2018 Year-In-Review
Volume
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Volume by Region ?
Most volume indicators showed eroding performance across regions in 2018, in alignment with national trends—with only a few exceptions. Discharges grew slightly for the Great Plains and Northeast regions, and Adjusted Discharges grew for the South. Average Length of Stay increased for all regions except the West, driving some important changes in cost that are reviewed in the Expense section.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
National Volume Observations
National volume indicators demonstrated eroding performance in 2018 relative to the previous year. Performance relative to Discharges, Adjusted Discharges, Adjusted Patient Days, ED Visits, and Operating Room (OR) Minutes all declined compared to 2017. All metrics also underperformed relative to budget, indicating a greater downward shift than expected. Average Length of Stay increased in 2018 from 2017, likely representing a rise in higher-acuity patients. Coupled with inpatient volume declines and increasing IP/OP factor, these trends indicate an increasing shift of lower-acuity patients to outpatient settings. It is important to note that a rapid rise in the IP/OP factor (as reviewed in the Revenue section) suggests that hospital leaders should be increasingly cautious about using adjusted metrics, as they are becoming less indicative of what is truly occurring.
Unless noted, figures are Actuals and Medians
Budget Variance
Year Over Year
Year Over Year Distributions (click to enlarge)
Discharges
(5.8%)
(4.6%)
discharges.svg
Adjusted Discharges
(2.3%)
(0.8%)
adj_discharges.svg
Adjusted Patient Days
(1.6%)
(1.0%)
adj_patient_days.svg
Average Length of Stay
(1.2%)
1.3%
av_length_of_stay.svg
ED Visits
(5.4%)
(3.8%)
ed_visits.svg
Operating Room Minutes
(6.1%)
(3.8%)
or_minutes.svg
By Region
By Bed Size
National Observations
Trends
Volume by Bed Size
Volume indicators for almost all bed-size cohorts aligned with national trends, with only a few exceptions. Adjusted Patient Days increased for the 26-199 bed-size cohort, and ED visits rose for the largest hospitals. Hospitals of 300-499 beds had a significant increase in OR Minutes, which demonstrates a recovery from a large dip the previous year.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Volume Trends
As noted earlier, most volume trends consistently underperformed in 2018 relative to 2017, with a few indicators demonstrating worsening performance. Discharges maintained a steady rate of decline, and increases in Adjusted Discharges and Adjusted Patient Days slowed. The increase in Adjusted Discharges was driven primarily by the adjustment factor, as more volumes shift toward outpatient settings. ED Visits continued to decline relative to the previous year, with an acceleration in unfavorable performance. Hospitals should expect continued decreases in ED Visits throughout 2019.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
By Region
By Bed Size
National Observations
Trends
©2018 Kaufman, Hall & Associates, LLC
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