April 2020
Revenue
Revenue by Region *
Revenue results showed significant variance across different regions in March. Looking first at absolute change, inpatient revenues fell 14% below budget for hospitals in three regions—the Great Plains, Northeast/Mid-Atlantic, and West. In the Midwest, inpatient revenues were 11% below budget, and 12% below budget in the South. For outpatient revenue, the Midwest had the biggest decrease to budget at 20%, followed by the West at 19%, and the Northeast/Mid-Atlantic at 18%.
For NPSR per Adjusted Discharge, the West and Midwest both saw increases year-over-year and to budget due to volumes dropping more rapidly than revenue. The South saw decreases year-over-year and to budget. NPSR per Adjusted Discharge rose 3% year-over-year, but fell 3% below budget in the Northeast/Mid-Atlantic, and decreased about 1% year-over-year and was essentially flat to budget in the Great Plains.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
NPSR per Adjusted Patient Day decreased to budget in three of five regions, increased slightly to budget in the Midwest, and was essentially flat in the Great Plains. Year-over-year, NPSR per Adjusted Patient Day increased in four out of five regions.
Bad Debt and Charity as a Percent of Gross was up for all regions. The Midwest had the lowest year-over-year increase at 8%, and the West had the greatest increase at 34%. IP/OP Adjustment Factor was down year-over-year and to budget in four out of five regions. The Midwest had the greatest decreases for this metric, down 4% year-over-year and 5% to budget. The Great Plains was the only region to see increases in IP/OP Adjustment Factor, which rose 3% year-over-year and 1% to budget.
National Revenue Observations
Overall revenues were down for hospitals across the country in March, as they felt the sting of volume declines the latter half of the month. Overall revenues fell dramatically below budget expectations as a result, down 13% for inpatient revenue and down 17% for outpatient revenue in absolute change.
Bad Debt and Charity as a Percent of Gross saw consistent increases, jumping 13% year-over-year, 8% month-over-month, and 11% above budget. These results are not out of line with previous months, as hospitals routinely face increases in bad debt and charity care. However, organizations likely will see these increases accelerate in coming months as people lose coverage due to a stagnant economy and rapidly rising unemployment, which jumped to 4.4% in March.

Looking at variances to prior performance, Net Patient Service Revenue (NPSR) per Adjusted Discharge and per Adjusted Patient Day both fell 2% compared to budget expectations, but were up year-over-year. The increases were due to volumes dropping more rapidly than revenues. The Inpatient/Outpatient (IP/OP) Adjustment Factor was down across all measures, falling 2% year-over-year, and down 3% both month-over-month and to budget.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
(1.8%)
(2.1%)
1.3%
npsr_per_adj_discharge.svg
NPSR per Adj. Patient Day
(1.8%)
0.7%
2.7%
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
(2.7%)
(3.2%)
(1.7%)
ipop_adjustment_factor.svg
Bad Debt and Charity as a % of Gross
11.4%
7.5%
12.6%
bad_debt_and_charity.svg
Unless noted, figures are Actuals and Medians
Revenue by Bed Size
Hospitals of all sizes saw inpatient and outpatient revenues fall below budget expectations. The nation’s smallest hospitals (0-25 beds) saw inpatient revenues 16% below budget and outpatient revenues 15% below budget in March, while the largest hospitals of 500 beds or more saw inpatient revenues down 11% to budget and outpatient revenues 16% below budget.
Absolute changes in inpatient revenues for other bed-size cohorts ranged from 11% below budget for hospitals with 300-499 beds and 500 beds or more, to 16% below budget for hospitals with 26-99 beds. Outpatient revenues for other cohorts ranged from a low of 15% below budget for hospitals with 0-25 beds, to 19% below budget for those with 300-499 beds.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
NPSR per Adjusted Discharge rose year-over-year and to budget for both the nation’s smallest hospitals of 0-25 beds, and the largest hospitals of 500 beds or more. NPSR per Adjusted Discharge decreased year-over-year and to budget for hospitals with 26-99 and 200-299 beds, and increased year-over-year but decreased to budget for hospitals with 100-199 and 300-499 beds. NPSR per Adjusted Patient Day rose year-over-year across all bed-size cohorts, but five of six bed-size cohorts saw decreases to budget for this metric.
IP/OP Adjustment Factor fell year-over-year and to budget for five of six bed-size cohorts. The decreases ranged from 1% year-over-year and to budget for hospitals with 26-99 beds, to 3% year-over-year and 4% to budget for those with 200-299 beds.
Increases in Bad Debt and Charity as a Percent of Gross hit hospitals of all sizes in March, both year-over-year and to budget. The smallest hospitals with 0-25 beds saw the greatest increase to budget at 15%, while the largest hospitals with 500 beds or more saw the greatest year-over-year increase, up 19%.
©2020 Kaufman, Hall & Associates, LLC
scroll_up.svg
kha_logo.svg
National Hospital Flash Report
menu_icon.svg
mail.svg
Share article
Sign up now for access to the latest news and reports
SUBMIT