September 2020
Revenue
Revenue by Region *
August NPSR per Adjusted Discharge was up year-over-year and compared to budget in four of five regions. The Great Plains and West saw the greatest year-over-year increase at 16%, and were 9% and 11% above budget for the month, respectively. The Northeast/Mid-Atlantic was the only region to fall below budget at 1% but was up 7% year-over-year.
NPSR per Adjusted Patient Day was above budget and up year-over-year in the Midwest, South, and West. The West saw the greatest increases at 10% year-over-year and 8% above budget. Hospitals in the Great Plains saw NPSR per Adjusted Patient Day rise 7% year-over-year but fall 3% below budget, while hospitals in the Northeast/Mid-Atlantic were down 1% year-over-year and 6% below budget.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
The IP/OP Adjustment Factor fell year-over-year across all regions, but two regions were below budget while three regions were above budget. The South saw the greatest decreases across both measures, falling 6% year-over-year and 3% below budget. The Northeast/Mid-Atlantic saw the greatest increase to budget at 3% but fell 3% year-over-year.
Bad Debt and Charity as a Percent of Gross fell year-over-year and compared to budget in four of five regions. The West saw the greatest decreases, dropping 32% year-over-year and 18% below budget. The Great Plains was the only region to see a year-over-year increase at 4%, but was 5% below budget expectations for this metric.
National Revenue Observations
Hospitals nationwide saw revenue declines in August without federal CARES relief. Not including the funding, Gross Operating Revenue is down 7% year-to-date compared to the first eight months of 2019. In August, Gross Operating Revenue fell 2% both year-over-year and month-over-month, and 4% below budget.
Outpatient Revenue saw the greatest decreases, down 10% year-to-date and falling 4% year-over-year, 2% month-over-month, and 6% below budget in August. Inpatient Revenue is down 4% since the start of the year, but rose less than 1% year-over-year, fell less than 1% month-over-month, and was 5% below budget in August.
On a positive note, hospitals also saw declines in Bad Debt and Charity, which fell 9% year-over-year, 2% month-over-month, and 11% below budget for the month. Overall, Bad Debt and Charity is down 5% over 2019 levels since the start of the year.
Revenues showed some gains once adjusted for the month’s low volumes. Net Patient Service Revenue (NPSR) per Adjusted Discharge jumped 12% year-over-year in August, and was up just 1% month-over-month and 4% above budget.
NPSR per Adjusted Patient Day rose 6% compared to August 2019 and was 2% above budget, but fell 2% from July 2020. The Inpatient/Outpatient (IP/OP) Adjustment Factor was down about 1% both month-over-month and compared to budget, and fell 3% year-over-year. Bad Debt and Charity as a Percent of Gross fell 8% year-over-year and 7% below budget, but was up 2% month-over-month.
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Total Gross Revenue Less CARES
(4.2%)
(1.7%)
(1.7%)
gross_operating_revenue_less_cares.svg
IP Revenue
(4.8%)
(0.8%)
0.8%
ip_revenue.svg
OP Revenue
(5.5%)
(1.8%)
(3.9%)
op_revenue.svg
Bad Debt and Charity
(11.0%)
(2.2%)
(9.2%)
bad_debt_and_charity.svg
NPSR per Adjusted Discharge
4.3%
1.3%
12.4%
npsr_per_adj_discharge.svg
NPSR per Adjusted Patient Day
2.0%
(2.0%)
6.1%
npsr_per_adj_patient_day.svg
IP/OP Adjustment Factor
(1.0%)
(0.5%)
(3.2%)
ip_op_adjustment_factor.svg
Bad Debt and Charity as a % of Gross
(7.3%)
1.8%
(8.2%)
bad_debt_and_charity_percent.svg
Unless noted, figures are Actuals and Medians
Revenue by Bed Size
Hospitals of all sizes saw increases both year-over-year and compared to budget for NPSR per Adjusted Discharge. Hospitals with 100-199 beds saw the greatest year-over-year increase at 15% and were 6% above budget. Hospitals with 200-299 beds saw the greatest increase to budget at 7% and were up 14% year-over-year.
Hospitals of all sizes also saw year-over-year increases in NPSR per Adjusted Patient Day, but three bed-size cohorts were below budget while three were above budget. Hospitals with 100-199 beds saw the greatest increases, jumping 18% year-over-year and 11% above budget for this metric. Smaller hospitals with 26-99 beds saw the greatest decrease to budget at 6%, but saw NPSR per Adjusted Patient Day rise 3% year-over-year.
NPSR per Adjusted Discharge
NPSR per Adjusted Patient Day
IP/OP Adjustment Factor
Bad Debt And Charity
The IP/OP Adjustment Factor fell year-over-year and below budget in four bed-size cohorts, and was down year-over-year but above budget in the other two. Hospitals with 100-199 beds and 0-25 beds both saw the greatest year-over-year decreases at 5%, but the larger hospitals were 2% below budget while the smaller hospitals were less than 1% above budget.
Bad Debt and Charity as a Percent of Gross fell year-over-year and below budget for hospitals of all sizes. The nation's largest hospitals with 500 beds or more saw the greatest year-over-year decrease at 13% and fell 7% below budget, while the smallest hospitals of 0-25 beds saw the greatest decrease to budget at 13% and were down 10% year-over-year.
©2020 Kaufman, Hall & Associates, LLC
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