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August 2019
Revenue
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Revenue by Region *
Year-over-year NPSR per Adjusted Discharge was positive for all regions. Most regions also were positive to budget, except for the South and Great Plains. Comparatively, NPSR per Adjusted Patient Day was positive year over year for most regions, except the Great Plains, while three regions—the South, Midwest, and West—were negative to budget. Just as with the overall IP/OP Adjustment Factor, all regions were positive year over year and compared to budget in July. Bad Debt and Charity was mixed, with the South and Northeast/Mid-Atlantic regions down year over year and to budget, while the remaining regions were up on both metrics.
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
Similar to prior months, revenue performance in July fell short of budget expectations for both NPSR per Adjusted Discharge and NPSR per Adjusted Patient Day, while the IP/OP Adjustment Factor demonstrated budget growth of 2.9 percent. At the same time, NPSR per Adjusted Discharge rose 0.9 percent month over month and 4.6 percent year over year, and NPSR per Adjusted Patient Day increased 0.7 percent month over month and 3.0 percent year over year. The trend in revenue per unit of service being under budget, while Adjusted Discharges and Adjusted Patient Days continue to be above budget, is explained by the IP/OP Adjustment Factor continuing to be higher than expected. This likely means that overall revenue growth is slowed by higher growth in lower-cost outpatient volume than in inpatient discharges. Bad Debt and Charity as a Percent of Gross was more than 5 percent above budget, and saw month-over-month and year-over-year growth in July, which also could be contributing to revenue per unit of service being under budget.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
(1.1%)
0.9%
4.6%
NPSR_Per_Adj_Discharge.svg
NPSR per Adj. Patient Day
(0.8%)
0.7%
3.0%
NPSR_Per_Patient_Day.svg
IP/OP Adjustment Factor
2.9%
0.6%
1.2%
IP_OP_Adj_Factor.svg
Bad Debt and Charity as a % of Gross
5.1%
2.0%
2.7%
Bad_Debt_And_Charity.svg
Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
All bed-size cohorts showed positive year-over-year performance for NPSR per Adjusted Discharge, but only the largest two cohorts were (slightly) positive to budget. NPSR per Adjusted Patient Day performance showed a different pattern. Most cohorts were positive year over year, with the exception of 0-25 bed hospitals, which was down -4 percent year over year for NPSR per Adjusted Patient Day. Most cohorts were either negative to budget or at budgeted levels for NPSR per Adjusted Patient Day in July, with only the 200-299 bed cohort performing above budget expectations.
All cohorts were positive to budget for the IP/OP Adjustment Factor, and only the 26-99 bed cohort showed negative year-over-year growth. Bad Debt and Charity was evenly divided, with three cohorts (26-99 beds, 200-299 beds, and >500 beds) below both budget and year over year performance, and the other three cohorts up for both.
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
©2019 Kaufman, Hall & Associates, LLC
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