This article is brought to you by Axxess. In this Voices interview, Hospice News interviews Amy Rose, senior product director at Axxess, to explore the impact of CMS's HOPE assessment on hospice and other home care operations. Rose shares early challenges, lessons learned, and insight into how Axxess is helping healthcare providers address new regulatory requirements while maintaining quality care. She also talks about the future of the home care environment and the growing importance of continued collaboration.
Hospice News: What life or career experience has most influenced your current work?
Amy Rose: I could go on and on about this, but my involvement in hospice care was sort of by chance. I was doing volunteer work and completely fell in love with the work. I had never thought of becoming a nurse until then, but I admired the staff's courteous treatment of patients.
At the time, I was volunteering on an inpatient unit, so I had a first-hand front-line view of how amazing that particular level of care was. I felt like they were receiving really good care, and that's what made me want to become a nurse and focus on end-of-life care. It was definitely my most important and career-defining moment and the beginning of my passion for hospice.
What do you think CMS is trying to do by implementing HOPE?
I think major regulatory changes are always driven by a combination of feedback from Medicare beneficiaries and what is emerging as evidence-based care. That's where change happens when CMS listens to Medicare enrollees and their families, especially hospices, where family voices are so important, and when that feedback matches the data.
To me, HOPE is about CMS recognizing that there is an opportunity to improve hospice care and aligning that opportunity with best practices. If you look at most major regulatory updates that CMS has made, CMS is always looking for those golden moments where the feedback and evidence are pointing in the same direction.
I think CMS is trying to make some big changes, especially when it comes to HOPE. The most important aspect is timely and effective symptom management. That was made very clear in the guidelines. Another big point is wound care. The additional questions about scars came as no surprise to many, as the data had been pointing them out for quite some time. There is an opportunity in this field to improve how hospice wounds are managed, and I think CMS is shining a spotlight on that with HOPE.
What were the biggest challenges providers faced during the transition to HOPE and how did your team help overcome those hurdles?
I think one of the biggest challenges with HOPE is that we're really just looking for good hospice care, and we're trying to capture that care in a specific snapshot or moment in time, and that can be difficult.
For example, consider symptom impact assessment. As a hospice nurse, every time you enter a patient's home, whether casually or formally, you are performing a symptom assessment. Symptom management is at the heart of what we do. So suddenly saying, “Healthcare providers need three different symptom impact assessments in the first 30 days of care, each of which may initiate a required 48-hour follow-up,'' turns what was already routine into a very clear and regulated task.
That's the difficult part. What was once natural is now a formal compliance process. The challenge, then, is how to align regulations with what is already part of routine hospice care.
That's where technology comes in. Axxess helps address these challenges by creating a more flexible environment for clinicians while maintaining organizational control. For example, you can capture data every time a nurse answers a HOPE question. Organizations can then decide what to send to the CMS and what makes the most sense.
I also implemented what I call a “force feature”. This is essentially a built-in reminder or hard stop that guides clinicians when regulatory action is required. This is a way to support compliance while allowing nurses to focus on what they've always done: provide excellent care.
Can you share any first-hand lessons learned or learnings from your early HOPE implementations?
One of the biggest challenges at hand is the enormous amount of work (one could even say administrative burden) involved in processing HOPE records.
Before HOPE, the personnel responsible for processing these records simply reviewed and submitted documentation at admission and discharge. Currently, three separate records must be submitted for the first 30 days of care alone. Therefore, their workload has essentially tripled, if not more.
It quickly became clear that this was a big change and we needed to make the process easier for them. Thankfully, Axxess had already built a strong foundation within their platform to support this, but I think it highlights something important across the industry: the people managing these submissions are not necessarily clinicians. Depending on the organization, this may be a volunteer. However, the role they play is important and directly influences quality outcomes.
So for me, the key is to recognize how important that workload really is and look for every opportunity to streamline it so that individuals can thrive without feeling overwhelmed. Especially when results are as important as here.
How does Axxess actively support clients to ensure HOPE compliance and success?
I think the most important thing is to give them visibility into the care that is already being provided and, just as importantly, the care that needs to be done but hasn't been done yet.
This kind of upfront visibility helps prevent things from leaking through the cracks. For example, if a symptom follow-up is scheduled but not yet completed, clinicians may not be aware that it is a regulatory requirement. That's why our software helps clients proactively identify those needs when they try to submit a HOPE record and find that important data is missing or timelines have been missed.
It's not just about what's graphed, it's about what needs to happen and hasn't happened yet. This level of visibility is how we really try to support our clients. We make sure they are compliant and equipped to continue to succeed.
What advice would you give to hospice leaders who are still implementing HOPE?
I challenge them to look back on the past few months and ask, what has really been going on? Missed your HOPE records or symptom follow-up visits?
Currently, CMS is in a unique situation with less regulatory oversight because it has not publicly reported for this quarter. These give organizations time to learn and become familiar with HOPE. It's a safe place to evaluate and adjust. Please feel free to use it. When you see a gap, take advantage of the opportunity. Don't be shy. Use this time to conduct targeted team training.
One area worth looking at is symptom impact data. Are there patterns in how clinicians ask and answer these questions?One of my big concerns is that some clinicians may unintentionally underestimate the impact of symptoms just to avoid follow-up visits. So keep an eye on these trends and make sure it's accurate and relevant.
Another great strategy is to bring HOPE into the IDG conversation. You can use that space to discuss logistics in real time with newly admitted patients. Collaboration like this helps put everything into practice.
Please fill in the blanks. In 2026, the home care industry will be defined as…
Cohesion and the ability to communicate across the continuum.
I want to extend that to in-home care as well as inpatient care. There is a renewed interest in individuals receiving more care at home. Gone are the days when everything had to be done inside a hospital or facility.
If we can truly establish cohesion across the continuum, that is the definition of success. Not just hospice, but hospice, home health, home care, palliative care, all of us. We need to collaborate better within the home care specialty and with inpatient providers. The goal is to create a seamless experience when someone transitions from hospitalization to hospice care and vice versa.
Editor's note: This interview has been edited for length and clarity.
Are you ready to simplify your transition to HOPE and ensure compliance without compromising care? Axxess can help. See how our dedicated hospice solutions and expert guidance can seamlessly bring HOPE to your organization: https://www.axxess.com/hope .
The Voices series is a sponsored content program in which leading executives discuss trends and topics shaping their industries in a Q&A format. For more information about Voices, please contact us. (email protected).
