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December 2018
Revenue
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Revenue by Region ?
Regionally, most results coincide with the national observations. NPSR per adjusted discharge was up for all regions except the West and Great Plains, with the Great Plains also performing under budget. Continuing a difficult month for the Great Plains region in terms of revenue, it was the only region with unfavorable NPSR per adjusted patient day. Interestingly, the IP/OP adjustment factor was tightly clustered for all regions in November, demonstrating a very similar shift in outpatient revenue across the nation.
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
Nationally, November was a strong month for revenue performance. Almost all indicators demonstrated favorable trends year over year and month over month. Net Patient Service Revenue (NPSR) per adjusted discharge was up 3.5 percent from prior year and 3.1 percent from last month. NPSR per adjusted patient day also was up, but not to the same extent as NPSR per adjusted discharge, indicating favorable per-case payment and a continued trend toward more value-based payment. The inpatient/outpatient adjustment factor continued its year-over-year increase, a trend observed almost all months of the year, indicating the continuing shift to outpatient settings. Bad Debt and Charity Care also was up in November, but under budget. This indicator will continue to be monitored as Congress contemplates changes to the ACA and coverage provisions.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
5.2%
3.1%
3.5%
npsr_per_adj_discharge.svg
NPSR per Adj. Patient Day
2.0%
2.5%
0.8%
npsr_per_adj_patient_days.svg
IP/OP Adjustment Factor
2.0%
(0.9%)
1.9%
ip_op.svg
Bad Debt and Charity as a % of Gross
(1.2%)
1.0%
0.8%
bad_debt.svg
Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
Most bed-size cohorts also aligned with national trends. Larger hospitals tended to perform less favorably on NPSR per adjusted discharge, both in terms of year-over-year performance and variance to budget. NPSR per adjusted discharge demonstrated a clustering of performance slightly favorable to budget and favorable to last year for all bed sizes, with 0-25 bed hospitals outperforming larger hospitals. Unlike performance across regions, there was a difference in clusters for IP/OP adjustment factor, with the 26-199 bed cohorts demonstrating a greater shift toward outpatient than other hospitals. Bad Debt and Charity Care was down significantly for the smallest hospitals, further bolstering their strong November performance.
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
©2018 Kaufman, Hall & Associates, LLC
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