Service & Spending Variation Index (SSVI): A New Window on Hospice Performance

CMS has introduced a new way to evaluate hospice providers by analyzing claims data for patterns that may suggest unusual utilization or Medicare spending.

The Hospice Service & Spending Variation Index (SSVI) identifies hospices whose care patterns and non-hospice Medicare spending differ from national norms. While SSVI is not a payment program or quality rating, it reflects CMS's growing emphasis on program integrity, consistency, and responsible stewardship of Medicare resources.

What is SSVI?

SSVI is a claims-based measure built from two components:

Hospice utilization (8 measures) that examine whether care patterns differ from expected practice, including:

• Length of stay and live discharge patterns

• Frequency, timing, and duration of visits

• Provision of Continuous Home Care (CHC) and General Inpatient Care (GIP)

• Patients who are discharged and quickly re-enroll

Non-hospice Medicare spending (8 spending thresholds) that evaluate Medicare services billed outside the hospice benefit while a beneficiary is enrolled in hospice. This includes physician services, outpatient and inpatient care, durable medical equipment, and Part D medications to identify potential cost-shifting patterns.

Together, these measures produce a composite SSVI score. Higher scores indicate greater variation from national norms and may draw additional attention from CMS and other stakeholders.

Why SSVI Matters

Although SSVI is currently an oversight tool, performance measures often expand beyond their original purpose.

Hospice leaders should expect SSVI data to be reviewed by:

• Referral sources evaluating hospice partners.

• Patients and families comparing providers before making care decisions.

• Lenders, investors, and valuation firms incorporating publicly available operational and quality measures into business decisions.

• CMS as it advances public reporting, program integrity efforts, and potentially future value-based payment models.

Understanding SSVI today positions organizations to identify opportunities for improvement before external stakeholders begin asking questions.

What Should Hospice Leaders Be Watching?

The operational patterns behind SSVI also represent many of the fundamentals of strong hospice care and compliance. Organizations should focus on:

• Patient Need: Delivering care that aligns with patient needs and hospice regulations.

• Documentation: Supporting enrollment, length of stay, and live discharge decisions with strong clinical documentation.

• Visit Patterns: Monitoring visit patterns, particularly during weekends and the final days of life.

• Non-Hospice Spending: Understanding non-hospice Medicare spending and strengthening coordination with physicians, hospitals, and community partners to reduce unnecessary services outside the hospice benefit.

Organizations that routinely monitor these trends will be better prepared to explain their performance, identify opportunities for improvement, and adapt as CMS continues expanding the use of claims-based analytics.

Berg Data Subscribers can benchmark their agency’s SSVI performance alongside market peers and explore related utilization metrics to drive improvements. To learn more about key trends in your community of service, contact Berg Data Solutions at: sarah@bergdatasolutions.com or marc@bergdatasolutions.com.