January 12 2026
OASIS Answers
Categories: HOPE

Untangling the Confusion Around HOPE SFVs: Part 3 – How to Operationalize SFVs

by Marian Essey, RN, BSN, COS-C

How to Operationalize SFVs

In Part 1 of this series, we established that an SFV is tied to the HOPE Admission or an HUV1 or HUV2. In Part 2 of this series, we covered how SFVs are documented as part of the assessment that triggered them—whether that’s the HOPE Admission or the HUV—and how to handle an SFV that occurs exactly as planned. In that example, the SFV was assigned to the same nurse who completed the HOPE Admission, which is the simplest scenario.

This is by far the easiest scenario. But what happens when there are complications? What happens when the patient refuses the visit or the person that makes the visit that triggers the SFV is NOT the person scheduled to make the SFV?

First, let’s review what we know about SFVs that can impact our actions:

When should and SFV occur? The SFV may occur anytime within two calendar days, or later on the same day as the assessment where the initial finding of a moderate or severe symptom impact was determined.
Who conducts an SFV? SFV Items (J2052 – Symptom Follow-up Visit and J2053 – SFV Symptom Impact) can only be conducted by an RN or LPN/LVN.
Where is the SFV documented? The SFV is part of the HOPE Admission or HUV that triggered the symptom follow-up visit.

Let’s look at some of the more challenging scenarios related to SFVs and how to potentially operationalize the SFV for these real-life situations. These are examples of potential scenarios and solutions. Hospice policies and procedures, clinical record systems, regulations, and internal communication systems may impact the processes at a hospice. Due to these potential limitations, hospice processes may not always align with the operational solutions depicted in these scenarios.

Scenario 1: The nurse assigned to the SFV is NOT the same nurse that conducted the triggering assessment.

It’s possible that the person scheduled to make the SFV will not be the person who conducted the HOPE assessment that triggered the SFV. To ensure the SFV goes smoothly, the hospice should:

Establish processes for handing off the HOPE assessment from the staff person conducting the HOPE assessment that triggered the SFV (the HOPE-Admission, HUV1, or HUV2) to the nurse conducting the SFV, and
Establish processes for completing the triggering assessment AFTER the SFV has been conducted.

Let’s look at this situation with a real-life example. Sammy RN conducts the HOPE Admission and Andy, RN conducts the associated SFV. Per agency policy, Sammy completes all the HOPE Admission items except the 2 SFV items (J2052 – Symptom Follow-up Visit and J2053 – SFV Symptom Impact).

Sammy alerts Andy when the HOPE Admission is ready for Andy using the agency’s electronic messaging system. Andy visits the patient for the SFV, opens the HOPE Admission (started by Sammy), completes SFV items J2052 – Symptom Follow-up Visit and J2053 – SFV Symptom Impact, and signs the HOPE Admission, alerting the HOPE reviewers at the hospice that the HOPE Admission is complete and ready for review.

Scenario 2: An LPN is assigned to the SFV.

In this scenario, the LPN making the SFV was not the staff person conducting the triggering assessment. When an LPN is scheduled to make the SFV, the hospice should establish the processes discussed in Scenario 1 AND should also identify if there are any additional processes required when an LPN conducts the SFV.

Here’s an example of how this may occur. Note that information in bold highlights processes that differ from Scenario

1. Sammy RN conducts the HOPE Update Visit 1. Chloe LPN is scheduled for the SFV. Per agency policy, Sammy completes all the HUV1 items except the 2 SFV items (J2052 – Symptom Follow-up Visit and J2053 – SFV Symptom Impact) and item Z0350 – Date Assessment was Completed. Z0350 is required for all HUVs.

Sammy alerts Chloe when the HUV is ready using the agency’s electronic messaging system. Chloe visits the patient for the SFV, opens the HUV (started by Sammy), completes SFV items J2052 – Symptom Follow-up Visit and J2053 – SFV Symptom Impact and alerts the supervisor when the 2 SFV items are completed using the hospice’s electronic messaging system.

The supervisor reviews the HUV record, ensuring all information is complete and completes item Z0350 – Date Assessment was Completed. The supervisor signs the HUV record, alerting the HOPE reviewers at the hospice that the HUV is complete and ready for review.

Scenario 3: The patient could not be reached for the SFV.

There will be times when a patient cannot be reached or will not want an SFV and the hospice cannot conduct the SFV. What happens in these situations?

Regardless of the SFV occurring or not, the hospice completes HOPE item

J2052 – Symptom Follow-up Visit. In these instances:
J2052A – Was an In-person SFV completed? Is coded as “0. No”.
J2052B – Date of the In-Person SFV – Is skipped
J2052C – Reason SFV not completed – Is completed, and one response is selected.

To operationalize SFVs, hospices will need to consider their processes for outreach and scheduling SFVs. The following are questions that hospices may consider in establishing their processes:

Who will conduct the outreach to the patient/family/caregiver to schedule the SFV?
If a patient/family/caregiver declines the SFV or cannot be reached, who will continue to outreach to them to schedule an SFV? Is this always the nurse assigned to conduct the SFV, or is it a scheduler or supervisor?
How many attempts will be made to reach the patient before the hospice completes item J2052 – Symptom Follow-up Visit?
Will the hospice make a “cold call” to the patient’s residence if they cannot be reached by phone to schedule the SFV?
How can the hospice ensure that the HOPE is finalized when an SFV does not occur as planned?
Who is ultimately responsible for completing the HOPE assessment? The staff conducting the triggering assessment (HOPE Admission, HUV1, or HUV2), the staff assigned the SFV, the clinical supervisor, the scheduler, others??

We hope (pun intended!) you found these scenarios helpful in planning your SFV processes.

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