October 2018
Revenue
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Revenue by Region ?
Regional trends in September mostly mirrored national observations. All regions—with the slight exception of the South—demonstrated favorable year-over-year and budget variance for NPSR per Adjusted Discharge and Patient Day. Although the national composite slightly decreased for NPSR per Adjusted Patient Day, the regions’ medians actually increased slightly. The IP/OP factor increased for most regions, except for the Northeast, where it was consistent with last year. All but the coastal regions demonstrated greater IP/OP factors than budgeted.
NPSR per Adj. Discharge
NPSR per Adj. Patient Day
IP/OP
Bad Debt and Charity
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
National Revenue Observations
Nationally, September was a decent month in terms of revenue performance. While volumes generally underperformed, net patient service revenue per adjusted discharge increased month over month and year over year. This may signify an increase in acuity and correlated payment, which might be further supported by an observed increase in patient days. NPSR per Adjusted Discharge also slightly outperformed budget expectations. While Adjusted Patient Days increased, Net Patient Service Revenue per Adjusted Patient Day decreased, highlighting the role that bundled payments and value-based payment may play. The IP/OP factor continues its trend of increasing over last year, further demonstrating the shift toward outpatient services. Bad debt and charity metrics declined year over year, but increased month over month and were unfavorable to budget. This denotes the importance of hospitals gaining a better understanding of local changes to government patient coverage, which may drive larger uncollectable patient balances.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
NPSR per Adj. Discharge
0.9%
1.4%
4.4%
NPSR per Adj. Patient Day
(3.0%)
1.0%
(1.4%)
IP/OP Adjustment Factor
1.4%
(2.8%)
0.7%
Bad Debt and Charity as a % of Gross
2.5%
0.9%
(0.9%)
Unless noted, figures are Actuals and Medians
By Region
By Bed Size
National Observations
Revenue by Bed Size
Key revenue performance metrics also mirrored the national composite across hospitals of all sizes. NPSR per Adjusted Discharge increased year over year for all bed sizes except the very largest, where about half outperformed budget and half underperformed. NPSR per Adjusted Patient Day demonstrated mixed performance, as hospitals with 200-299 beds and greater than 500 beds underperformed relative to last year and to budget. These bed-size cohorts tend to drive the national composite down due to their frequency. IP/OP adjustment factor was greater than budget for all bed sizes, and all but the 200-299 and greater than 500 bed cohorts were greater than last year. Bad debt and charity were up for most hospitals, with the exception of those with 26-99 and 300-499 beds, which drove down the national composite.
NPSR per Adj. Discharge
NPSR per Adj. Patient Day
IP/OP
Bad Debt and Charity
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
By Region
By Bed Size
National Observations
©2018 Kaufman, Hall & Associates, LLC
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