Decoding Your SSVI Score, Part 2: The Utilization Score

If non-hospice spending is about the dollars Medicare spent around your patients, the Utilization Score is about the care you delivered to them — as your own claims describe it. It is worth up to 8 of the 16 SSVI points, and unlike the spending half, it isn’t one ranked number. It’s eight separate tripwires, each worth a single point. Trip any of them and your score goes up by one. Here is exactly what each measure tests, the real FY2025 thresholds, and what you can do about them.

New to the SSVI? Start with our overview, CMS Built a New Score That Flags Your Hospice for Oversight, and look up your own score free. The SSVI runs 0–16 and is the sum of two halves: the Non-Hospice Spending Score (0–8) and the Utilization Score (0–8). This post is about the second half.

How the Utilization Score Works

The mechanics are different from the spending half, and the difference matters:

• Every hospice starts at zero.
• There are eight measures. For each one, you either meet the flagging condition or you don’t. Meet it, and you get 1 point. The eight points sum to your 0–8 Utilization Score.
• Six of the eight thresholds are percentile-based — the 25th or the 75th percentile of where all hospices land that year — so they move every year. Two measures (no CHC/GIP, and the nursing-facility share) are fixed rules that don’t move.
• Like the rest of the SSVI, it’s built from FY2024 and FY2025 claims. The behavior is already in the books; what you change today shows up the next time the window rolls forward.

Because each measure is independent, two hospices can land on the same Utilization Score for completely different reasons. That’s why the number alone doesn’t tell you much — you have to know which tripwires you hit.

The Eight Measures, With the Real FY2025 Thresholds

Here are all eight, straight from CMS’s SSVI overview document. A point is assigned when your hospice meets the condition in the right-hand column.

Measure	Earns a point when (FY2025)
No CHC and no GIP all year	You billed zero continuous home care and zero general inpatient care
RHC days in a nursing home / SNF	≥ 40% of RHC days
Skilled visits in the last two days of life	≤ 87.5% of decedents (25th percentile)
Discharge rate, length of stay 180+ days	≥ 33.3% (75th percentile)
Live discharge rate	≥ 46.7% (75th percentile)
Average skilled-nursing minutes per RHC day	≤ 9.9 minutes (25th percentile)
Weekend RHC days with a skilled visit	≤ 4.8% (25th percentile)
Live discharges returning to you within 7 days	≥ 18.2% (75th percentile)

FY2025 figures from CMS’s SSVI overview document. The FY2024 cut points differ slightly — for example, the live-discharge threshold was 47.7%, the 7-day-return threshold was 15.0%, and the last-two-days visit threshold was 85.7% — because the percentile-based measures are recalculated against the full hospice population each year. One thing operators routinely get backwards: it’s the 180+ day long-stay discharge rate that trips at 33.3%, while the live discharge rate trips higher, at 46.7%. Several published summaries have these two swapped.

It’s easier to hold all eight in your head if you group them by what they’re really testing.

Group 1: Are You Providing the Full Benefit? (2 measures)

These two are fixed rules — they don’t move with the percentile each year — and they’re about the shape of your care model.

• No CHC and no GIP all year. Continuous home care is the crisis level — intensive nursing at home during a symptom emergency. General inpatient care is short-term inpatient management when symptoms can’t be controlled at home. A hospice that bills neither one all year is telling CMS its patients never had a crisis that required escalation — which, across a full census, reads as a hospice that doesn’t surge care when patients need it most.
• 40% or more of RHC days in a nursing home or SNF. A heavy facility-based census is associated with the long-stay, lower-acuity patient mix that program-integrity analytics watch closely. It isn’t improper — many legitimate hospices serve facility patients — but past 40% of routine-home-care days, you’re an outlier on care setting.

Group 2: Are You Actually Visiting? (3 measures)

These three all flag under-provision of hands-on care. Each fires at the 25th percentile — the bottom quarter of hospices on visit intensity.

• Skilled visits in the last two days of life ≤ 87.5%. Among patients who died on routine home care, what share got a skilled visit (nurse, social worker, or therapist) in their final two days? If you’re at or below 87.5%, you’re in the bottom quarter — under-attending people at the exact moment hospice is supposed to deliver the most.
• Average skilled-nursing minutes per RHC day ≤ 9.9. Under ten nursing minutes per routine-home-care day, averaged across your census, is very thin coverage. It’s one of the cleanest signals of a hospice spread too far across too many patients.
• Weekend RHC days with a skilled visit ≤ 4.8%. If almost none of your weekend routine-home-care days include a skilled visit, you look like a weekday-only operation — and dying patients don’t keep business hours.

Group 3: Length of Stay and Discharge Patterns (3 measures)

These three flag the opposite problem — not too little care, but stay-and-discharge patterns that raise eligibility and churn questions. Each fires at the 75th percentile (the top quarter).

• 180+ day long-stay discharge rate ≥ 33.3%. Of the beneficiaries you discharged, what share had a lifetime length of stay over 180 days? If a third or more did, you’re a long-stay outlier — the pattern most associated with recertification scrutiny and aggregate-cap exposure.
• Live discharge rate ≥ 46.7%. Of all your discharges, what share were patients leaving alive rather than dying on service? A high live-discharge rate is the classic “were these patients really terminal?” flag — and we’ve written before about the live discharge rate trap for exactly this reason.
• Live discharges returning within 7 days ≥ 18.2%. Of patients you discharged alive, what share re-elected your hospice within a week? A high “revolving door” rate suggests discharges that arguably shouldn’t have happened — for example, discharging around a hospitalization that would have hit your per-diem, then re-admitting.

Why CMS Built It This Way

Read the groups together and the design intent is obvious. The Utilization Score is hunting for two mirror-image failure patterns:

• Under-service — enrolling patients and then providing thin care (few visits, few minutes, no weekends, no crisis-level care, dying patients unvisited). That’s Groups 1 and 2.
• Churn and questionable eligibility — long-stay concentration, high live discharges, and revolving-door re-admissions. That’s Group 3.

Both patterns are statistical signatures of the same underlying concern that drives the whole SSVI: hospices collecting the per-diem while the care, or the eligibility, doesn’t match. As with the spending half, CMS is explicit that a high SSVI is not a finding of fraud, waste, or abuse. A point on any measure can have a perfectly legitimate explanation. But each point tells CMS where to look — and the more tripwires you hit, the higher you sort when the next round of oversight is targeted.

Where the Scores Land

Across the roughly 6,600 scored hospices in FY2025, total SSVI scores cluster in the middle — scores of 5, 6, 7, and 8 each account for about 13–14% of hospices, and only a small tail sits at 12 or above. A high Utilization Score specifically means you’re tripping multiple care-pattern measures at once, which is exactly the profile CMS designed the index to surface. The takeaway isn’t the single number — it’s which of the eight you’re tripping, because that tells you what to fix.

What You Can Do to Lower Your Utilization Score

You can’t change a score built on FY2024–FY2025 data. You can change where you land next time. By group:

1. Use the full benefit. If you’ve gone a year with no CHC and no GIP, that’s worth a hard look — not to bill levels of care you didn’t provide, but because a census that truly never needed crisis or inpatient-level symptom management is unusual. Make sure your team knows when to escalate and that the escalation is captured on the claim.
2. Measure your own visit intensity — especially at end of life and on weekends. Track skilled visits in the last two days of life, average nursing minutes per RHC day, and weekend skilled-visit coverage. These three are the under-service tripwires, and they’re squarely within your operational control.
3. Watch your length-of-stay and live-discharge patterns. Know your 180+ day discharge share and your live-discharge rate before CMS does. Long-stay concentration and high live discharges each deserve a documented clinical story — recertification rigor on the long-stay side, and clear eligibility/revocation documentation on the live-discharge side.
4. Investigate your seven-day readmissions. A revolving-door pattern is both a quality flag and an SSVI point. Find the patients who left and came back within a week and ask what really happened on each one.
5. Pull your own component breakdown. CMS published not just the composite score but which measures each hospice tripped. That FY2024/FY2025 scoring-components detail is the map — it tells you precisely which of the eight to work on.

Next in the Series

With both halves of the score now decoded — non-hospice spending and the eight utilization measures — the next installment puts them together: how the two combine into your total SSVI, what a “high” score actually looks like against the national distribution, and how to read your full component breakdown like CMS does.

Related Reading

• Decoding Your SSVI Score, Part 1: Non-Hospice Spending
• CMS Built a New Score That Flags Your Hospice for Oversight: Meet the SSVI
• Now Live: A Free Tool to Look Up Your Hospice’s SSVI Score
• The Live Discharge Rate Trap: How to Check Yours Before You’re Next

Disclaimer: The SSVI is part of CMS’s FY2027 Hospice Wage Index proposed rule (CMS-1851-P) and is not finalized; the comment period closed June 1, 2026, and the methodology or thresholds could change. The measures and thresholds above are FY2025 figures from CMS’s published SSVI overview document. This article is informational and not legal or compliance advice; verify against the CMS source and your own counsel before acting.

Reference guides: each of the eight utilization measures now has an evergreen page with its threshold, common causes, and concrete fixes — start from the SSVI scores-by-state directory.