Hospice Quality Measures on Care Compare Explained
What the hospice quality measures on Care Compare mean, how the switch from HIS to HOPE affects them, their limits, and how to report a concern.
Where these measures come from
Medicare-certified hospices take part in the Hospice Quality Reporting Program (HQRP), and hospices that do not submit required data face a reduction in their annual Medicare payment update. CMS publishes results on Care Compare, refreshing data quarterly in February, May, August, and November (CMS: Hospice public reporting). Besides the family survey (covered in our CAHPS guide), Care Compare shows measures built from two sources: patient assessment records that hospices submit to CMS, and Medicare claims.
From the HIS to HOPE
For about a decade, hospices recorded admission and discharge information on a form called the Hospice Item Set (HIS). On October 1, 2025, CMS replaced it with the Hospice Outcomes and Patient Evaluation (HOPE) tool (CMS: HOPE; CMS: HIS). HOPE collects information at admission and discharge and adds up to two update visits during the first 30 days of care.
Because quality scores are calculated from past data, the switch shows up on Care Compare gradually. CMS's February 2026 program update shows that Care Compare refreshes throughout 2026 still use HIS data from 2024 and 2025. The first HOPE data is expected in the February 2027 refresh, and November 2027 is expected to be the first refresh using only HOPE data (CMS HQRP Forum, February 2026). So if you see a note about HIS on a hospice's page in 2026, the information is still current for its time period.
The comprehensive assessment measure
The full name is the Hospice and Palliative Care Composite Process Measure: Comprehensive Assessment at Admission. It reports the share of patients for whom the hospice completed all seven applicable care processes when the patient was admitted (CMS: HQRP current measures):
- Asking about beliefs and values, if the patient wishes
- Asking about treatment preferences
- Screening for pain, and a fuller pain assessment when needed
- Screening for shortness of breath, and treating it when needed
- Offering a bowel regimen to patients started on opioid pain medicine
A higher percentage is better. This measure continues under HOPE. Its limits: it is a process measure. It shows whether important steps were completed and recorded at admission, not whether pain or breathlessness was actually relieved in the days that followed.
Hospice Visits in the Last Days of Life
You may see references to an older measure called "Hospice Visits when Death is Imminent." CMS removed that HIS-based measure and replaced it, starting with public reporting in 2022, with a claims-based measure: Hospice Visits in the Last Days of Life (HVLDL) (CMS public reporting tip sheet). HVLDL reports the share of patients who received in-person visits from a registered nurse or a medical social worker on at least two of their final three days of life (CMS: HQRP current measures). Higher is better.
Its limits: the last days of life are hard to predict, some families prefer privacy at the end, and visits from other staff, such as chaplains or aides, do not count toward this measure. A lower score is a good reason to ask how the hospice supports families when death is near.
The Hospice Care Index
The Hospice Care Index (HCI) is a single score from 0 to 10, calculated from Medicare claims. A hospice earns one point for each of ten indicators on which its performance meets a set threshold (CMS: HQRP current measures). The indicators include:
- Whether continuous home care or general inpatient care was provided at all
- Gaps in skilled nursing visits, and skilled nursing minutes per routine home care day and on weekends
- Early and late live discharges (patients leaving hospice alive)
- Two kinds of burdensome transitions involving discharge from hospice followed by hospitalization
- Medicare spending per beneficiary
- Visits near death
Higher is better. Its limits: Care Compare shows only the total, not which indicators a hospice met. Because it is based on billing data, it describes patterns of service rather than the experience of care, and CMS excludes hospices with too few discharges to calculate it reliably.
Measures coming later
CMS has adopted two new HOPE-based measures, Timely Follow-up for Pain Impact and Timely Follow-up for Non-Pain Symptom Impact. They look at whether the hospice made a follow-up visit within two days after an assessment found that pain or other symptoms were having a moderate or severe impact on the patient. CMS has said public reporting will begin no sooner than fiscal year 2028, with a first posting anticipated in late 2027 (CMS HQRP Forum, February 2026).
How to report a concern
Quality scores cannot capture everything. If you have a concern about a hospice's care, CMS suggests several options (CMS: How to file a complaint about hospice care):
- Talk to the hospice first. Patients have the right to voice grievances without reprisal, and the hospice must address them (42 CFR 418.52).
- Your state survey agency inspects hospices and investigates complaints about improper care or unsafe conditions. Contact information is on CMS's state survey agency list.
- Your BFCC-QIO reviews quality-of-care complaints from people with Medicare and handles fast appeals if a hospice says a patient no longer qualifies (CMS: BFCC-QIOs; Medicare fast appeals).
- 1-800-MEDICARE (1-800-633-4227) can help you find the right office.
This guide is general information, not medical or legal advice.