HOPE Guidance Manual v1.02, Item F2200

Timepoint(s) Item Completed

Admission (ADM)

Item-Specific Instructions

• Item completion should be based on what is included in the clinical record.

• Review the clinical record for information regarding patient preference for hospitalization.

• Consider care processes and discussions documented in the clinical record that took place during preadmission or educational visits, as well as those during the admission assessment.

• Review all response choices before making a selection.

• Use the date on which the discussion first occurred.

• For the purposes of this item, “hospitalization” does not include hospice care (such as general inpatient

or respite level of care) provided in contracted acute care settings or hospital-based inpatient hospice

units.

o This is not referring to the patient's choice of a particular facility, but rather if the patient/caregiver

has a preference regarding hospitalization as a care option to consider.

o Examples of discussions with the patient or family that could be considered include but are not

limited to those where the patient and/or caregiver:

 expressed the desire to keep the patient at home and not to be transferred/admitted to a hospital

again.

 discussed specific situations in which they feel hospitalization would be the preferred location

for their care.

 state that, at this time, they are unsure if being transferred/admitted to a hospital for care is

something they would consider.

A. Was the patient/responsible party asked about preference regarding hospitalization?

• Code 0, No, if there is no documentation that the hospice discussed (or attempted to discuss)

preference regarding hospitalization with the patient or responsible party. Skip to Item F3000,

Spiritual/Existential Concerns.

o This applies to situations where there is no documentation that a discussion occurred or was

attempted with the patient or responsible party (e.g., the patient was unable to discuss and/or the

responsible party was unavailable).

• Code 1, Yes, and discussion occurred, if there is documentation that the hospice discussed

preference regarding hospitalization with the patient or responsible party.

o This applies to situations where there is documentation that the hospice brought up the topic of

hospitalization, engaged, and/or had a conversation with the patient, the responsible party, or both.

The conversation does not have to result in the patient stating a preference for or against

hospitalization.

• Code 2, Yes, but the patient/responsible party refused to discuss, if there is documentation

that the hospice asked about preference regarding hospitalization, but the patient or responsible party

refused to discuss or was unable to discuss. The hospice was not successful in engaging the patient

and/or responsible party in a discussion.

o This applies to situations where there is documentation that the hospice attempted to have a

conversation with the patient and responsible party, but both the patient and responsible party

explicitly refused to discuss the topic with the hospice (e.g., “I don’t want to talk about this”) or the

patient was unable to discuss because of their clinical status and the responsible party explicitly

refused to discuss.

B. Date the patient/responsible party was first asked about preference regarding

hospitalization.

• Enter the date the hospice first discussed (or attempted to discuss) patient preference regarding

hospitalization.

• Multiple discussions regarding the use of CPR may be documented in the clinical record.

• Completion of this item is based on the first dated discussion about preference regarding the

hospitalization that appears in the clinical record.

Coding Tips

• Evidence of a discussion could be documented in the clinical record or via a Do Not Hospitalize (DNH)

order, or equivalent.

• A newly completed order or form that is completed after the admission to hospice or during a

preadmission visit is sufficient provided there is evidence of involvement from the patient/responsible

party (e.g., signature of the patient/ responsible party, or documentation that DNH preference was

confirmed with patient/responsible party).

• Orders alone or short statements in the clinical record, such as “DNH”, without evidence of discussion

or involvement from the patient/responsible party, are not sufficient to code “Yes” for F2200A.

• For pre-existing orders or forms signed in a prior care setting, the hospice should re-affirm the patient’s

preferences and document them in the clinical record.

Examples

1. Patient admitted on 08-01-2025. Clinical note dated 08-01-2025 reads, “Talked with the patient about

preference for readmission to hospital; the patient was hesitant and stated they weren’t sure. Told the

patient we could discuss at a later date.”

Coding: F2200A: Was the patient/responsible party asked about preference regarding hospitalization?

would be coded “1, Yes, and discussion occurred.” F2200B: Date the patient/responsible party was first

asked about preference regarding hospitalization: Enter “08-01-2025.”

Rationale: The most appropriate response option is “1” because although the patient did not express a

clear preference regarding hospitalization, a discussion occurred.

2. Patient admitted 08-01-2025. The clinical record for the patient includes a POLST form completed in

the prior care setting indicating the selection of comfort-oriented care, including a desire to avoid

hospitalization, which is dated 07-15-2025. There is no discussion documented in the clinical record on

this topic.

Coding: F2200A: Was the patient/responsible party asked about preference regarding hospitalization?

would be coded “0, No.” Skip to Item F3000, Spiritual/Existential Concerns.

Rationale: Although the patient has a recently dated POLST, it was signed in a prior care setting.

There is no documentation in the clinical record to indicate that the hospice re-confirmed the patient’s

preferences for comfort-oriented care and avoidance of hospitalization. If a statement such as “All

POLST treatment preferences confirmed with the responsible party, patient’s daughter” was included,

that would be sufficient to code “1, Yes.”