August 2020
Revenue
Revenue by Region *
NPSR per Adjusted Discharge rose year-over-year and compared to budget in the Midwest, South, and West, with the West seeing the biggest increases at 13% and 15%, respectively. The Great Plains was up 3% year-over-year but flat compared to budget for this metric in July, while the Northeast/Mid-Atlantic was up 2% year-over-year but down 2% below budget.
NPSR per Adjusted Patient Day also rose year-over-year and compared to budget for hospitals in the Midwest, South, and West. The West and South saw the greatest year-over-year increases, with both regions up 8%. The Northeast/Mid-Atlantic was up 3% year-over-year but 1% below budget for NPSR per Adjusted Patient Day, while the Great Plains rose just 1% year-over-year but fell 11% below budget.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
Bad Debt and Charity as a Percent of Gross fell both year-over-year and compared to budget in four of five regions. The West saw the greatest year-over-year decrease at 25% and was 4% below budget, while the South saw the greatest decrease to budget at 13% and was down 7% year-over-year. The Midwest was the only region to see a slight year-over-year increase at 3%, but fell 12% below budget.
Performance for the IP/OP Adjustment Factor varied widely. The West and South both fell year-over-year and below budget for this metric, while the Great Plains was up year-over-year and above budget. The Northeast/Mid-Atlantic was down slightly year-over-year but 3% above budget, while the Midwest was essentially flat year-over-year and 2% above budget.
National Revenue Observations
Not including federal CARES funding, Gross Operating Revenues are down 8% year-to-date compared to the same period in 2019, Inpatient Revenue is down 5%, and Outpatient Revenue is down 11%. In July, Gross Operating Revenues were essentially flat year-over-year and 2% below budget, but up 5% month-over-month (without CARES). Inpatient Revenue increased just 1% compared to July 2019 and 6% compared to June 2020, but fell 3% below budget for the month. Outpatient Revenue was down 1% year-over-year and 2% below budget, but up 5% month-over-month. Bad Debt and Charity decreased 6% year-over-year and was 9% below budget, but up 3% month-over-month.
Net Patient Service Revenue (NPSR) per Adjusted Discharge rose 7% year-over-year and was 5% above budget, but was flat month-over-month. NPSR per Adjusted Patient Day rose 6% year-over-year and was 3% above budget, and fell less than 1% month-over-month.
The Inpatient/Outpatient (IP/OP) Adjustment Factor has declined about 3% year-to-date compared to the first seven months of 2019. For July, the IP/OP Adjustment Factor was down 2% year-over-year and flat month-over-month, and rose less than 1% above budget expectations. Bad Debt and Charity as a Percent of Gross fell 8% year-over-year and 10% below budget, but was up about 4% month-over-month.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Total Gross Revenue Less CARES
(1.6%)
5.4%
0.4%
gross_operating_revenue_less_cares.svg
IP Revenue
(3.0%)
5.5%
1.0%
ip_revenue.svg
OP Revenue
(1.9%)
5.0%
(1.1%)
op_revenue.svg
Bad Debt and Charity
(8.9%)
3.4%
(6.1%)
bad_debt_and_charity.svg
NPSR per Adjusted Discharge
4.7%
(0.2%)
6.5%
npsr_per_adj_discharge.svg
NPSR per Adjusted Patient Day
3.2%
(0.5%)
6.0%
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
0.6%
(0.1%)
(1.7%)
ip_op_adjustment_factor.svg
Bad Debt and Charity as a % of Gross
(10.2%)
3.5%
(8.1%)
bad_debt_and_charity_percent.svg
Unless noted, figures are Actuals and Medians
Revenue by Bed Size
NPSR per Adjusted Discharge rose year-over-year and compared to budget for five of six bed-size cohorts. Hospitals with 100-199 and 300-499 beds saw the greatest year-over-year increases, with both cohorts up 9% compared to July 2019. Smaller hospitals with 26-99 beds were the only ones to fall slightly below budget for the month, but were up 5% year-over-year for NPSR per Adjusted Discharge.
Hospitals in five of six bed-size cohorts also were up year-over-year and compared to budget for NPSR per Adjusted Patient Day in July. Hospitals with 100-199 beds saw the greatest increases at 10% and 7%, respectively. The smallest hospitals of 0-25 beds were up less than 1% year-over-year, but it was the only cohort to fall below budget for the month, down 8%.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
Hospitals of all sizes were down year-over-year for the IP/OP Adjustment Factor, but three cohorts fell below budget while the other three were above budget. Hospitals with 100-199 beds saw the greatest year-over-year decrease of 2%, while hospitals with 0-25 beds saw the greatest budget variance at 4% above budget.
Bad Debt and Charity as a Percent of Gross fell year-over-year and below budget in four of six bed-size cohorts, with the smallest hospitals of 0-25 beds seeing the biggest decreases down about 15% across both measures. Hospitals with 26-99 beds were up less than 1% year-over-year but 4% below budget for this metric in July, while hospitals with 500 beds or more were down 4% year-over-year but 1% above budget.
©2020 Kaufman, Hall & Associates, LLC
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