Adjusted patient days convert outpatient activity into inpatient-day equivalents so hospitals can compare unit costs regardless of their outpatient mix. Calculate cost, revenue and margin per adjusted patient day and per adjusted discharge.
How it works
Convert inpatient volume into adjusted patient days and adjusted discharges that reflect outpatient activity, then measure cost, revenue and margin per unit of service.
Outpatient factor = (Gross inpatient revenue + Gross outpatient revenue) ÷ Gross inpatient revenue
Adjusted patient days = Inpatient days × Outpatient factor
Adjusted discharges = Discharges × Outpatient factor
Cost per APD = Operating expenses ÷ Adjusted patient days
CMI-adjusted cost per adjusted discharge = Cost per adjusted discharge ÷ CMICommon uses
- Hospital cost benchmarking against peers
- Board and finance committee dashboards
- Budgeting expense per unit of service
Worked example
The calculator above opens with this example. Change any input to see the results update instantly, or select Reset to return to these figures.
| Inpatient days | 48,600 |
| Inpatient discharges | 10,850 |
| Gross inpatient revenue | $612,000,000 |
| Gross outpatient revenue | $388,000,000 |
| Total operating expenses | $296,000,000 |
| Net patient revenue (optional) | $289,000,000 |
| Case mix index (optional) | 1.62 |
| Cost per adjusted patient day | $3,727 |
| Cost per adjusted discharge | $16,696 |
| Adjusted patient days | 79,412 |
| Adjusted discharges | 17,729 |
| Outpatient adjustment factor | 1.63× |
| Average length of stay | 4.5 days |
| Net revenue per adjusted patient day | $3,639 |
| Margin per adjusted patient day | ($88) |
Adjusting for outpatient revenue lets hospitals with different outpatient mixes compare unit costs on a common basis.
Interpreting the results
- Gross revenue is used because charges are set on a consistent chargemaster basis across inpatient and outpatient services.
- Compare cost per adjusted discharge only after adjusting for case mix; sicker patients cost more.
- Exclude non-patient-care operations (retail pharmacy, physician practices) if peers report them separately.
Frequently asked questions
What is an adjusted patient day?
An adjusted patient day is inpatient days multiplied by an outpatient factor, which equals total gross patient revenue divided by gross inpatient revenue. It expresses total hospital activity in inpatient-day equivalents.
Why use gross revenue for the outpatient adjustment?
Gross charges are set from the same chargemaster for inpatient and outpatient services, so they provide a consistent weighting of activity. Net revenue varies by payer contract and would distort the adjustment.
What is the difference between cost per adjusted patient day and per adjusted discharge?
Cost per adjusted patient day reflects both cost per case and length of stay. Cost per adjusted discharge measures cost per case, so it is less affected by length of stay and pairs well with case mix index.
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