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2018 Year-In-Review
Revenue
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Revenue by Region ?
Similar to the national trends, most regions had relatively strong revenue performance in 2018, as compared with 2017. Net Patient Service Revenue (NPSR) per Adjusted Patient Day increased for all regions, again underscoring a shift toward higher-acuity patients. NPSR per Adjusted Discharge also increased for most regions, except the West and South. The IP/OP Adjustment Factor continued its upward trend, which was greater than was budgeted for all regions.
NPSR per Adj. Discharge
NPSR per Adj. Patient Day
IP/OP
Bad Debt and Charity
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
National Revenue Observations
National revenue indicators improved in 2018 compared to the previous year, and were a primary contributor to profitability improvements, despite declining volumes. As more lower-acuity patients are moved to outpatient settings, bundled payments appear to increase for the higher-acuity patients, resulting in higher payment per Adjusted Discharge and Adjusted Patient Day. Most revenue indicators for the year were unfavorable to budget (the rationale for this was explored in the Spotlight articles in the December 2018 and January 2019 issues of the National Hospital Flash Report). Additionally, 2018 saw an increase in Bad Debt and Charity Care, likely resulting from federal policy changes that do not enforce healthcare coverage for individuals.
Unless noted, figures are Actuals and Medians
Budget Variance
Year Over Year
Year Over Year Distributions (click to enlarge)
NPSR per Adj. Discharge
(1.4%)
1.1%
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NPSR per Adj. Patient Day
(0.9%)
2.6%
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IP/OP Adjustment Factor
2.4%
1.2%
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Bad Debt and Charity as a % of Gross
2.6%
2.4%
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By Region
By Bed Size
National Observations
Trends
Revenue by Bed Size
Almost all bed-size cohorts experienced similar changes as the national medians. NPSR per Adjusted Discharge decreased for hospitals with 0-25 and 100-199 beds, but NPSR per Adjusted Patient Day improved for all bed-size cohorts in 2018 relative to 2017. Bad Debt and Charity Care continued to increase for most bed-size cohorts, with the only exception being the smallest hospitals with 0-25 beds.
NPSR per Adj. Discharge
NPSR per Adj. Patient Day
IP/OP
Bad Debt and Charity
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
Revenue Trends
Most revenue trends indicate consistent growth in 2018 over 2017. NPSR per Adjusted Discharge and Patient Day rose 1-2.5 percent overall over the course of the year—but fluctuations meant declines in those metrics for about half of the months of the year, and improvements the other half. Bad Debt and Charity Care continued to rise, but the pace of change slowed toward the end of 2018. Finally, the IP/OP Adjustment Factor continued its upward trend, while the shift of care to outpatient settings accelerated throughout 2018.
NPSR per Adj. Discharge
NPSR per Adj. Patient Day
IP/OP
Bad Debt and Charity
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
By Region
By Bed Size
National Observations
Trends
©2018 Kaufman, Hall & Associates, LLC
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