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Find any Medicare-certified hospice's CMS Service and Spending Variation Index score, and see which measures drove it. The Service and Spending Variation Index (SSVI) is a CMS score that rates every Medicare-certified hospice from 0 to 16 on nine claims-based measures — eight utilisation measures worth one point each, plus a non-hospice spending score worth up to eight.
Based on publicly available FY2025 CMS data — the most recent available.
SSVI stands for Service and Spending Variation Index — a CMS score, from 0 to 16, that rates every Medicare-certified hospice on nine claims-based measures: eight utilization measures worth one point each, plus a non-hospice spending score worth up to eight. CMS uses it to flag hospices whose billing patterns differ from typical ones and to decide where to direct education or scrutiny; it is not a quality rating, a penalty, or a fraud finding.
The score is calculated per agency, made public, and built entirely from previously submitted claims; it cannot be revised after the fact through documentation. It reflects what a hospice actually billed in FY2024 and FY2025.
CMS describes the SSVI as a descriptive tool that scores hospices across several dimensions at once rather than on any single one. The stated intent is to identify agencies that are unusual on multiple independent measures, not on just one.
Medicare expects that when a patient elects hospice, nearly all of their care is covered under the hospice benefit. In FY2024, Medicare paid over $2.8 billion for items and services outside the hospice benefit for patients enrolled in hospice, across Parts A, B and D. That figure is the stated basis for the SSVI.
Non-hospice spending under Parts A and B rose from roughly $790 million in FY2020 to over $2 billion in FY2024 — a 160% increase, with $770 million of that added between FY2023 and FY2024 alone. Part D non-hospice spending grew 47% over the same period, from $552.9 million to $813.1 million.
One line item accounts for a large share of the increase. Carrier claims for ulcers rose from $18 million in FY2020 to $714 million in FY2024 — a rise of nearly 4,000% — driven largely by skin substitutes, which made up 47% of carrier claim spending. CMS states in the final rule that pressure ulcers in bedbound and chairbound terminal patients are foreseeable, related to the terminal condition, and are the hospice's responsibility.
Two additional figures from the final rule:
CMS states its purposes for the SSVI as: assessing utilization patterns, identifying variation between providers, supporting program-integrity work, and helping beneficiaries and families make more informed choices.
The score has two halves, each worth up to 8 points.
SSVI = Non-Hospice Spending Score (0–8) + Utilization Score (0–8)
If a hospice has no reported non-hospice spending, it scores 0. Every other hospice is sorted by total non-hospice spending and divided into eight roughly equal groups — octiles. Higher spending means more points.
Two things follow from this design. First, it is total spending, not spending per patient, so a large hospice will tend to score higher than a small one with identical practices. CMS was asked about this and kept the total-dollar version deliberately, on the grounds that a per-day measure would mask exactly the high-volume providers it wants visible. CMS notes that the top 100 hospices for total non-hospice spending include agencies ranging from under 5,000 hospice days to over 25,000.
Second, this half is relative: a hospice is ranked against every other hospice, so its point total can shift even when its own spending does not change.
Eight measures, one point each if a hospice crosses the threshold.
The thresholds are not clinical standards. For most measures, CMS set the cut at the 25th or 75th percentile, capturing roughly the quartile of providers with the most potentially concerning pattern on that measure. Crossing a threshold indicates a hospice falls in the bottom quarter on that measure, not that an error occurred. CMS describes the quartile cut as a preliminary filter and states that triggering it on a single measure is not uncommon.
Thresholds below are the FY2025 values published with the FY2027 final rule on August 3, 2026. Because most are set at a percentile, they move each year as the underlying distribution moves.
Definitional notes relevant to reproducing a score independently:
Most hospices score somewhere in the middle. Because six of the eight utilization thresholds are set at a quartile, and because most hospices have some non-hospice spending, a score of zero is rare and a score in the mid-single digits is typical.
The median is 6, and scores of 5 through 8 account for 54% of all hospices. No hospice scored 16, and exactly one scored 15. (Median and share figures are calculated from the distribution CMS published in Table 10 of the final rule; CMS does not publish these figures directly.)
CMS states in the final rule that it considers a hospice with 13 or more points an outlier, at the 99th percentile of the distribution. Sixty-nine hospices meet that threshold on FY2025 claims. CMS also states that every hospice scoring 13 or above sits in the top two octiles for non-hospice spending and scores above 4 on utilization — high spending and unusual utilization together, rather than either alone.
Trade press commentary has used 10 as a "high-risk" threshold. That figure does not appear in CMS's final rule; CMS's stated outlier threshold is 13.
A high score means a hospice's claims look unusual compared with other hospices. CMS states that the SSVI is not a direct indicator of fraud, waste, or abuse, and is not a finding, an allegation, or a quality measure.
There are non-adverse reasons a hospice may score points on a given measure. A hospice serving mostly nursing-facility patients will register a point on the nursing-facility measure by design. A hospice with a stable long-stay population may sit above the long-stay discharge threshold without that reflecting a practice change.
Commenters argued to CMS that flagging the bottom quartile on each individual measure is not a valid way to identify outliers. CMS agreed, and responded that single-measure flags were not intended to identify outliers on their own — the composite score is what identifies outliers. A point on one measure functions as a filter; points across many measures function as the signal.
The current SSVI covers FY2024 and FY2025 claims, published with the FY2027 final rule on August 3, 2026. The FY2025 file draws on 6,773,919 hospice claims across 6,673 hospices and roughly 157 million hospice days, from a claims pull dated May 12, 2026.
CMS states it plans to calculate the SSVI for each fiscal year using that year's data, publishing the update with each year's final rule: annually, arriving with the final rule each summer.
Two consequences follow from this lag. Claims data trails actual practice by roughly one to two years, so a current score reflects billing behavior from one to two years earlier, and a score does not reflect any changes made since that data was collected. Because the underlying data is refreshed between the proposed and final rule each year, published thresholds can also change without a change in methodology: the FY2025 thresholds published in April 2026 differ from those published in August 2026 on five of eight utilization measures. Analyses published before August 3, 2026 reflect the earlier, proposed-rule figures.
Three CMS numbers get conflated. They measure different things from different data.
CAHPS measures reported experience of care, from surveys, and is the most straightforward to distinguish: a hospice can score well on CAHPS and poorly on the SSVI, since they measure different things.
The HCI is more easily conflated with the SSVI because both are built from billing claims. CMS's position is that the SSVI is designed to complement the HCI. Several SSVI utilization measures have an HCI counterpart, though the specifications differ:
CMS is re-specifying the HCI and plans to submit the revised measure to the 2026 Measures Under Consideration list. A technical expert panel raised concerns that several existing HCI indicators — covering continuous home care, general inpatient care, and some live discharge and burdensome transition measures — may not cleanly reflect quality. Revisions to the HCI would shift the overlap between the two indices.
A separate measure, sometimes confused with the SSVI, is the HQRP reporting penalty: missing the requirement to submit 90% of HOPE assessments within 30 days reduces a hospice's annual payment update by four percentage points. For FY2027 that reduction changes the update from +2.3% to -1.7%. Approximately one in five hospices misses this requirement each year — 20.37% in FY2026. From no earlier than October 2027, CMS will mark non-compliant hospices with an icon on Care Compare. This penalty is unrelated to the SSVI; the SSVI carries no payment consequence.
SSVI points fall into two categories: those that reflect who a hospice serves, and those that reflect how care is scheduled.
Points tied to patient population — a facility-heavy census, a long-stay population — are structural. They can be documented and explained, but are not necessarily actionable.
Points tied to scheduling patterns are different. Low skilled nursing minutes per day, a weekend visit rate at or below 4.8%, and missed visits in the final two days of life are operational outcomes, visible to CMS in claims regardless of internal tracking.
Points on the spending half are harder to attribute, since a portion of that spending originates with providers outside the hospice's direct control. CMS's position in the final rule does not treat that as a mitigating factor: wound care for pressure ulcers in a bedbound terminal patient is treated as related to the terminal condition and within the benefit's scope. Starting October 2026, the mandatory election statement addendum requires every relatedness determination to be recorded in writing, which changes the audit trail for this half of the score.
Align tracks the same measures CMS uses in the SSVI. Where a flagged measure reflects a scheduling pattern — weekend coverage, visit frequency, visits in the final days of life — Sync and Vantage address the underlying pattern directly.
Yes. CMS published provider-level SSVI scores for FY2024 and FY2025 with the FY2027 final rule on August 3, 2026, at the CMS Hospice Information Center. Anyone can look up any Medicare-certified hospice. CMS was asked by commenters to take the scores down and declined, stating removal would not be in beneficiaries' interest.
No. CMS describes the SSVI as one of several inputs that inform program-integrity work, not a trigger for any specific action. A high score means a hospice is more likely to draw attention, not that any action will necessarily follow.
Zero means nothing about a hospice's claims stands out, and only four of 6,673 hospices achieved it on FY2025 claims. The median is 6. CMS treats 13 or higher as an outlier — the 99th percentile — which 69 hospices reached.
No. Commenters asked CMS for provider-specific preview reports and a reconsideration process. CMS declined, on the grounds that the SSVI is calculated from finalised claims the hospice itself submitted, so there is nothing to reconsider. There is no appeal, no preview period, and no correction mechanism. The available recourse is to submit accurate claims and wait for the next annual refresh.
Completely different. Star ratings come from CAHPS family caregiver surveys and reflect reported experience of care. The SSVI comes from billing claims and reflects service delivery patterns and surrounding Medicare spending. A hospice can score well on one and poorly on the other.
No. The SSVI carries no payment consequence. The measure that does is the HQRP reporting requirement — missing the 90% timely-submission threshold reduces a hospice's annual payment update by four percentage points for that fiscal year.
Because CMS published the SSVI twice. The proposed rule in April 2026 used a January claims pull; the final rule in August used a May pull. The methodology did not change, but the percentile thresholds moved on five of the eight utilization measures. Analyses published before August 3, 2026 use the earlier figures.
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