Every Hospice Now Has a Public SSVI Score: How to Find Yours and What Drives It
Every Medicare hospice now has a public SSVI score, and the score can reveal more than a single compliance number. This article explains how to find the score, understand its non-hospice spending and utilization components, and respond to the documentation risks behind it. It also shows how SSVI findings may affect buyer underwriting, EBITDA multiples, and sale value. Owners will leave with a practical action plan for strengthening compliance and exit readiness.
10/5/20267 min read
Every Medicare hospice now has a public Service and Spending Variation Index score, whether leadership has reviewed it or not. This guide explains where to find the score, what drives it, and how owners can address documentation and operating risks before they affect oversight, buyer underwriting, or exit value.
Quick Scan Summary
Who this is for
Hospice owners and operators with $2 million to $10 million in annual revenue
Home health or hospice leaders responsible for compliance, billing, clinical operations, and payer performance
Owners considering a sale, succession plan, or strategic partnership with an acquiring organization
Key takeaways
The SSVI runs from 0 to 16 and combines non-hospice spending with eight utilization measures.
CMS publishes hospice-level scores and scoring components in an Excel file searchable by CCN.
A high score does not prove poor care or improper conduct, but it can lead to additional education, medical review, investigations, payment suspension, or revocation if fraud, waste, or abuse is identified.
Documentation related to non-hospice services, election statements, relatedness determinations, length of stay, and live discharges now matters to both regulators and buyers.
Why the SSVI matters now
CMS finalized the SSVI in the FY 2027 Hospice Wage Index and Payment Rate Update final rule, CMS-1851-F. The rule was published August 3, 2026 and became effective October 1, 2026.
CMS created the SSVI in response to rising Medicare Part A, Part B, and Part D spending during hospice elections. CMS states that it would be “unusual and exceptional” for patients approaching the end of life to routinely receive services outside the hospice benefit. CMS has also reiterated since 1983 that “virtually all” care needed by terminally ill beneficiaries would be provided by the hospice.
That position makes the score especially important. Non-hospice spending does not automatically mean a hospice acted improperly. However, it can signal that relatedness determinations, election statement addenda, care coordination, or clinical documentation need closer review.
The same final rule made the hospice election statement addendum mandatory for every beneficiary electing hospice. CMS has allowed enforcement discretion through December 31, 2026, but owners should treat the addendum as an operating requirement now rather than waiting for enforcement activity.
How to find your hospice score
CMS publishes the SSVI data through the CMS-1851-F page.
The downloadable Excel file includes:
FY 2024 and FY 2025 total SSVI scores
Non-hospice spending scores
Utilization scores
Underlying claims-based data
Scoring components that earned points
Hospice name, location, ownership information, and CCN
Search by your CMS certification number, or CCN. Review both FY 2024 and FY 2025 because CMS plans to publish updated SSVI information with each future final rule using more recent claims data.
The FY 2025 data includes 6,773,919 hospice claims, 6,673 hospices, and 156,995,825 hospice days. CMS pulled the claims data on May 12, 2026.
What drives the SSVI score?
The total score is the sum of two components. Each component can contribute up to eight points.
The methodology and thresholds are documented in the FY 2027 Final SSVI Overview.
Non-hospice spending score
The non-hospice spending score is based on total spending, not spending per day. That means census matters. A larger hospice may have more total spending simply because it serves more beneficiaries, but the score still reflects the total amount attributed to the hospice.
For FY 2025, the thresholds are:
0 points: $0
1 point: More than $0 up to $6,532.96
2 points: More than $6,532.96 up to $21,341.05
3 points: More than $21,341.05 up to $44,437.57
4 points: More than $44,437.57 up to $79,420.80
5 points: More than $79,420.80 up to $138,572.14
6 points: More than $138,572.14 up to $253,592.84
7 points: More than $253,592.84 up to $538,406.00
8 points: More than $538,406.00
Hospices with no non-hospice spending receive zero points for this component.
Utilization score
A hospice receives one point for each triggered measure:
No continuous home care and no general inpatient care provided during the year
At least 40 percent of routine home care days provided in a nursing home or skilled nursing facility
Skilled visits during the last two routine home care days of life at or below 87.5 percent
Discharges with a length of stay of 180 days or more at or above 33.3 percent
Live discharge rate at or above 47.0 percent
Average skilled nursing minutes per routine home care day at or below 9.9
Weekend routine home care days with a skilled visit at or below 4.8 percent
Live discharges returning to the same hospice within seven days at or above 18.2 percent
For this analysis, skilled visits include nursing, medical social services, or therapy.
A single threshold does not necessarily indicate poor performance or improper practices. CMS says the concern is a pattern across measures. Some values are suppressed with an asterisk where the numerator or denominator is very small.
Where hospices land by score
Most hospices cluster in the middle of the distribution.
Scores of 5 through 8 each represented roughly 13 to 14 percent of hospices. Fewer than one percent landed at each individual score level from 13 through 16. The SSVI overview states that the intent of the report is to identify hospices that may be outliers compared to their peers. CMS describes a high score as an indicator that a hospice might have more than one area of concern. Possible responses include targeted education, medical review, and investigations that could result in payment suspension. Revocation may follow when fraud, waste, or abuse is identified. CMS also states that the SSVI will be one of several information sources used in program integrity actions.
The documentation and valuation connection
Consider an owner with a hospice census of roughly 400 and $4 million in annual revenue. The owner assumes relatedness determinations are a clinical formality. After reviewing the public file, the owner discovers a non-hospice spending score of 6, plus points for long length of stay and live discharge patterns.
That result does not prove the hospice delivered poor care. It does tell a buyer that the documentation controls require validation. The buyer will likely test election statements, addenda, physician certifications, relatedness determinations, discharge records, care coordination, and claims history.
The financial impact can be material. For illustration only:
Write your text here...The difference is $675,000. This is not a market quote or a prediction of how every buyer will price an agency. It demonstrates how compliance risk can affect a buyer’s confidence, the multiple applied to EBITDA, and the final sale price.
A practical action plan
Download the CMS file and search your CCN. Record your FY 2024 and FY 2025 total, non-hospice spending, and utilization scores.
Identify every point earned. Do not focus only on the total. The individual components show where operating review should begin.
Reconcile non-hospice spending. Review patients with outside Part A, Part B, or Part D spending during the hospice election. Confirm the clinical basis for relatedness decisions.
Audit election statement addenda. Confirm the addendum is complete, consistent with the plan of care, and understandable to the beneficiary or representative.
Review length of stay and live discharges. Segment by referral source, diagnosis, facility, clinician, and location. Look for patterns that require clinical explanation.
Validate visit intensity. Review routine home care minutes, weekend skilled visits, and skilled visits during the final two routine home care days.
Create a monthly SSVI review. Assign ownership to clinical, compliance, revenue cycle, and executive leaders. CMS does not provide a reconsideration or appeal process because the score is built from finalized claims.
Put the findings in your buyer data room. Explain known issues, corrective actions, audit results, and trend improvements before a buyer discovers them independently.
Home health owners should pay attention to the same direction of travel. Medicare compliance data is becoming more transparent across post-acute care, and buyers are placing greater weight on claims integrity, documentation, quality reporting, and payer-specific performance.
Alongside SSVI monitoring, home health or hospice owners managing payer mix should track these eight monthly metrics:
Net reimbursement per completed visit by payer
Authorized visits compared with clinically ordered visits
Denials and appeal overturn rates
Authorization labor hours per 100 Medicare Advantage episodes
Days in accounts receivable by payer
EBITDA margin by payer
Revenue concentration by individual Medicare Advantage plan
Referral volume by payer and referral source
These metrics do not replace SSVI reporting. They help an owner understand the broader operating and underwriting picture.
Plain Language Glossary
SSVI: A CMS score from 0 to 16 that identifies hospice utilization and non-hospice spending patterns that may differ from peers.
CCN: The CMS certification number assigned to a Medicare-certified provider.
Non-hospice spending: Medicare Part A, Part B, and Part D spending during a beneficiary’s hospice election.
Relatedness determination: The clinical and documented decision about whether a service, item, or drug is related to the terminal illness and related conditions.
RHC: Routine home care, the standard hospice level of care.
CHC: Continuous home care, a higher intensity level used during periods of crisis.
GIP: General inpatient care for symptoms that cannot be managed in another setting.
Live discharge: A discharge from hospice while the beneficiary is still living.
Length of stay: The amount of time a beneficiary has used hospice, including lifetime hospice use when CMS methodology applies.
HQRP: The Hospice Quality Reporting Program, which requires hospices to submit specified quality data.
So what should you do now?
Download your public SSVI file and review the score by component, not just the headline number.
Audit non-hospice spending, relatedness determinations, election statement addenda, and discharge patterns before a buyer or regulator asks.
Build a monthly operating dashboard that connects compliance findings to EBITDA, referral quality, staffing, and payer performance.
If you may sell within the next one to three years, document corrective actions now so your buyer sees a controlled process rather than an unresolved risk.
Senate Healthcare LLC is evaluating acquisitions and strategic partnerships with home health or hospice agencies. We are the buyer, not a broker, agent, or advisor. If your agency is not perfectly positioned today, that does not mean a conversation is premature. A confidential discussion can help identify the risks affecting underwriting, clarify what should be addressed before a transaction, and explore whether a sale or strategic partnership with Senate Healthcare fits your goals.
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