collection under HOPE in Q4 2025, with the earliest pieces coming in Q1. Let’s take a closer look at what agencies can expect:

Q1 2025

Both in preparation for HOPE and in recognition of the greater emphasis placed on symptomology generally with the new rule, Muse will incorporate several features that facilitate tracking and responding to the same key symptoms focused on by CMS: Pain, anxiety, agitation, dyspnea, nausea, vomiting, constipation, and diarrhea. These features are distributed throughout the product, from the Muse homepage to the patient census and individual patient pages:

1. Elevated Symptoms Widget: On the Muse homepage, agencies will benefit from the addition of a new widget that presents a pre-populated list of all patients with one or more symptoms classified as elevated, as recorded in the most recent skilled nursing visit. By default, a symptom will be considered elevated if the patient shares that they are experiencing at a level of 4 or higher, on a 10-point scale, or the response was ‘Y’ for Yes if it wasn’t on a point scale. As with other features, however, Muse enables users to set custom thresholds for elevated symptoms to better reflect agency priorities and resource availability. Users will be able to quickly dive into helping impacted patients with just a click.    

2. Visibility into Symptom Responses: 

• Census Page: It’s important for providers to be able to efficiently address key elevated symptoms. Muse users working through the patient census will be able to review responses on CMS’s 8 priority symptoms from the last skilled nursing visit. This feature will also include the option to specifically distinguish which responses were from a HUV visit. For each symptom that exceeds the agency’s thresholds, a flag will be generated on the census page in the listing for each impacted patient. This will not only help call attention to which patients’ symptoms need to be addressed but will also help clinicians know where to start with visits at a glance.   

• Patient Details Page: As with the census page, symptom flags will appear on individual patient pages, but clicking into the patient view reveals additional functionality. Because patients’ needs are rarely static, it’s important to understand trends in condition and symptoms. On the patient page, Muse will enable users to visualize how patients have rated these key symptoms over time, with changes since the last visit clearly called out. This will help providers anticipate needs and identify recurring issues for more informed care planning. 

In an industry with chronic understaffing and burnout, it’s essential to make compliance with new requirements as simple and undemanding as possible. Taken together, these new Muse features will direct users to patients whose symptoms require attention, without navigating complicated records. Agencies can start building responsiveness to these prompts now, so they can excel as the new “Timely Reassessment of Pain Impact” and “Timely Reassessment of Non-Pain Symptom Impact” measures come into play.

Prior to October 2025

In addition to the symptom-focused features we’ve outlined, Muse updates over the next several months will include features purpose built to help agencies succeed as HOPE begins in October. While the full details of this feature set will take shape as development continues, providers can expect a collection of helpful new resources:

1. HOPE Homepage Widgets: Because providers must already keep track of so many elements of patient care, the goal is to minimize the lift of complying with HUV and SFV timelines. Muse users will be able to use these widgets to understand potential compliance issues at a glance and click directly into individual patients to address scheduling needs. Planned resources include: 

• Patients at Risk of Missing HUV Visit: Present an up-to-date list of patients who have been identified as requiring an HUV visit, but who do not have one scheduled yet.  

• HUV Visit Past Due: Presents a current list of patients identified as having missed the required HUV visit timeline, who do not have a visit scheduled. 

• Add Symptom Follow-Up Visit (SFV): Shows patients who indicated moderate or severe symptoms in the HOPE admission or HUV visit, who do not have an SFV scheduled within 2 days. 

• Past-Due Symptom Follow-up Visit: Lists patients who did not receive SFV within 2 calendar days of identified moderate or severe symptom(s). 

2. Reporting will also be available that allows agency leaders to view missed HUVs and SFVs. This will help identify trends and opportunities for improvement and training as agencies adapt to the latest requirements.  

3. Key symptoms (including admission and HUV visit responses) will be viewable on the symptom burden chart of the Muse census page. 

As with all additions to Medalogix solutions, these features are a targeted toolbox that will allow agencies to respond with confidence as HOPE and related requirements take effect.

Some Final Thoughts

With increasing regulatory complexity comes added difficulty for providers and staff who are already spread too thin. Forward-thinking agencies recognize that the best way to consistently and effectively manage care under these limitations is to partner with the right technologies. The 2024 Hospice News Outlook Survey and Report identified key areas of technology investment for hospice, including predictive analytics and patient engagement, making Muse the ideal tool for hospice providers today. At its core, Muse is a breakthrough predictive analytics solution that helps get patients the right care for their condition. These new features in support of HOPE and symptom-related requirements add to an already robust platform for patient engagement by identifying where agencies should focus for improved care and compliance. Hospice agencies across the country are leveraging Muse to provide proactive right-sized care for an ever-growing number of patients. To learn more about joining them, visit our Muse solution page to set up a free demo.