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May 2019
Revenue
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Revenue by Region ?
Year-over-year revenue indicators mostly showed increases (unfavorable in the case of Bad Debt and Charity) for all four metrics across regions. The West, Midwest, and Northeast/Mid-Atlantic saw the greatest year-over-year increases in NPSR per Adjusted Discharge, all clustered between about 5 to 6 percent. The Great Plains was an outlier in this metric, at -8 percent compared to April 2018. The Northeast/Mid-Atlantic region was an outlier in Bad Debt and Charity Care, down about -14 percent both year over year and compared to budget. The IP/OP Adjustment Factor exceeded prior year performance by more than 2 percent in most regions, with the exceptions of the West and South.
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
Revenue performance was mixed in April. Net Patient Service Revenue (NPSR) per unit of service for the month fell short of budget expectations, despite year-over-year growth in NPSR per Adjusted Discharge and NPSR per Adjusted Patient Day. With discharge volume within -0.1 percent of budget expectations, volume growth in lower-cost outpatient care appears to temper the per unit revenue growth relative to budgets. The rate of year-over-year change in NPSR per Adjusted Discharge stands out given the increases in Adjusted Discharges over the same period. The IP/OP Factor exceeded expectations and prior year and prior month performance, indicating that the trend of increases in outpatient volumes is continuing at a faster pace than expected. Bad Debt and Charity Care increased 2.8 percent year over year, but had favorable variances over budget and prior month.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
(1.9%)
(0.2%)
1.4%
npsr_per_adj_discharge.svg
NPSR per Adj. Patient Day
(1.9%)
1.3%
3.6%
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
2.7%
2.3%
1.9%
ip_op.svg
Bad Debt and Charity as a % of Gross
(1.4%)
(1.4%)
2.8%
bad_debt.svg
Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
Bed-size cohort trends mirrored those seen in the regional data, with most cohorts experiencing positive year-over-year revenue per unit performance. Most bed-size cohorts experienced year-over-year increases in the IP/OP Adjustment Factor, except for hospitals with 100-199 beds, which remained flat compared to April 2018. All cohorts were above budget expectations for this metric, indicating ongoing increased growth in outpatient volumes. Bad Debt and Charity Care as a percent of gross performance was mixed by bed size, with most experiencing an unfavorable year-over-year variance. The largest (>500 beds) and smallest (0-25 beds) cohorts both fell short of budgets by approximately 5 percent.
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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