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January 2020
Revenue
Revenue by Region *
Hospitals in the South saw the biggest year-over-year increase in NPSR per Adjusted Discharge at 3.5 percent, but fell slightly below budget at -0.2 percent. The Northeast/Mid-Atlantic was essentially flat at just 0.1 percent year over year but below budget, while the West, Great Plains, and Midwest all were up year over year and above budget for NPSR per Adjusted Discharge.
For NPSR per Adjusted Patient Day, the Great Plains, South, and Northeast/Mid-Atlantic all saw year-over-year decreases and were below budget for December. The Great Plains saw the greatest year-over-year decrease at -3.1 percent, and the West saw the greatest year-over-year increase at 5.7 percent. The West was the only region positive to both budget and year-over-year results.
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 performance was relatively clustered across most regions. The Midwest and Great Plains saw year-over-year increases of 6.8 percent and 1.7 percent, respectively, but both fell below budget. The Northeast/Mid-Atlantic was down -3.2 percent year over year, while the South was down -8.5 percent year over year. The West was an outlier, with Bad Debt and Charity jumping 36.0 percent year over year and performing 26.5 percent above budget.
Hospitals in the West, Northeast/Mid-Atlantic, and South all saw the IP/OP Adjustment Factor increase year over year and perform above budget in December. The IP/OP Adjustment Factor increased 2.1 percent year over year in the Great Plains, but fell slightly below budget. The Midwest was the only region to see a year-over-year decrease for this metric, at -1.5 percent, as well as be below budget for December.
National Revenue Observations
Revenue performance for December was somewhat mixed, with increases and decreases across the measures for Net Patient Service Revenue (NPSR) per Adjusted Patient Day and Inpatient/Outpatient (IP/OP) Adjustment Factor, and across-the-board increases in NPSR per Adjusted Discharge and Bad Debt and Charity as a Percent of Gross.
NPSR per Adjusted Discharge increased 3.3 percent year over year and 1.2 percent month over month, performing 1.0 percent to budget—mirroring similar patterns in Adjusted Discharges. NPSR per Adjusted Patient Day fell slightly -0.6 percent year over year, but increased slightly 0.2 percent month over month, falling -3.8 percent below budget expectations, despite the across-the-board increases in Adjusted Patient Days.
The IP/OP Adjustment Factor was up 1.7 percent year over year, but down -0.9 percent month over month, performing 1.2 percent to budget. Bad Debt and Charity as a Percent of Gross was up across all measures. This metric rose 2.6 percent year over year and 3.6 percent month over month, performing 2.0 percent above budget.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
1.0%
1.2%
3.3%
npsr_per_adj_discharge.svg
NPSR per Adj. Patient Day
(3.8%)
0.2%
(0.6%)
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
1.2%
(0.9%)
1.7%
ipop_adjustment_factor.svg
Bad Debt and Charity as a % of Gross
2.0%
3.6%
2.6%
bad_debt_and_charity.svg
Unless noted, figures are Actuals and Medians
Revenue by Bed Size
Hospitals with 100-199, 200-299, 300-499, and 500 or more beds all saw year-over-year NPSR per Adjusted Discharge increases of about 3.5 percent in December; with 100-199 and 300-499 bed hospitals also being below budget. The smallest hospitals of 0-25 beds saw the greatest year-over-year increase at 8.0 percent and were above budget, while hospitals with 26-99 beds were the only cohort to see a decrease in NPSR per Adjusted Discharge at -0.6 percent; albeit well above expected at 3.9 percent to budget.
NPSR per Adjusted Patient Day was relatively flat year over year for five of the six bed-size cohorts. Among the five, year-over-year performance ranged from -1.1 percent for hospitals with 0-25 beds to 1.2 percent for hospitals with 300-499 beds. Hospitals with 26-99 beds were the outlier, with NPSR per Adjusted Patient Day down -9.2 percent compared to December 2018 and -8.9 percent to budget.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
IP/OP Adjustment Factor performance was relatively clustered across most bed-size cohorts, with year-over-year increases ranging from 0.8 percent to 1.9 percent for five of the six cohorts and all at or above budget. Hospitals with 0-25 beds were an outlier, with IP/OP Adjustment Factor up 4.7 percent year over year and 5.7 percent to budget.
Hospitals with 100-199, 200-299, and 300-499 beds all saw Bad Debt and Charity increase year over year and rise above budget in December. The 300-499 bed-size cohort saw the biggest year-over-year increase at 10.7 percent. Meanwhile, hospitals with 26-99 beds and 500 beds or more saw year-over-year declines of -3.8 percent and -6 percent, respectively. Hospitals with 0-25 beds saw a year-over-year increase of 5.5 percent for Bad Debt and Charity, but performed -6.2 percent below budget for the month.
©2020 Kaufman, Hall & Associates, LLC
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