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January 2019
Revenue
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Revenue by Region ?
Regional performance was mixed, primarily with respect to budget variance. The West had a strong month, with NPSR per Adjusted Discharge up nearly 8 percent from December 2017, and exceeding budget by about 8 percent. This indicates that revenue projections mirrored that of 2017, but actual performance was quite favorable. The South had the highest year-over-year improvement on NPSR per Adjusted Patient Day, due primarily to a decrease in Length of Stay. Year-over-year and budget variance change for the IP/OP Factor was highest for the Great Plains region, which has a large number of small hospitals.
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, the key performance indicators for revenue demonstrated a strong month in December 2018 compared to December 2017, but not as strong as November 2018. Net Patient Service Revenue (NPSR) per Adjusted Discharge rose 2.5 percent compared with 12 months prior, but remained slightly under budget. NPSR per Adjusted Patient Day also rose compared with December 2017, but an increase in Length of Stay led it to lag the performance gains of NPSR per Adjusted Discharge. This highlights the continued role of more value-based payment. Bad Debt and Charity Care rose significantly over November 2018 and December 2017, and was well above budgeted expectations. While a rise in this metric is not uncommon at the end of the year, the sharpness of the rise in December 2018 reflects the overall state of the uninsured population, which is the highest it has been since 2014.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
(0.9%)
(1.7%)
2.5%
npsr_per_adj_discharge.svg
NPSR per Adj. Patient Day
(1.5%)
(1.5%)
1.3%
NPSR_per_adj_patient_day.svg
IP/OP Adjustment Factor
1.1%
(1.7%)
1.3%
ip_op.svg
Bad Debt and Charity as a % of Gross
3.6%
7.7%
1.9%
bad_debt.svg
Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
Overall, most bed-size cohorts seemed to reflect national revenue trends. Mid-size hospitals with 200-299 beds experienced a slight decrease in NPSR per Adjusted Discharge and Patient Day, well below budget expectations and reflecting an overall decrease. The IP/OP Factor continued the shift toward outpatient, with most hospital cohorts being only slightly above or below budget expectations. The smallest hospitals were the exception, with a shift toward outpatient at about 5 percent above budget.
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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