Mississippi Hospices Beat the Nation on Six of Eight SSVI Care Measures — and Still Post the Worst Median Score in America

CMS scored 82 Mississippi hospices on the FY2025 Service and Spending Variation Index, and the state median is an 8 out of 16 — the worst state median in America, tied with Florida and West Virginia and two full points above the national median of 6. Here’s what makes Mississippi the strangest state in this series: on the care-pattern side of the index, Mississippi beats the national rate on six of the eight utilization measures. Its live-discharge flag rate is less than a third of the nation’s. Its long-stay rate is roughly half. The points are coming from somewhere else — and the file says exactly where.

Every state we’ve covered so far had a care-pattern signature: Texas’s thin visits, California’s enrollment churn, Nevada’s crisis-care void. Mississippi’s signature is financial. The typical Mississippi hospice is being scored not on how it cares for patients day to day, but on how much Medicare pays other providers while those patients are on its census — plus one very fixable staffing gap on weekends.

What a Median of 8 Actually Means

A score of 8 sits at roughly the 79th percentile nationally — the typical Mississippi hospice scores worse than about four in five hospices in America. And the state distribution is piled up right at that number: 21 of the 82 scored hospices — one in four — score exactly 8, roughly double the national share at that score. 44 of 82 (54%) score 8 or higher, versus about 35% nationally. The danger tail is elevated too — 8 hospices (9.8%) at 11+ versus the 6.4% national norm — but the tail isn’t the story here the way it was in Texas or California. The story is that the middle of the state sits where other states’ problem hospices sit.

The Driver: Non-Hospice Spending, 8 of the 16 Points on the Table

Half the SSVI — up to 8 of the 16 points — is the Non-Hospice Spending Score: how much Medicare paid outside the hospice benefit (Part A, B, and D claims) for patients while they were enrolled. CMS ranks every hospice with any non-hospice spending into eight national brackets; your bracket is your score.

By construction, each bracket holds about an eighth of the nation. Mississippi doesn’t distribute that way. The state’s median spending score is 6 of 8, versus 4 nationally. 63% of Mississippi’s scored hospices sit in the top three national brackets (37% do nationally), and 44% are in the top two (24% nationally).

Do the arithmetic on the median hospice: Mississippi’s utilization median is actually a point better than the nation’s (1 versus 2). The entire two-point gap between Mississippi’s median of 8 and the national median of 6 is the spending component. This is a state whose hospices, per the claims file, deliver comparatively disciplined care — while Medicare simultaneously pays hospitals, physicians, and Part D plans for care those same enrolled patients are receiving outside the benefit. That’s the exact pattern the index was built to surface, and it usually traces to three mundane failures: terminal-illness medications left on Part D, outside providers who never learned the patient elected hospice, and “unrelated” determinations that wouldn’t survive a records request. Our deep dive on the spending score walks through all three.

The Two Care Flags Mississippi Does Trip

Two utilization measures run hot, and they’re related:

• Weekend visits: 45.1% of the state flagged — tied with Texas for the highest rate of any state, nearly double the 25% national rate. The flag trips when skilled visits (nursing, social work, or therapy) happen on 4.8% or fewer of weekend routine-home-care days.
• Seven-day returns: 32.9% flagged, versus 24.3% nationally — live discharges who re-enroll in the same hospice within a week, the discharge-readmit cycling pattern.

Worth naming the operational reality: 60% of Mississippi’s scored hospices are rural, versus 13% nationally, and weekend skilled coverage is genuinely harder when your service area is measured in counties, not zip codes. But the measure counts LPN, social-worker, and therapy visits — not just RNs — so a Saturday LPN or MSW visit clears days that an RN-only weekend model leaves exposed. Tied-for-worst-in-America is a scheduling problem before it’s a geography problem.

The Ten Worst Scores in Mississippi: Four 12s, Four 11s, Two 10s

The state’s ten highest FY2025 totals run from 10 to 12 out of 16 — a lower ceiling than Texas’s 14s, consistent with a state whose problem is the middle, not the extremes. The persistence pattern holds here as everywhere in this series: nine of the ten scored 9 or higher in FY2024; one jumped from 3 to 12 in a single year. (Names masked, CCNs shown, as always — verify any score in our free lookup tool.)

What the ten have in common, from the CMS scoring-component files:

• 9 of 10 tripped weekend visits — the state’s signature care flag, near-universal at the top.
• 7 of 10 scored 7 or 8 out of 8 on non-hospice spending — the top two national brackets.
• 7 of 10 tripped No CHC / No GIP — no crisis-level care billed all year.
• 6 of 10 tripped seven-day returns.
• 6 of 10 tripped skilled-nursing minutes.

Notice what’s scarce on that list: only four of the ten trip long stays and only two trip nursing-facility concentration. Even the state’s worst scores aren’t built on enrollment games — they’re built on outside spending, missing weekends, and never escalating care.

What Mississippi Is Not Failing — and Why That Matters

Here’s the credibility check, and Mississippi’s is the longest in this series. Statewide, across all 82 scored hospices, Mississippi is better than the national rate on six of the eight utilization measures:

• Live discharges: 7.3% flagged, vs. 24.7% nationally — less than a third of the national rate. Mississippi patients who elect hospice overwhelmingly stay on service.
• Long stays (180+ days): 13.4%, vs. 25.4% nationally — roughly half.
• No CHC/GIP: 26.8%, vs. 45.1% nationally — well under; compare Nevada’s 68%.
• Last-days-of-life visits: 14.6%, vs. 23.3% nationally — Mississippi shows up at the bedside when it matters most.
• Skilled-nursing minutes: 15.9%, vs. 25% nationally.
• Nursing-facility concentration: 8.5%, vs. 9.2% nationally.

Six for eight, including the two enrollment measures that define the California profile and the visit-intensity measures that define the Texas profile. If the SSVI were only its utilization half, Mississippi would look like one of the better hospice states in the country. That’s exactly why the median of 8 should get an operator’s attention: the score isn’t coming from the bedside. It’s coming from the billing environment around it — and that concentrates the fix into a short list.

Mississippi Isn’t on CMS’s Watch List — and Scored Worse Than the States That Are

The SSVI is still a proposed methodology (CMS-1851-P, the FY2027 Hospice Wage Index proposed rule), and CMS says plainly that a high score is not a finding of fraud, waste, or abuse. Mississippi is also the first state in this series that is not one of CMS’s four enhanced-oversight states — that cohort is Arizona, California, Nevada, and Texas, and we’ve now covered all four. Yet Mississippi’s median outscores every one of them. That’s the uncomfortable lesson of this file: the enhanced-oversight list was about a surge of new enrollments in four hot markets, but the SSVI is national, claims-based, and indifferent to geography. A Mississippi hospice at 8, 10, or 12 is published in the same public file, against the same thresholds, as a Los Angeles startup — and the spending pattern behind Mississippi’s scores is the single component CMS weighted at half the index.

The Mississippi Fix List — In Order of Effort

1. Weekend coverage: schedule it this month. Tied for the worst flag rate in America, and the cheapest point in the state to win back. Build a weekend skilled-visit rotation and remember the definition: LPN, MSW, and therapy visits all count — this is not an RN-only mandate. A Saturday MSW visit is a skilled visit. The full guide.
2. Seven-day returns: stop the revolving door at the discharge decision. A live discharge who’s back in a week usually shouldn’t have been discharged — audit every return against the original discharge reason, and route borderline “no longer terminally ill” calls through the medical director before, not after, the paperwork. The full guide.
3. Non-hospice spending: own everything Medicare pays for your patients. This is the structural one — up to 8 points, and the component driving the state median. Reconcile every census patient against Part D data for terminal-illness medications; confirm the Notice of Election reached every facility, attending, and DME supplier on day one; and document every “unrelated” determination with a physician narrative you’d be willing to hand an auditor. The full guide, and our deep dive on the spending score.
4. Crisis care: build the capability. A quarter of the state bills zero CHC and zero GIP all year — better than the nation, but 7 of the state’s worst 10 trip it. A GIP contract and a symptom-crisis protocol close the flag and reduce the ER visits that feed the spending score at the same time. The full guide.

Related Reading

• Mississippi Hospice SSVI Scores — the full state page: all ten scores, measures tripped, and state stats
• Decoding Your SSVI Score, Part 1: Non-Hospice Spending — the component driving Mississippi’s median
• Two-Thirds of Nevada Hospices Billed Zero Crisis Care All Year — the routine-home-care-only profile
• California Has More Hospices on CMS’s SSVI Watch List Than Any State — the enrollment-churn profile
• Texas Has the Biggest SSVI Problem in America — the thin-service-delivery profile
• SSVI Scores by State — every state’s directory page

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. All figures in this article are derived from analysis of the CMS FY2024 and FY2025 SSVI score and scoring-component data files published April 2026; state assignment uses the CMS-reported facility state. A high SSVI score is not a finding of fraud, waste, or abuse. This article is informational and not legal or compliance advice; verify against the CMS source and your own counsel before acting.