Understanding the SSVI calculation is becoming increasingly important for hospice providers. In this post, we’ll break down key components introduced in the Hospice Proposed Rule and what they mean for your organization.
One component of the SSVI calculation is the utilization score. To clearly explain how it works, it’s easiest to walk through the spreadsheet. This part of the calculation is made up of eight components. As shown, each has specific criteria, and if the criteria are met, you earn one point per component, for a total possible score of eight points.
The calculation includes the following components:
No CHC and No GIP:
If you have no claims, or none of your claims include Continuous Home Care (CHC) or General Inpatient (GIP) services during the measurement period, you receive one point.
40% or more Routine Home Care days in a nursing home or Skilled Nursing Facility:
If at least 40% of your Routine Home Care days occur in a nursing home or SNF setting, you receive one point.
Rate of skilled visits during the last two Routine Home Care days of life:
If fewer than 87.5% of patients received a skilled nursing visit in the final two days of life, you receive one point.
Rate of discharge for beneficiaries with a length of stay (LOS) of 180 days or more:
If this rate is greater than or equal to 33%, you receive one point. In general, long lengths of stay will contribute to a point in this category.
Rate of live discharge:
If your live discharge rate is greater than or equal to 46%, you receive one point. It’s important to note that we’ve seen significant regulatory attention in this area. For example, there have been over 400 suspension letters issued to hospices in California based solely on high live discharge rates.
While the SSVI calculation assigns one point at 46% or higher, some agencies with live discharge rates in the 30–35% range have still received suspension notices. This highlights the importance of monitoring this metric closely.
Average skilled nursing minutes on Routine Home Care days:
If the average number of minutes per Routine Home Care day is less than or equal to 9.9 minutes, you receive one point. For context, current data shows an average closer to 12.5 minutes per day.
Percentage of weekend Routine Home Care days with a skilled visit:
If fewer than 4.8% of patients receive a skilled visit on the weekend, you earn one point.
Rate of live discharge where the beneficiary returns to the same hospice within seven days:
If this rate is greater than or equal to 18%, you receive one point. This refers to patients who are discharged alive and then readmitted to the same hospice within seven days, which is factored into this measure.
It should be emphasized that at this point, CMS has not clearly defined how this data will ultimately be used. With that said, it’s widely expected that it could lead to increased medical review activity.
It’s also important to keep in mind that the utilization score is only one portion of the overall calculation. It accounts for up to eight points, but there are eight additional points available across other measures. One of those includes non-hospice spending during a patient’s hospice stay, specifically when Medicare pays for services under Part B or Part D that may have fallen under the hospice’s responsibility.
Shortly after releasing the proposed rule, CMS also published a spreadsheet outlining each agency’s individual scores and related statistics. It would be worthwhile to review that information to understand where your agency currently stands.
We will be covering SSVI in more detail in a future Monday Minute, including best practices to help you adjust your scores and avoid falling into outlier categories that could trigger additional medical review.
Healthcare Provider Solutions is available to support your medical review needs, including analyzing your SSVI data. If you’ve received a suspension letter, we can also assist you through the rebuttal process. Please reach out to us.
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