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November 2018
Revenue
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Revenue by Region ?
Regional trends in October mostly mirrored national observations. All regions—with the slight exception of the South and Great Plains—demonstrated favorable year over year and budget variance for NPSR per Adjusted Discharge and Patient Day. The South and Great Plains regions both demonstrated favorable year-over-year change with respect to NPSR per Adjusted Patient Day, but underperformed relative to budget. The IP/OP factor increased for all regions, with the South and Midwest having the largest change relative to budget and 2017. The large shift to outpatient in these regions in October explains the underperformance for NPSR per Adjusted Discharges. Future editions of the National Hospital Flash Report will continue to monitor such pressures in the ongoing shift to outpatient care.
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
October was a strong month in terms of revenue performance. Net Patient Service Revenue (NPSR) per Adjusted Discharge increased month over month and year over year. NPSR per Adjusted Discharge also slightly outperformed budget expectations, likely driven by the increase in patient days and decrease in lengths of stay. While Adjusted Patient Days increased, NPSR per Adjusted Patient Day also increased, highlighting that the majority of hospitals still operate on a majority fee-for-service basis. The IP/OP factor continued its trend of increasing over 2017, further demonstrating the shift toward outpatient services. Bad debt and charity metrics declined year over year and month over month, and were favorable to budget.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
1.6%
1.6%
1.1%
npsr_per_adj_discharge.svg
NPSR per Adj. Patient Day
0.3%
2.8%
2.1%
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
2.0%
2.0%
1.8%
ip_op.svg
Bad Debt and Charity as a % of Gross
(1.8%)
(5.7%)
(0.9%)
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Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
Key revenue performance metrics also mirrored the national composite across hospitals of all sizes. NPSR per Adjusted Discharge increased year over year for all bed sizes except the smallest, where about half outperformed budget and half underperformed. NPSR per Adjusted Patient Day demonstrated strong year-over-year performance for all hospital sizes, but mixed performance relative to budget. The IP/OP adjustment factor was greater than budget for all bed sizes, and all but the largest bed cohorts were greater than last year. Bad debt and charity demonstrated mixed performance, with about half of bed sizes worse and half better than last year. The largest cohort (>500 beds) was an outlier with large year-over-year decreases, while also remaining 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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