July 2018
Volume
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Volume by Region ?
Regionally, volume performance generally varied widely and mirrored overall underperformance relative to budget. One outlier is the Great Plains, where hospitals saw significant increases in discharge volume. Coupled with underperformance relative to operating room minutes, it is possible that acuity is trending lower than expected this year. This can be further confirmed by the significant underperformance of Net Patient Service Revenue (see Revenue section) year over year and relative to budget. If these trends continue, corresponding decreases in expenses will be needed in order to preserve operating margins.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
National Volume Observations
Overall, hospital discharges showed significant underperformance relative to budget (discharge budget variance -4 percent) and month over month (-3 percent). Other volume indicators were down as well, with emergency department visits and operating room minutes showing similar declines. Volume statistics were largely in line with 2017, indicating that organizations projected year-over-year increases that have not materialized. Both day and discharge indicators varied widely year over year, however, with about half of the hospitals seeing volume increases, and half seeing decreases. The wide variation in performance underscores the challenges to succeeding in the current healthcare environment. It is imperative that healthcare leaders not lose focus of near- and long-term initiatives to drive performance.
Unless noted, figures are Actuals and Medians
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Discharges
-4%
-3%
-1%
img_1807_Discharges_Box.svg
Adjusted Discharges
2%
-4%
0%
img_1807_Adjusted_Discharges_Box.svg
Adjusted Patient Days
-3%
-5%
-1%
img_1807_Adjusted_Patient_Days_Box.svg
Average Length of Stay
-2%
0%
0%
img_1807_Avg_Length_of_Stay_Box.svg
ED Visits
-4%
-6%
-2%
img_1807_ED_Visits_Box.svg
Operating Room Minutes
-3%
-5%
-6%
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By Region
By Bed Size
National Observations
Volume by Bed Size
Hospital size generally did not factor into volume performance, with each cohort seeing declines in most categories. However, larger hospitals (>300 beds) exhibited a better ability to reduce length of stay than smaller organizations. This likely is due to improved patient management across the continuum, including discharge planning. The ability to better control length of stay increases capacity and allows hospitals to control costs if variable expenses are appropriately managed. Going forward, it will be important to monitor the wide variance in Adjusted Discharges and Adjusted Patient Days. These indicators may highlight significant variations between large and small hospitals in regard to their ability to build ambulatory networks, which is a strong predictor of future success.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
By Region
By Bed Size
National Observations
©2018 Kaufman, Hall & Associates, LLC
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