HOPE In Practice: Lessons From the Field [Free Webinar]
After months of preparation, training, and anticipation, the Hospice Outcomes and Patient Evaluation (HOPE) tool is now part of everyday clinical life for hospice agencies across the country. And while the implementation itself is behind us, the real work—embedding HOPE into workflows that already feel stretched thin—is very much ongoing.
In our webinar, "HOPE In Practice: Lessons From the Field", Maxwell TEC's own Senior Consultant Keri Shockley sat down with experienced hospice consultant, Holly Davis, to talk through what agencies are encountering now that HOPE is live. Because Davis has practiced across multiple states and care settings, her perspective reflects what she's seeing in the field, from bedside to back office.
Read on to review some of our top takeaways from their webinar conversation.
Six to seven months into HOPE, Davis notes that the biggest challenge for hospice agencies isn’t learning what HOPE requires; it’s operationalizing it—making it work in the context of real clinical visits, real patients, and real staff who are already at capacity.
One of the most common pain points is inconsistent interpretation of the requirements themselves. What day is day zero? When exactly must an HUV visit occur? When does a symptom follow-up visit get triggered?
These questions have direct compliance consequences. A visit completed one day too soon may not count. A documentation code entered incorrectly in the EMR may not be recognized as a qualifying visit at all.
The solution, Davis explains, is moving from broad general training to role-specific education. Admission nurses need to understand what’s expected of them. RN case managers—who now carry new HOPE responsibilities that historically weren’t part of follow-up visits—need targeted guidance. Items such as decision trees, quick-reference tools, and case-based examples help staff think through the clinical scenarios they’re facing in the field.
The admission visit has always been demanding. Nurses are obtaining election benefits, signing consents, reviewing medications, conducting head-to-toe assessments, and walking patients and families through after-hours contact procedures.
Adding HOPE assessment requirements into that visit without thoughtfully restructuring how the visit flows? It makes an already full workflow feel longer and more fragmented.
When workflow isn’t intentionally and mindfully adjusted, documentation burden increases, quality suffers, and the ripple effects reach staffing. Our experts have found that those agencies handling HOPE most successfully have redesigned their admission and follow-up visit workflows to embed HOPE questions into the natural rhythm of the clinical conversation.
That requires training clinicians not only on what to document, but how to gather HOPE-relevant information organically and the order in which documentation should be completed. Scheduling expectations also need to reflect the added time that HOPE requires, ensuring that clinicians are set up for realistic completion rather than perpetual catch-up.
One of the more nuanced challenges Davis highlights involves how HOPE scoring actually works. The symptom follow-up visit is triggered not by the severity of a symptom score, but by the impact that symptom has on the patient.
A patient who scores a nine on pain but has lived with chronic pain for years may not be functionally impacted the same way as a patient experiencing that level of pain for the first time. Clinicians may understand this distinction, but often struggle to translate it consistently into compliant HOPE documentation.
The result is scoring that doesn’t align with the supporting narrative, documentation that doesn’t fully capture what the nurse observed, and HOPE responses that reflect habit and individual style more than standardized practice.
Hospice agencies need to define what good HOPE documentation looks like. Davis recommends building examples of compliant versus non-compliant documentation, creating opportunities for peer review, and using real chart examples in staff meetings. When clinicians can see problematic documentation for themselves, the standard becomes much clearer than any policy description alone.
Checking the box on HOPE training is not "one and done", and it does not mean your staff is fully competent in HOPE. Davis notes that many agencies completed initial education and moved on—only to find the same questions and errors resurfacing.
HOPE brought changes not just to the admission visit, but to follow-up visits as well, pulling RN case managers into new documentation responsibilities they haven’t historically held. That’s a significant shift that requires ongoing reinforcement.
Effective approaches include integrating HOPE education into new hire orientation, incorporating HOPE into annual competency assessments and QAPI, and using office hours and peer support structures to build real-time coaching into clinical operations. When leaders and managers can address documentation issues in the moment, they have the best chance of changing behavior.
Most agencies don’t yet have enough HOPE data to identify meaningful trends, and many haven’t designed audit processes specifically around HOPE. Traditional chart audits weren’t built to capture HOPE requirements, and the new quality outcome measures require a different lens.
Davis suggests building a HOPE-focused audit routine now, before issues become systemic. That means tracking required visits at the patient level from admission—knowing when each HUV and symptom follow-up visit is due and monitoring compliance in near-real time.
For multi-branch organizations, trending findings by branch and by visit type can help reveal whether a problem is localized to a specific clinician or location, or if it reflects a broader operational gap.
Even when an EMR is technically HOPE-compliant, it may not be operationally efficient. For example, documentation screens don’t always match the natural flow of a clinical assessment; new features added to support HOPE are unfamiliar to staff; and templates may not include the right prompts.
Davis notes that when staff don’t like the way the system moves them through a visit, they'll find workarounds—workarounds that create inconsistency and compliance risk.
Hospice agencies need to actively evaluate their EMR and ask important questions: does this support efficient, accurate HOPE completion? Where are staff relying on workarounds, and why? How can the system be optimized to meet regulatory requirements without creating unnecessary friction?
Leaders can’t manage what they can’t see. And right now, many hospice leaders aren’t sure where their HOPE risk areas are. Some EMRs have developed dashboards and reports to support monitoring; others have not. And where dashboards exist, they vary significantly in usability.
The hospice agencies best positioned for ongoing HOPE compliance are those where leadership has meaningful, accessible insight into visit completion, documentation trends, and emerging compliance gaps—at the clinician, branch, and organizational levels.
Building that visibility now, while HOPE data is still in its early stages, creates the foundation agencies will need as quality reporting demands continue to grow.
The HOPE challenges our consultants discussed aren’t simply hypothetical. These issues reflect what our consultants are actively working through with hospice agencies right now.
Maxwell TEC’s hospice consulting services are designed to help organizations assess where they stand with HOPE compliance, identify operational and documentation gaps, and build the workflows, education structures, and audit practices needed to sustain performance.
Whether your hospice agency is seeking a targeted HOPE readiness assessment, workflow optimization support, or guidance for ongoing compliance monitoring, Maxwell TEC's team of experts brings the deep hospice expertise and hands-on field experience needed for HOPE success.