Hospital BI
Hospital KPIs: the ones the executive board should track
A short, useful list: the KPIs that change decisions in a hospital, grouped by topic, with the formula and the reading caveat for each.
Hospital KPIs (key performance indicators) are measures that show, comparably over time, how a hospital's operations and results are doing. A hospital executive should track a few indicators per topic: revenue and margin, billing and denials, cash, costs and operations. What matters is not the quantity, but that each indicator has a single definition and a reference for comparison.
Revenue and result KPIs
| KPI | Formula | Reading caveat |
|---|---|---|
| Gross revenue | Total billing for the period, by accrual | Separate SUS, private payers and self-pay |
| Contribution margin | Revenue − (denials + variable costs and expenses) | Read in amount and as % of revenue, by payer and specialty |
| EBITDA | Operating result before interest, income taxes, depreciation and amortization | Compare with the same period last year |
| Net result | Revenue − all costs and expenses | Separate operating from financial or non-recurring items |
| Average ticket | Revenue ÷ number of encounters | Break down by type: inpatient, emergency, outpatient |
Billing and denial KPIs
| KPI | Formula | Reading caveat |
|---|---|---|
| Denial rate | Denied amount ÷ billed amount | Distinguish initial denial, appeal and final denial |
| Unbilled accounts | Accounts with completed care not yet billed | Track the amount and how many days they have been open |
| Write-offs | Billed accounts that will not be collected | Look by payer and by reason |
Cash KPIs
| KPI | Formula | Reading caveat |
|---|---|---|
| Average collection period | Receivables ÷ average daily billing | Break down by payer: each has its contractual term |
| Default rate | Overdue balance ÷ billing for the period | Separate late payment from denial |
| Average payment period | Payables ÷ average daily purchases | Compare with the collection period |
Operations KPIs
| KPI | Formula | Reading caveat |
|---|---|---|
| Occupancy rate | Patient-days ÷ operational bed-days × 100 | Read by unit (ICU, medical, surgical) |
| Average length of stay | Patient-days ÷ discharges (including deaths and external transfers) | Compare by specialty and payer |
| Volume | Surgeries, consultations, tests and patient-days | Always against the same month last year |
| SUS excess stay | Days beyond the expected stay for the procedure | Measure the financial impact, not just the count |
The definitions of occupancy rate and average length of stay follow the Brazilian Ministry of Health's standard hospital census terminology. Details are in the articles on occupancy rate and average length of stay.
Cost and efficiency KPIs
- Cost by cost center and its variance against budget.
- Supplies and drug cost by department and per patient.
- Department efficiency: revenue-generating departments assessed by revenue, margin and result; support and administrative ones by cost and productivity.
How to read a KPI
- Compare with a reference: the same month last year, the average of the last three months or the budget.
- Break the number down: a hospital-wide indicator hides offsets. Average occupancy can look fine with the ICU full and the medical ward empty.
- Look at the trend: one bad month is noise; three months in the same direction is a signal.
- Connect the indicators: high denials pull margin down; long SUS stays create excess days and cost without revenue.
An annotated list is in the article 15 essential hospital management KPIs. Full formulas are in the glossary.