October 2018
Volume
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Volume by Region ?
Regionally, hospitals in the Midwest appear to have experienced the poorest relative volume performance, significantly lagging budget and year-over-year figures in key metrics. Interestingly, this did not translate to poor financial performance, as the Midwest outperformed most regional peers relative to budget. This disconnect between volumes and profitability could be driven by several factors, including improved payer mix and/or aggressive expense control. The Northeast/Mid-Atlantic also saw challenges across most metrics, while other regions saw varied performance.
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
Adjusted Patient Days
Adjusted Discharges
ED Visits
OR Minutes
National Volume Observations
September was a challenging month for hospitals, with strong underperformance in volume indicators. These declines were a primary contributor to the poor financial performance highlighted in the previous section. Inpatient discharges declined 5.9 percent and 4.1 percent materially month over month and year over year respectively. Inpatient discharges lagged behind budgets by 6.8 percent, indicating that these declines were not anticipated. Outpatient gains partially offset inpatient volume declines, while ED visits mirrored inpatient underperformance.
Hospitals underperformed compared to budgets in June, August, and September. Year-over-year discharges have been volatile the last four months, performing above for the prior year two months and below prior year the other two months. Lengths of stay increased in September, further supporting the idea that providers are seeing fewer but sicker patients. Over the past quarter, inpatient volumes generally have fallen short of expectations and decreased year over year. This reflects the long-term trend of declining utilization and the ongoing impact of value-based care initiatives, making it imperative that hospital leaders build appropriate assumptions into their strategic and financial plans.
Unless noted, figures are Actuals and Medians
Budget Variance
Month Over Month
Year Over Year
Year Over Year Distributions
(Click to enlarge)
Discharges
(6.6%)
(5.9%)
(4.1%)
Adjusted Discharges
(3.8%)
(7.9%)
(2.9%)
Adjusted Patient Days
(0.4%)
(5.4%)
0.5%
Average Length of Stay
2.1%
3.3%
1.6%
ED Visits
(2.3%)
(3.6%)
(2.5%)
Operating Room Minutes
(6.6%)
(12.9%)
(4.1%)
By Region
By Bed Size
National Observations
Volume by Bed Size
Smaller organizations continue to bear the brunt of volume declines, with all metrics showing negative to minimal growth. Hospitals of all sizes experienced underperformance relative to budget in both ED visits and Operating Room Minutes—both significant contributors to ancillary revenues. The outpatient effect was most pronounced between small and large facilities, with larger hospitals outperforming budget and smaller hospitals underperforming relative to budget.
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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