May 2020
Revenue
Revenue by Region *
Adjusted revenue results varied significantly across different regions in April. NPSR per Adjusted Discharge increased year-over-year and to budget for hospitals in the South, Midwest, Northeast/Mid-Atlantic, and West. The Midwest had the greatest year-over-year increase at 19%, while the West had the greatest increase to budget at 17%.
For NPSR per Adjusted Patient Day, hospitals in the South, Midwest, and West again saw increases year-over-year and to budget. The Northeast/Mid-Atlantic was down year-over-year but close to budget, and the Great Plains was essentially flat year-over-year and slightly below budget for NPSR per Adjusted Patient Day. The Midwest had the greatest increases for this metric, up 14% year-over-year and 6% above 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 was up year-over-year and compared to budget in the Great Plains, West, Midwest, and South, with the Midwest and South both having the greatest year-over-year increases at 9%. The Northeast/Mid-Atlantic was an outlier, up 1% year-over-year but falling 13% below budget expectations.
The IP/OP Adjustment Factor fell year-over-year and to budget for hospitals across all regions. The Northeast/Mid-Atlantic had the greatest declines, down 23% year-over-year and 22% below budget. The Great Plains had the least decreases, down 11% year-over-year and 9% below budget for IP/OP Adjustment Factor.
National Revenue Observations
Revenue results were down across most measures in April, but outpatient revenues took the biggest hit as patients avoided seeking care for fear of contracting the virus and many non-emergent services remained closed. Outpatient Revenues fell 50% year-over-year in April, fell 40% month-over-month, and were 51% below budget. By comparison, Inpatient Revenues declined slower than Discharges, at 25% year-over-year and 21% month-over-month, and were 30% below budget.
Looking at Total Gross Revenue, performance fell 30% compared to April 2019, 19% compared to March, and 33% below budget expectations. Bad Debt and Charity also declined, but Bad Debt and Charity as a Percent of Gross increased 4% year-over-year, ending the month 3% above budget.
The Inpatient/Outpatient Adjustment Factor decreased 17% year-over-year, 13% month-over-month, and was 16% below budget, reflecting the month’s low outpatient volumes.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Total Gross Revenue
(32.6%)
(18.9%)
(30.0%)
total_gross_revenue.svg
IP Revenue
(29.1%)
(20.5%)
(25.1%)
ip_revenue.svg
OP Revenue
(51.0%)
(40.3%)
(49.3%)
op_revenue.svg
Bad Debt and Charity
(40.6%)
(39.9%)
(38.7%)
bad_debt_and_charity.svg
NPSR per Adjusted Discharge
7.3
8.5%
10.0%
npsr_per_adj_discharge.svg
NPSR per Adjusted Patient Day
2.5
3.7%
4.1%
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
(16.3%)
(13.2%)
(16.9%)
ip_op_adjustment_factor.svg
Bad Debt and Charity as a % of Gross
3.0%
(7.8%)
4.2%
bad_debt_and_charity_percent.svg
Unless noted, figures are Actuals and Medians
Revenue by Bed Size
Looking at different bed-size cohorts, NPSR per Adjusted Discharge increased year-over-year and to budget for hospitals of all sizes. The smallest hospitals with 0-25 beds saw the greatest year-over-year increase for this metric at 15%, while hospitals with 200-299 beds had the greatest increase to budget, also at 15%. Smaller hospitals with 26-99 beds saw the least increases at 6% year-over-year and less than 1% above budget.
NPSR per Adjusted Patient Day increased year-over-year and to budget for five of six bed-size cohorts. Hospitals with 100-199 beds had the greatest year-over-year increase at 9%, while hospitals with 0-25 beds had the greatest increase to budget at 5%. Hospitals with 300-499 beds were the outlier for this metric, falling less than 1% below April 2019 performance, and 2% below budget.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
The IP/OP Adjustment Factor, however, was down year-over-year and compared to budget for all bed-size cohorts. Hospitals with 26-99 had the most significant declines, down 19% compared to April 2019 and 18% below budget.
Bad Debt and Charity as a Percent of Gross saw relatively small deviations year-over-year, ranging from down 8% for hospitals with 0-25 beds, to up 18% for hospitals with 500 beds or more. There was greater variation compared to budget, ranging from 12% below budget for hospitals with 0-25 beds, to 19% above budget for hospitals with 26-99 beds.
©2020 Kaufman, Hall & Associates, LLC
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