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September 2019
Revenue
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Revenue by Region *
Revenue performance by region for August was mixed. Notably, the South and Great Plains outperformed last year’s revenue per-unit results, while missing budget expectations—the Great Plains missing budget significantly by 16 percent for NPSR per Adjusted Discharge. Conversely, hospitals in the Northeast/Mid-Atlantic underperformed last year’s NPSR per Adjusted Discharge results while barely making budget. All cohorts were below budget for NPSR per Adjusted Patient Day, with only the South and Great Plains positive year over year. The Great Plains outperformed all other cohorts for Bad Debt and Charity as a Percent of Gross Revenue results. All regional cohorts outperformed IP/OP Adjustment Factor budget expectations, with mixed performance compared to last year. The Great Plains region led the group with a 2.4 percent increase over last year for this metric.
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 per unit performance for August fell short of budget expectations and July results. However, Net Patient Service Revenue (NPSR) per Adjusted Discharge grew 3.6 percent year over year, while NPSR per Adjusted Patient Day was flat. As summarized in our Volume commentary, Adjusted Discharges and Adjusted Patient Days exceeded performance for all periods, except for a year-over-year decline in Adjusted Discharges. This indicates that NPSR compared to budget expectations and last month did not match the pace of volume growth, but NPSR growth outperformed volume declines year over year. Once again, the IP/OP Adjustment Factor exceeded expectations, but was essentially flat compared to prior month and prior year performance. Hospitals across the country continue to struggle with rising levels of unpaid care, as Bad Debt and Charity as a Percent of Gross rose 5.2 percent year over year and 1.5 percent month over month, performing 1.5 percent above budget in August.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
(1.1%)
(1.2%)
3.6%
NPSR_Per_Adj_Discharge.svg
NPSR per Adj. Patient Day
(3.9%)
(1.4%)
0.0%
NPSR_Per_Patient_Day.svg
IP/OP Adjustment Factor
2.6%
0.7%
0.0%
IP_OP_Adj_Factor.svg
Bad Debt and Charity as a % of Gross
1.5%
1.5%
5.2%
Bad_Debt_And_Charity.svg
Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
August revenue across different bed-size cohorts was mixed. All bed-size cohorts outperformed NPSR per Adjusted Discharges year over year, with the larger cohorts (>200 beds) also outperforming budget. In NPSR per Adjusted Patient Day, all cohorts fell short of budget expectations with mixed results compared to the same period last year. This is notable considering that the consolidated national results for NPSR per Adjusted Patient Day were flat year over year. Given this national result, and the mixed results by bed-size cohort, one can surmise that the year-over-year performance of the 100-299 cohorts balance the performance of the larger bed-size cohorts for this metric. For the IP/OP Adjustment Factor, four of the six cohorts achieved slightly better results compared to budget but slightly worse compared to the prior-year results. The smallest (0-25 beds) cohort was an outlier, exceeding budget expectations by almost 9 percent and improving over last year by 2.3 percent. Consistent with the consolidated national performance, most cohorts (four of the six) exhibited an increase compared to budget and prior year results for Bad Debt and Charity as a Percent of Gross.
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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