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2019 Year-In-Review
Revenue
Revenue by Region ?
NPSR per Adjusted Discharge was up year over year for hospitals in four of the five regions. The Great Plains was the only region to experience a slight year-over-year drop of -0.3 percent, with NPSR per Adjusted Discharge down -1.7 percent to budget.
NPSR per Adjusted Patient Day performance was relatively clustered for hospitals in the Northeast/Mid-Atlantic, South, West, and Midwest. Hospitals in those regions saw modest year-over-year increases ranging from 1.1 to 2.7 percent. The Great Plains was the outlier, experiencing a significant year-over-year drop in NPSR per Adjusted Patient Day of -7.8 percent, performing -10.4 percent below budget for the year.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
Bad Debt and Charity as a Percent of Gross was up year over year for hospitals in the Great Plains, West, and Midwest, but down for hospitals in the Northeast/Mid-Atlantic and South. The Great Plains region saw the largest year-over-year increase at 5.1 percent, which negatively impacted the region’s Revenue per Adjusted Patient Day and Revenue per Adjusted Discharge performance. The Northeast/Mid-Atlantic saw the biggest year-over-year decrease at -2.6 percent, falling -1.4 percent below budget.
The IP/OP Adjustment Factor was up compared to 2018 and to budget for hospitals in all regions. The Great Plains saw the greatest year-over-year increase at 2.1 percent, performing 3.0 percent to budget. The Midwest saw the lowest increase at 0.3 percent, and performed 1.9 percent to budget.
National Revenue Observations
The nation’s hospitals saw favorable revenue performance in 2019 compared to 2018. Net Patient Service Revenue (NPSR) per Adjusted Discharge rose 3.7 percent or 326.0 bps year over year and was up slightly 0.8 percent to budget, while NPSR per Adjusted Patient Day rose 1.5 percent or 25.9 bps and performed right on par with budget expectations.
The Inpatient/Outpatient (IP/OP) Adjustment Factor was up 1.3 percent year over year, and was 2.5 percent above budget. Meanwhile, hospitals contended with increases in Bad Debt and Charity as a Percent of Gross, which rose 1.0 percent in 2019 over 2018, and saw the greatest variance to budget of any revenue metric at 3.2 percent.
Unless noted, figures are Actuals and Medians
Budget Variance
Year Over Year
NPSR per Adj. Discharge
0.8%
3.7%
NPSR per Adj. Patient Day
0.0%
1.5%
IP/OP Adjustment Factor
2.5%
1.3%
Bad Debt and Charity as a % of Gross
3.2%
1.0%
Revenue by Bed Size
NPSR per Adjusted Discharge was up year over year and above budget for hospitals in five of the six bed-size cohorts. Hospitals with 200-299 beds saw the biggest increase at 5.7 percent compared to 2018. Smaller hospitals with 26-99 beds also saw NPSR per Adjusted Discharge increase year over year, but was the only cohort to fall below budget expectations.
NPSR per Adjusted Patient Day rose for five of the six bed-size cohorts, with hospitals ranging in size from 26 to 500 beds or more. Hospitals with 0-25 beds were the lowest-performing cohort year over year in both NPSR per Adjusted Discharge and per Adjusted Patient Day. It was the only cohort to see a year-over-year drop in NPSR per Adjusted Patient Day, falling -1.4 percent compared to 2018 and -2.8 percent to budget. The IP/OP Adjustment Factor rose year over year for hospitals of all sizes. The smallest hospitals of 0-25 beds saw the greatest increase of 3.1 percent compared to 2018, and was up 4.8 percent to budget.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
Bad Debt and Charity Care as a Percent of Gross rose year over year for hospitals with 0-25, 100-199, and 200-299 beds, but fell year over year for hospitals with 26-99, 300-499, and 500 beds or more. The largest hospitals of 500 beds or more saw the most significant year-over-year decline of -3.6 percent, and was the only cohort to see Bad Debt and Charity fall below budget expectations at -2.0 percent for the year.
Revenue Trends
NPSR per Adjusted Discharge performance was consistently above 2018 performance last year, but saw slight, but steady declines in the level of that performance throughout 2019. Year-over-year performance peaked at 5.7 percent in February, and was at its lowest level of 0.8 percent in April.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
NPSR per Adjusted Patient Day saw a similar pattern, performing above 2018 levels for 10 of 12 months in 2019, but steadily decreasing in its positive year-over-year variance throughout the year. NPSR per Adjusted Patient Day peaked at 4.8 percent year over year in February, and was at its lowest of -0.8 percent in June. Year-over-year performance on the IP/OP Adjustment Factor was relatively consistent throughout the year, peaking at 4.1 percent in January, but never dipping below 2018 levels.
Performance was more varied for Bad Debt and Charity, with year-over-year variances jumping significantly from one month to the next. Even so, the overall trend shows a steady decline in this metric, which peaked at 5.7 percent in August, and fell to its lowest level the following month, at -3.1 percent in September.
©2018 Kaufman, Hall & Associates, LLC
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