Hospice Quality Reporting Program Explained

The Hospice Quality Reporting Program (HQRP) shapes how hospice services are measured and reported under Medicare. Managed by the Centers for Medicare & Medicaid Services (CMS), HQRP affects payment updates, public visibility on Care Compare, and organizational reputation. This article explains how HQRP works, upcoming changes, and strategies for compliance and quality growth.

How HQRP Works

HQRP requires all Medicare-certified hospice providers to submit quality data through three sources:

• The Hospice Item Set (HIS)

• Medicare claims (for certain measures)

• The CAHPS® Hospice Survey

Hospice providers who do not meet reporting deadlines may face a 4 percent reduction in their annual market basket update,¹ effectively reducing reimbursement for the following fiscal year. HQRP data are also published publicly via CMS Care Compare for informed consumer and referral decision-making.

1. Hospice Item Set (HIS) Reporting

The Hospice Item Set (HIS) is a standardized data collection tool used to assess and report patient care processes at both admission and discharge. All Medicare-certified hospices are required to submit HIS data for every patient, regardless of age, payer, or care setting.

HIS focuses on key clinical actions, including:

• Screening and treatment for pain and dyspnea

• Discussions about opioid risks

• Documentation of spiritual, emotional, and treatment preferences
  
  

Hospices must submit HIS-Admission and HIS-Discharge records within 30 calendar days of the patient’s admission and discharge dates. To maintain compliance and avoid a payment reduction, providers must ensure that at least 90 percent of their HIS records are submitted and accepted on time each calendar year.¹ Ensuring timely and accurate submission is a core compliance requirement.

2. CAHPS® Hospice Survey

This survey gathers feedback from families and caregivers after a patient’s passing, capturing their experiences with communication, care quality, and emotional support.

Hospices must contract with a CMS-approved vendor to administer the CAHPS® Hospice Survey, which includes 47 questions across eight quality domains:²

• Communication with family

• Getting timely help

• Treating the patient with respect

• Emotional and spiritual support

• Help for pain and symptoms

• Training the family to care for the patient

• Rating of this hospice

• Willingness to recommend this hospice

Hospices with 50 or more survey-eligible decedents in a reference year are required to participate to receive their full Annual Payment Update (APU).² There are two types of exemptions:

• Size exemption: For hospices with fewer than 50 survey-eligible patient/family caregiver pairs (must be applied for annually).

• Newness exemption: Automatically granted to hospices that receive their CMS Certification Number after January 1 of the data collection year.

To remain compliant and avoid a payment reduction, hospices must ensure that their approved vendor submits complete CAHPS® data each quarter and that all submissions are accepted by CMS.

3. CMS Claims-Based Measures

In addition to HIS and CAHPS data, HQRP includes quality measures derived from Medicare claims. These claims-based measures currently include:

• Hospice Visits in the Last Days of Life (HVLDL): Evaluates the percentage of patients who received visits from hospice staff in the final days of life

• Hospice Care Index (HCI): A composite measure assessing multiple indicators of care quality, including visit patterns and care transitions

Claims-based data complement HIS and CAHPS results by providing a broader, multidimensional view of clinical performance and patient experience.

4. Transition to the HOPE Tool

CMS is implementing the Hospice Outcomes & Patient Evaluation (HOPE) tool to replace HIS, beginning October 1, 2025. While HIS captures retrospective chart data at admission and discharge, HOPE is a real-time patient assessment designed to improve care planning and quality measurement throughout the hospice episode.³

HOPE introduces HOPE Update Visits (HUVs), which are standardized assessment points conducted during the first 30 days of care. Providers may be required to submit up to two HUVs per patient, depending on the length of the hospice stay.³

To prepare effectively for this transition, hospice providers can view our free webinar recording, "Hospice Quality Reporting Program: Where Quality Meets Compliance".

HOPE is intended to:

• Capture real-time patient and family care needs

• Support proactive, individualized care planning

• Create a longitudinal dataset to inform future quality measures and potential payment refinements

To prepare, hospice organizations should:

1. Review EHR workflows to support routine assessment scheduling

2. Train staff on HOPE’s item sets, data entry, and care integration

3. Monitor CMS updates and training materials

5. Public Reporting: Visibility and Response

Quality data submitted through the HQRP are publicly reported on CMS Care Compare, increasing transparency for patients, families, referral sources, and payers. This includes data from the Hospice Item Set (HIS), the CAHPS® Hospice Survey, and Medicare claims.

Publicly reported metrics include:

• Timely and complete admission assessments

• Symptom screening and management (e.g., pain, dyspnea)

• CAHPS® summary scores on communication, emotional support, and respect

• Claims-based quality indicators such as Hospice Visits in the Last Days of Life (HVLDL) and the Hospice Care Index (HCI)

These ratings help consumers make informed choices, guide referral decisions, and highlight areas for quality improvement and organizational growth.

Actionable Strategies for Success

Embed Quality in Training

Educate team members on why regular assessments and symptom management matter. This promotes buy-in and improves data integrity.

Monitor Performance Continuously

Set up internal tools or dashboards that mirror CMS metrics. Regularly review HIS completion rates, CAHPS response summaries, and claims-based quality indicators.

Optimize Documentation Tools

Evaluate EHR or hospice management software for batch HIS submission and automated reminders. For HOPE, ensure systems support repeat assessments and seamless data transmission to CMS.

Building a Culture of Quality

HQRP provides a structure for measuring hospice care delivery through clinical and experiential data. From HIS and CAHPS to claims-based metrics and the incoming HOPE tool, each component supports detailed quality evaluation.

Hospice leaders who integrate structured training, continuous monitoring, and technology-supported workflows can maintain compliance, improve performance, and strengthen organizational reputation.

To learn how Medbridge supports hospice and home health providers with training solutions, documentation platforms, and compliance avenues, visit our home health software page.

References

1. Centers for Medicare & Medicaid Services. (2021, September). Getting started with the HQRP. https://www.cms.gov/files/document/getting-started-hqrpseptember2021.pdf

2. Centers for Medicare & Medicaid Services. (n.d.). CAHPS® Hospice Survey. U.S. Department of Health and Human Services. https://www.cms.gov/medicare/quality/hospice/cahpsr-hospice-survey

3. Centers for Medicare & Medicaid Services. (n.d.). Hospice Outcomes and Patient Evaluation (HOPE). U.S. Department of Health and Human Services. https://www.cms.gov/medicare/quality/hospice/hope