The hospice SSVI is mostly a spending index
CMS published a Service and Spending Variation Index score for every Medicare-certified hospice in the country. We analyzed all 6,643 of them. Roughly 69% of the average score comes from a single half of the formula — and two agencies with the same score can be there for opposite reasons.
Published July 30, 2026 · Connect Shield
The two halves are not equal
The SSVI is built from two components worth eight points each. On paper they carry the same weight. In the data they do not. The average agency earns 4.4 of its 6.4 points from non-hospice spending and only 2.0 from the eight claims-based utilization measures combined.
The ceilings tell the same story. 811 agencies — 12% of everyone scored — sit at the maximum 8 on spending. Not one agency in the country is flagged on all eight utilization measures; the highest anyone reaches is 7, held by 11 agencies.
Highest spending scores
State averages, non-hospice spending half
The two lists barely overlap. FL leads on spending at 7.5 of 8 while posting only 0.8 on utilization. TX leads on utilization at 2.6 with a spending score of 4.6. Their totals differ by 1.0 points. The compositions are nothing alike.
Two agencies can post the same SSVI and need completely different responses. One is a non-hospice spending pattern — what is being billed outside the benefit for its patients. The other is a care-pattern issue — visit timing, length of stay, live discharge rates. A ranking tells you neither. Only the composition does.
Average SSVI by state
Darker states have higher average scores. Shading is by rank rather than raw value, so differences stay visible across a narrow range. Click any state to see its highest-scoring agencies and the split between its two halves.
How scores are distributed
Scores cluster in the middle and fall off sharply above 8 — the point at which an agency has effectively exhausted one half of the formula and has to start accumulating points from the other. No hospice in the country scored a 16. The highest is 15, held by 1 agency.
FY2025 SSVI score (0–16) by number of agencies.
Scores move
The SSVI is not a fixed label. Between FY2024 and FY2025, 2,402 hospices saw their score rise, 2,142 saw it fall, and 1,775 stayed put — meaning roughly 72% of agencies moved in a single year.
Urban agencies average 6.6 against 5.3 for rural, a gap of 1.3 points across 5,791 urban and 851 rural providers.
Where the hospices are
State counts vary far more than population does. These five states hold the most Medicare-certified agencies:
Because counts differ this sharply, state averages are not directly comparable as market descriptions. A state with 2,002 agencies and one with fewer than a hundred are describing very different provider landscapes, even when their averages land close together.
Highest average SSVI
Rankings include only states with at least 20 scored agencies. Small states swing heavily on a handful of providers.
Every state and territory
Sorted by average FY2025 SSVI, with each half shown separately. Click any state for its full agency list.
| State | Agencies | Avg SSVI | Spending | Utilization |
|---|---|---|---|---|
| FL | 58 | 8.3 | 7.5 | 0.8 |
| MS | 82 | 7.5 | 5.8 | 1.6 |
| DC | 5 | 7.4 | 5.2 | 2.2 |
| WV | 18 | 7.4 | 6.7 | 0.7 |
| NJ | 61 | 7.3 | 5.8 | 1.6 |
| OK | 134 | 7.3 | 5.4 | 1.9 |
| TX | 998 | 7.3 | 4.6 | 2.6 |
| OH | 162 | 7.0 | 5.5 | 1.5 |
| MA | 75 | 7.0 | 5.5 | 1.5 |
| DE | 10 | 6.9 | 6.0 | 0.9 |
| AZ | 221 | 6.7 | 4.4 | 2.4 |
| RI | 11 | 6.6 | 5.4 | 1.3 |
| MD | 26 | 6.6 | 6.0 | 0.6 |
| SC | 88 | 6.6 | 5.0 | 1.6 |
| GA | 259 | 6.5 | 4.5 | 2.0 |
| IL | 146 | 6.5 | 4.7 | 1.8 |
| AL | 86 | 6.5 | 5.4 | 1.1 |
| CA | 2,002 | 6.5 | 3.9 | 2.6 |
| AR | 46 | 6.4 | 5.2 | 1.2 |
| NC | 76 | 6.3 | 5.5 | 0.8 |
| MI | 170 | 6.3 | 4.5 | 1.8 |
| NV | 153 | 6.3 | 4.0 | 2.3 |
| LA | 121 | 6.3 | 4.4 | 1.8 |
| CT | 27 | 6.3 | 5.5 | 0.8 |
| PA | 182 | 6.2 | 4.9 | 1.3 |
| NY | 39 | 6.2 | 5.3 | 0.9 |
| MO | 137 | 6.2 | 4.6 | 1.6 |
| TN | 60 | 6.2 | 5.3 | 0.9 |
| ME | 17 | 6.1 | 5.6 | 0.4 |
| VA | 113 | 6.0 | 4.7 | 1.3 |
| IN | 103 | 6.0 | 4.8 | 1.2 |
| NH | 23 | 5.8 | 4.8 | 1.0 |
| WI | 86 | 5.7 | 4.6 | 1.1 |
| KS | 85 | 5.5 | 3.8 | 1.8 |
| WA | 50 | 5.5 | 4.1 | 1.4 |
| CO | 84 | 5.5 | 4.1 | 1.4 |
| KY | 23 | 5.3 | 4.7 | 0.7 |
| MN | 80 | 5.2 | 3.8 | 1.4 |
| UT | 84 | 5.1 | 3.5 | 1.6 |
| HI | 11 | 5.1 | 3.5 | 1.5 |
| NM | 54 | 5.0 | 3.5 | 1.5 |
| IA | 71 | 4.9 | 3.8 | 1.1 |
| ID | 55 | 4.7 | 3.6 | 1.1 |
| NE | 42 | 4.7 | 3.1 | 1.6 |
| SD | 17 | 4.6 | 3.3 | 1.4 |
| VT | 9 | 4.4 | 4.0 | 0.4 |
| PR | 41 | 4.3 | 2.0 | 2.2 |
| MT | 31 | 4.3 | 2.8 | 1.5 |
| OR | 66 | 4.2 | 2.7 | 1.5 |
| VI | 3 | 4.0 | 1.0 | 3.0 |
| ND | 13 | 3.7 | 2.4 | 1.3 |
| AK | 6 | 3.3 | 2.5 | 0.8 |
| WY | 19 | 3.3 | 2.5 | 0.8 |
| MP | 1 | 3.0 | 1.0 | 2.0 |
| GU | 2 | 2.0 | 1.0 | 1.0 |
About the SSVI and this analysis
The Service and Spending Variation Index is a 0–16 score CMS introduced in the FY2027 hospice wage index proposed rule (CMS-1851-P). It combines a 0–8 non-hospice spending score, based on Medicare spending outside the hospice benefit for an agency's enrolled beneficiaries, with a 0–8 utilization score built from eight claims-based measures: live discharge rate, length of stay over 180 days, nursing facility patient share, absence of continuous home care or general inpatient care, visits in the last two days of life, skilled nursing minutes, weekend visit rate, and return to hospice within seven days.
A higher score means an agency's claims patterns diverge further from peer norms. It is not a quality rating, and it does not establish that any agency has done anything wrong. It is one of the inputs CMS uses to decide where to focus oversight.
Analysis by Connect Shield using the CMS SSVI data file published with CMS-1851-P. State figures are unweighted means across agencies with a FY2025 score; 6,643 agencies had one, and agencies without a score are excluded throughout. Composition rankings include only states with at least 20 scored agencies. Year-over-year comparisons use the 6,319 agencies with both a FY2024 and FY2025 score. The FY2027 rule was proposed, not final, at the time of publication; figures reflect the SSVI data file as released with the proposed rule. Connect Shield is not affiliated with CMS.
Look up a specific agency
Every Medicare-certified hospice has its own page showing the full eight-measure breakdown, both halves of the score, national and state ranking, and year-over-year change. Free, no signup.