2019 Year-In-Review
Volume
Volume by Region ?
By Region, Discharges were up year over year, but below budget in the West, Great Plains, and South. However, Discharges were down year over year and below budget in the Northeast/Mid-Atlantic and Midwest. The West saw the greatest year-over-year increase at 3.7 percent, while the Midwest saw the greatest year-over-year decrease at -6.0 percent.
Adjusted Discharges rose year over year and were above budget in the South, West, and Great Plains, but down year over year and below budget in the Northeast/Mid-Atlantic and Midwest. The Great Plains saw the biggest year-over-year increase in Adjusted Discharges, at 4.4 percent.

Adjusted Patient Days rose year over year and were above budget in four of the five regions. The Midwest was the only region to see Adjusted Patient Days decline in 2019 compared to 2018, and fall below budget. Again, the Great Plains saw the greatest year-over-year increase in Adjusted Patient Days at 6.7 percent.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Most regions saw year-over-year increases in Average LOS, with the Northeast/Mid-Atlantic seeing the largest jump of 4.5 percent compared to 2018. The West was the only region to see a slight decline in Average LOS at -0.1 percent compared to 2018, and -0.8 percent below budget expectations.
ED Visits were flat or declined across most of the country in 2019. The Midwest saw the greatest year-over-year decrease of -3.1 percent, falling -3.6 percent below budget. The West was the only region to see a year-over-year increase in ED Visits of 2.8 percent, performing 1.9 percent to budget.
OR Minutes, however, increased year over year in four of five regions. The Great Plains was the only region to see a slight year-over-year decrease in OR Minutes of -0.3 percent, falling -0.6 percent below budget. Despite year-over-year increases, the Midwest and Northeast/Mid-Atlantic also fell below budget expectations in 2019.
National Volume Observations
National volume indicators showed mixed performance in 2019 compared to 2018, with most indicators showing year-over-year increases, but a majority performing below budget expectations. Adjusted Patient Days saw the greatest year-over-year increase at 2.5 percent or 815.2 bps, but was up just 0.3 percent to budget. Adjusted Discharges were up 0.7 percent or 43.2 bps year over year, but performed -0.7 percent to budget.
Discharges and Emergency Department (ED) Visits both showed slight year-over-year decreases of -0.5 percent and -0.4 percent, respectively. Average Length of Stay (LOS) rose 1.9 percent over 2018 levels, and Operating Room (OR) Minutes rose 2.2 percent year over year.
Unless noted, figures are Actuals and Medians
Budget Variance
Year Over Year
Discharges
(2.7%)
(0.5%)
Adjusted Discharges
(0.7%)
0.7%
Adjusted Patient Days
0.3%
2.5%
Average Length of Stay
0.3%
1.9%
ED Visits
(1.0%)
(0.4%)
Operating Room Minutes
(0.3%)
(2.2%)
Volume by Bed Size
Discharges were down year over year and compared to budget for hospitals with 0-25, 26-99, 200-299, and 500 or more beds. The nation’s smallest hospitals with 0-25 beds saw the greatest decrease compared to 2018 at -4.8 percent. Hospitals with 100-199 and 300-499 beds saw year-over-year increases in Discharges, but still fell at or below budget for the year.
The results were a little more mixed for Adjusted Discharges. Hospitals with 26-99, 100-199, and 300-499 beds all saw Adjusted Discharges increase over 2018 and perform above budget in 2019, while hospitals with 0-25 and 200-299 beds saw Adjusted Discharges decline and perform below budget. The nation’s largest hospitals with 500 beds or more had the greatest variance to budget, falling -3.6 percent below expectations—but the cohort saw Adjusted Discharges remain close to 2018 levels, down just -0.1 percent year over year.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Hospitals of all sizes saw year-over-year increases of 1.6 percent or more for Adjusted Patient Days, with the smallest hospitals of 0-25 beds seeing the biggest jump at 2.8 percent. Even so, hospitals with 26-99, 100-199, and 200-299 beds all fell below budget, while the other bed-size cohorts were above budget for the year. Average LOS also increased year over year for all bed-size cohorts in 2019. The smallest hospitals with 0-25 beds saw the greatest increase over 2018 of 3.8 percent, while the largest hospitals of 500 beds or more saw the least increase, at just 0.1 percent.
ED Visits declined year over year and fell below budget for the smallest three bed-size cohorts (hospitals with 0-25, 26-99, and 100-199 beds), but increased slightly year over year for the larger bed-size cohorts. Hospitals with 500 beds or more saw the greatest year-over-year increase—with ED Visits up 1.6 percent compared to 2018—and was the only cohort to perform above budget for this metric.
Overall, OR Minutes were relatively flat year over year for five of the six bed-size cohorts. The smallest hospitals of 0-25 beds were the only cohort to see a significant increase, with OR Minutes up 17.3 percent over 2018.
Volume Trends
Overall, the nation’s hospitals saw modest increases in both Discharges and Adjusted Discharges over the course of 2019 compared to 2018. Discharges fluctuated from a low of -5.8 percent year over year in January, to a high of 3.0 percent in September. Adjusted Discharges peaked in April at 4.6 percent year over year, but dipped below 2018 performance in January, February, March, June, August, and November.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Year-over-year performance on Adjusted Patient Days rose steadily for most of the year, performing at its lowest at -0.3 percent at the start of the year in January, and at its highest of 5.3 percent at the end of the year in December. Average LOS saw moderate year-over-year increases throughout much of 2019, but was below 2018 levels in January, February, April, and October.

ED Visits saw significant variations from month to month, but trended upward throughout the year, reaching a low of -7.0 percent year over year in January and a high of 5.5 percent in December. OR Minutes also saw significant variations. While the overall trend increased just slightly throughout 2019, year-over-year performance fluctuated from one month to the next, peaking at 8.6 percent in July, and reaching a low of -1.9 percent the following month.
©2018 Kaufman, Hall & Associates, LLC
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