HQRP Forum

America's hospice care system faces a critical deadline as providers scramble to adopt new quality measurement tools, risking hefty financial penalties that could strain services for terminally ill patients.

The Centers for Medicare & Medicaid Services (CMS) mandated a shift from the old Hospice Item Set (HIS) to the Hospice Outcomes and Patient Evaluation (HOPE) tool starting October 1, 2025. This change aims to capture real-time patient data rather than retrospective records, potentially improving care planning and outcomes in end-of-life services. But with submissions for the legacy system ending on February 16, 2026, many hospices are racing against time to comply.

Recent updates exacerbate the pressure. On February 23, 2026, key reports for reviewing and correcting data will migrate to the internet Quality Improvement and Evaluation System (iQIES), a new platform replacing the outdated Quality Improvement and Evaluation System (QIES). By March 15, 2026, all quality measure reports must be accessed via iQIES, forcing providers to adapt quickly or face disruptions.

Fiscal year 2026 brought a 2.6% payment increase for hospices, adding an estimated $750 million nationwide compared to 2025. Yet this boost comes with strings: providers must meet a 90% data submission threshold under HOPE to avoid a 4% penalty, which could turn the raise into a net loss. The annual per-patient cap rose to $35,361.44 from $34,465.34, reflecting inflation but also tightening scrutiny on high-volume operators.

These reforms stem from a final rule issued in August 2025, correcting prior errors and soliciting input on future digital quality measures. The push for better data follows years of criticism that existing metrics failed to fully reflect hospice performance, amid rising Medicare spending on end-of-life care—over $23 billion in 2024.

Hospice providers, numbering around 5,900 nationwide, bear the brunt. Non-compliance could slash revenues, leading to staff cuts or reduced services in an industry already grappling with workforce shortages. Smaller rural hospices, often with limited IT resources, are especially vulnerable.

Patients and families stand to gain from enhanced transparency. Publicly reported quality scores on Medicare.gov, refreshed quarterly—including the February 2026 update now live—help inform choices. Better measures could drive improvements in pain management, emotional support, and timely interventions, affecting millions who rely on hospice annually.

Yet the transition highlights broader tensions in U.S. healthcare: balancing innovation with feasibility. As deadlines approach, industry groups warn of potential chaos, urging CMS for more guidance. The stakes are high—subpar implementation risks undermining trust in a vital service for the dying.