This question is creating a lot of confusion for hospice leaders reviewing their Service and Spending Variation Index, or SSVI, data.

The answer is simple, but the name of the measure is misleading:
CMS is not calculating the average length of your skilled nursing visits.
CMS is measuring the overall intensity of skilled nursing care provided across your hospice’s entire Routine Home Care census. The calculation includes both RN and LPN minutes reported on Routine Home Care days.

Here Is How the Calculation Works
Let’s say your hospice has 10 patients.
Each patient receives two skilled nursing visits per week, and every visit lasts 30 minutes.
That gives you:

• 10 patients
• Two visits per patient
• 20 total skilled nursing visits
• 30 minutes per visit
• 600 total skilled nursing minutes for the week

However, CMS does not divide those 600 minutes by the number of visits. CMS divides the minutes by every Routine Home Care day billed for those patients. Ten patients multiplied by seven Routine Home Care days equals 70 RHC days.

600 skilled nursing minutes ÷ 70 RHC days = 8.6 skilled nursing minutes per RHC day.
Your nurses did not spend only 8.6 minutes with each patient. Every visit still lasted 30 minutes.
The 8.6-minute result represents the average amount of skilled nursing care provided for every Routine Home Care day billed across the census.

Why This Number Matters

For FY 2025, the SSVI threshold is 9.9 skilled nursing minutes per Routine Home Care day. A hospice at or below that threshold receives an adverse point for this component of its SSVI utilization score.

In our example, two 30-minute visits per patient each week would produce an average of only 8.6 minutes per RHC day, placing the hospice below the threshold.

The average increases when patients receive:

• Longer skilled nursing visits
• Additional PRN visits
• Increased visit frequency
• Daily visits during significant decline
• More intensive nursing support as death approaches

CMS is looking at whether the agency’s claims reflect an appropriate mixture of routine care and intensified nursing care when patients’ clinical needs increase.

What Hospice Leaders Should Take From This

First, verify that all skilled nursing visit units are being reported accurately on your claims. CMS calculates the nursing minutes from the claims data your hospice submits.

Second, review whether your visit frequency and duration accurately reflect each patient’s clinical needs. The answer is not to arbitrarily increase visits or keep nurses in the home longer just to improve a score. Every visit must remain individualized, clinically necessary and consistent with the plan of care.

Finally, look at caseloads.

A nurse carrying an unmanageable caseload may not have the time or flexibility to increase visit frequency, make necessary PRN visits or spend additional time with patients experiencing significant decline.

Manageable caseloads give hospice nurses the ability to respond when patients need more intensive support. They improve care, strengthen documentation and allow the claims data to reflect the actual needs of a terminally ill population.

When we talk about protecting hospice quality, supporting nurses and staying ahead of increased CMS scrutiny, we keep returning to the same foundation:
Manageable caseloads. It is always manageable caseloads.
When staffing shortages make manageable caseloads difficult, Amity can help. Our experienced, local hospice nurses provide flexible clinical support, allowing your team to protect continuity, respond to changing patient needs and give every patient the time they deserve.
Learn more at www.amitystaffing.com.