What is it, and what is it intended to do?

The Centers for Medicare & Medicaid Services (CMS) introduced the Service and Spending Variation Index (SSVI) in the FY 2027 Proposed Rule as a new tool to evaluate hospice providers. This scoring system analyzes nine claims-based metrics, including non-hospice spending, to identify potential risks, increase transparency, and improve oversight.

Think of the Service and Spending Variation Index (SSVI) as a new “health check” or scorecard that Medicare is using to keep tabs on how hospices operate. If you’re running a hospice, this is essentially CMS’s way of spotting outlier organizations who might be gaming the system.  In this era of widespread reporting of healthcare fraud, this is something to pay attention to.

Key Aspects of the Hospice SSVI

• Purpose: To detect potential fraud, waste, abuse, or inappropriate utilization of services.
• Scoring Metric: The SSVI uses nine claims-based measures to create a “red flag” scorecard for hospice providers.
  • Note: You do not want to accumulate points (Points = potential Red Flags).

Key Metrics Involved (9):

1. Non-hospice spending: This tracks money spent on your patients through regular Medicare (Parts A, B, or D) for services that should have been covered by your hospice benefit.
2. Lack of Higher Care Levels: You get a point if you provided zero Continuous Home Care (CHC) and zero General Inpatient Care (GIP) during the year.
3. Nursing Home Concentration: A point is triggered if 40% or more of your Routine Home Care (RHC) days were provided to patients in a nursing home or skilled nursing facility.
4. End-of-Life Visit Intensity: CMS expects visits in the final days. You get a point if your rate of skilled visits during the last two days of life falls into the bottom 25% of all providers.
5. Long Length of Stay (180+ Days): A point is added if your rate of patients staying on service for more than six months is in the top 25% nationally.
6. Overall Live Discharges: If your total rate of discharging patients alive is in the top 25%, it triggers a point.
7. “Revolving Door” Discharges: This tracks patients who are discharged alive but return to your same hospice within 7 days. If you’re in the top 25% for this, you get a point.
8. RHC Visit Minutes: CMS looks at the “density” of your care. You get a point if your average skilled nursing minutes per Routine Home Care Day fall into the bottom 25%.
9. Weekend Care: You get a point if your rate of providing skilled visits on the weekend is in the bottom 25%.

• Oversight: While most hospices are expected to have a low score, high-end scores may subject providers to additional, heightened reviews.
• Transparency: CMS will post provider-level SSVI scores to the CMS Hospice Center webpage.

Regarding Scoring

The Hospice SSVI (Service and Spending Variation Index) is essentially a “risk-based scorecard” that Medicare uses to identify providers who look like outliers compared to their peers.

Here is the high-level summary of how the scoring works:

• The 16-Point Scale: Every hospice is given a score from 0 to 16. A higher score indicates a higher risk of “inappropriate utilization” or potential fraud, waste, and abuse.
• The Threshold Method: CMS calculates a national “tripwire” for nine specific behaviors. If your agency performs in the bottom or top 25% (depending on the metric) compared to the rest of the country, you get points added to your score.
• Weighted Scoring: Not all behaviors are equal. Non-hospice spending (money spent on your patients outside the hospice benefit) is the heaviest hitter, accounting for half of your total possible score (up to 8 points). The other behaviors are worth 1 point each.
• Public Accountability: CMS plans to publish these scores on their Hospice Center webpage. This turns a behind the scenes data tool into a publicly available reputation metric.
• The “Audit Trigger”: While a high score doesn’t automatically mean you are doing something wrong, it acts as a “red flag” that puts you at the top of the list for heightened oversight, audits, and medical reviews.

What will be Visible and When?

The Service and Spending Variation Index (SSVI) scores have already entered the public domain as part of the FY 2027 Proposed Rule released on April 2, 2026.

Here is the timeline for how these scores are becoming visible:

• Currently Available: Provider-level data and individual SSVI scores for FY 2024 and FY 2025 have been published for public review on the CMS Hospice Center webpage.
• Public Comment Phase: The official comment period for the FY 2027 proposed rule (which includes the SSVI rollout) is open until June 1, 2026. This is the window for owners to provide feedback before the policy is finalized.
• Final Rule Publication: Expect the “Final Rule” in Summer 2026. This will confirm exactly how and where these scores will be displayed permanently.
• Permanent Consumer Display: While data is currently on the technical Hospice Center page, a broader “Care Compare” rollout on Medicare.gov is expected to follow shortly after the finalization of the rule.

What is it intended to do?

In short: It’s an automated way for Medicare to “police” the industry by flagging any agency whose data suggests they are avoiding high-cost care, maintaining patients too long, or shifting costs back to the taxpayer.

Most of these metrics aren’t about “bad care“—they are about patterns. For example, if you have a high “Live Discharge” rate (Metric 6) and those patients are returning within a week (Metric 7), CMS sees that as a red flag for potential “churning” to avoid hitting the aggregate cap.

This is meant to detect unusual or potentially inappropriate patterns, not automatically “bad care.”  SSVI was created to provide CMS with another tool to identify providers whose patterns deviate from the norms and flag possible issues like poor care coordination, under servicing of patients, and/or overuse or inappropriate enrollment.  This is intended to provide more objective measures to CMS and the MACs, etc., to help decide which hospices may need audit, education, or to be investigated. 

A higher SSVI score = more concern but does not in of itself prove any wrongdoing by the hospice.  However, the hospice had best be able to adequately explain any of those point scoring metrics in which the agency scores above its peers.

Conclusion

All hospice operators should be versed on SSVI and how it could impact their agency in the near future.  Everyone should have read this section of the Proposed Rule and read the FINAL Rule, when published to get an idea of CMS’ plans.  Additionally, as soon as the FINAL Rule is published, all Hospice operators should measure themselves on how they score to prepare for additional scrutiny that is sure to follow.