Look up your Hospice Service and Spending Variation Index (SSVI) score:
Why the SSVI matters
For years, hospice leaders had to infer how CMS viewed their utilization patterns. Now CMS has published that view. The FY 2025 analysis spans more than 6,600 hospices and nearly 157 million hospice days.
CMS is explicit that a high SSVI score does not establish fraud or inappropriate care. But it is equally clear about intent: the index exists to flag potential outliers for targeted education and oversight and to support program integrity work. Once a score is public, it will be read by surveyors, referral partners, health systems building preferred networks, and anyone underwriting a transaction.
In effect, the SSVI is a national benchmark built around the exact patterns drawing the most oversight attention.
What each measure means
The SSVI runs from 0 to 16 and has two halves: a utilization score (0–8) and a non-hospice spending score (0–8). Each is built from what CMS sees in Medicare claims. Thresholds below are CMS’s FY 2025 cut points.
The utilization score (0–8)
A hospice earns one point for each of these eight patterns.
1. No continuous home care or general inpatient care Point if: the hospice provided neither level of care during the year. Hospices are expected to offer all four levels of care when a patient needs them. Never furnishing the two higher levels can signal that symptom crises are going unmanaged, or that admissions skew toward stable patients. It can also simply reflect a small hospice with no inpatient contract.
2. Nursing facility concentration Point if: 40% or more of routine home care (RHC) days were delivered in a nursing home or SNF. Nursing facility residents tend to have longer hospice stays, and oversight bodies have long watched this population for enrollment questions. High concentration often follows referral mix, which makes it explainable when documented.
3. Skilled visits in the final days of life Point if: the share of patients receiving a skilled visit in their final two RHC days is at or below the 25th percentile (≤87.5%). The last days of life are when visits matter most to patients and families. CMS reads a low rate as a gap in end-of-life presence.
4. Live discharge rate Point if: live discharges are at or above the 75th percentile (≥47.0%). A high share of patients leaving hospice alive can suggest admissions of patients who were not terminally ill, or discharges when care became costly.
5. Long stays Point if: the share of discharges with a length of stay of 180+ days is at or above the 75th percentile (≥33.3%). Hospice eligibility requires a prognosis of six months or less. A large share of long stays raises eligibility questions, though some diagnoses, such as dementia, run longer by nature.
6. Skilled nursing time per day Point if: average skilled nursing minutes per RHC day are at or below the 25th percentile (≤9.9 minutes). This is a measure of visit intensity. Low minutes can indicate thin clinical contact relative to the per diem being paid.
7. Weekend skilled visits Point if: the share of weekend RHC days with a skilled visit is at or below the 25th percentile (≤4.8%). Patient needs do not pause on weekends. A low rate points to staffing coverage gaps.
8. Returns within seven days of a live discharge Point if: live discharges followed by a return to the same hospice within seven days are at or above the 75th percentile (≥18.2%). Short discharge-and-return cycles can mean a patient’s costly care, such as a hospitalization, was billed outside the hospice benefit during the gap.
The non-hospice spending score (0–8)
9. Non-hospice Medicare spending Score: 0 if a hospice’s patients had no Medicare spending outside the hospice benefit; otherwise 1–8, based on which of eight roughly equal tiers its spending falls into. The hospice benefit is meant to cover care related to the terminal illness. Significant spending outside it can indicate costs shifting from the hospice to the rest of Medicare.
The market question the score does not answer
The SSVI places a hospice in a national distribution. It does not show where that hospice stands against the providers it actually competes with for referrals.
That gap matters. A score of 8 reads differently in a market where competitors cluster at 9 than in one where they cluster at 4. Nursing facility concentration, length of stay, and live discharge patterns are all shaped by local referral mix. Reading a score without its market is reading half the story.
The more useful questions are comparative:
- How does your score compare to the hospices that share your referral sources? Not the national median; the providers your top SNFs and health systems also discharge to.
- Which measures drive scores up across your market? If every hospice in the market flags nursing facility concentration, that is a market structure story. If only you do, it is an operational one.
- Are high-scoring providers gaining or losing referral share? That is the clearest early signal of how referral sources are responding.
- Where did competitors move between FY 2024 and FY 2025? Movement shows which organizations are stable and which are changing their utilization patterns.
- Do the patterns behind your score track your referral mix? Long stays and nursing facility concentration often follow where patients come from. That is a defensible narrative when you can document it.
What to do in the next quarter
Break your score down measure by measure. A 10 built from spending tiers is a different problem than a 10 built from visit-intensity flags, and each calls for a different response.
Build the market view. Compare your score and your competitors’ scores against local referral sources and admission volume. You will see not just where you stand, but whether standing there is costing you referrals.
Prepare your narrative before someone else writes it. Referral partners and network teams will start asking about these numbers. Hospices that can explain their score in the context of their patient population and market will be far better positioned than those hearing the question for the first time in a partnership review.
