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Claims-based composite score flagging utilization and spending outliers
A claims-based nine-measure composite that flags hospices with outlier utilization and spending patterns; finalized in CMS-1851-F (July 30, 2026) and publicly reported on the CMS Hospice Center webpage.
The Service and Spending Variation Index (SSVI) is a claims-based composite score, ranging from 0 to 16, that CMS uses to flag hospices whose utilization and spending patterns may warrant added transparency and oversight. A higher score signals greater potential concern — CMS is explicit that it is not a finding of fraud, waste, or abuse.
CMS introduced the SSVI in the FY2027 Hospice Wage Index and Payment Rate Update proposed rule (CMS-1851-P), published in the Federal Register on April 6, 2026, with the comment period closing June 1, 2026. CMS finalized the SSVI in the FY2027 final rule (CMS-1851-F), issued July 30, 2026, with no substantive changes to the methodology.
The total SSVI runs from 0 to 16 and is calculated from nine claims-based metrics. The score is the sum of two components: a non-hospice spending sub-score built on eight separate spending thresholds, and a utilization sub-score drawn from eight claims-based metrics, each worth up to one point. Metrics include non-hospice spending during a hospice election, the percentage of beneficiaries discharged with a length of stay of 180 days or more, average minutes per routine home care day, and the percentage of live discharges where the beneficiary returns to the same hospice within seven days, among others.
CMS calculated the index using FY2024 and FY2025 claims data. Provider-level data and each facility's score are posted publicly on the CMS Hospice Center webpage. Facilities with high-end scores may be subject to additional review to assess potential program integrity or compliance issues.
The SSVI converts a hospice's own claims history into a public number visible to regulators, referral partners, and prospective buyers, and a high score invites scrutiny without requiring a formal finding of wrongdoing. Long lengths of stay and elevated non-hospice spending — often clinically typical for certain diagnoses — translate directly into SSVI points with no case-mix risk adjustment. Because the index is built on FY2024-FY2025 claims, it reflects care already delivered; scores cannot be corrected retroactively, only managed through future utilization and documentation practices. A high SSVI is an early-warning signal that can precede program-integrity review, not a penalty determination in itself.
SSVI stands for Service and Spending Variation Index. It is a CMS claims-based composite score that measures how far a hospice's utilization and non-hospice spending patterns diverge from CMS's target ranges [3].
No. CMS states the SSVI is not a direct indicator of fraud, waste, or abuse; a high score represents a potentially higher level of concern that may warrant increased transparency and oversight, not a determination of wrongdoing [4].
Yes. It was proposed in CMS-1851-P (April 6, 2026) and finalized with no substantive methodology changes in CMS-1851-F (July 30, 2026). Provider-level SSVI scores for FY2024 and FY2025 are published on the CMS Hospice Center webpage (CMS FY2027 final rule fact sheet)[2].
CMS calculated the SSVI using FY2024 and FY2025 claims data, reporting a separate spending score, utilization score, and total for each hospice (https://www.cms.gov/files/document/ssvi-overview.pdf; CMS FY2027 final rule fact sheet)[2].
Vitalis Care is the end-of-life care app that helps hospices deliver compassionate care — while staying on top of schedules, field operations, documentation, compliance, and reimbursement.
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