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ADC or Average Daily Census = Total patient days in a period/number of period days.

This is the standard measurement of hospice size.

All across the nation hospices are setting census records, especially in areas where there is competition. We see programs that have been in "cruise mode" until a new hospice opens up. Suddenly, there is a sense of urgency and people start to question their services and marketing. And in the face of this "threat", the hospice increases significantly -- even doubling in many cases. Though not appreciated at the time, competition keeps us on our toes and if we are good at providing hospice and run a tight ship, we should have few fears.

Growth in ADC can create an illusion of organizational financial health. In the case of rapid growth, a hospice's staffing-needs outpace its ability to hire clinical staff. Therefore, the hospice builds census on the backs of overworked clinicians. However, when the ADC slows down, profitability reverses or lessens as the hospice's normal staffing patterns and habits of clinical practice and management catch-up. Be aware that your profitability could only be due to this situation. This situation can also create a false expectation in management and Boards of Directors. They may ask, "Where did our margins go?" The fact is that we were working short and unless we are willing to change our model of care, we will not see those profit margins again.

An organization that is alive is growing... both in terms of increased business as well as in quality of products and services. The absolutely fastest growing hospices are ones with the best training systems. Part of the concept of Natural Growth is the idea of building infrastructure... training and equipping staff. When we train staff, we build CAPACITY. Here is a graphical representation of growth and training:

When we are training, we sow capability into our staff and enable growth. It is during the "plateaus" that we can catch our breath and develop better training systems. Hospices that have truly dedicated themselves to training have added hundreds of patients to their ADCs in short periods of time. One hospice that got serious added 400 patients a day, in a year, as a result of what... training!


ADC Average Length of Stay Benefits Percent Caseload Expectations Computed Caseloads Crisis Care Percent Served Days Cash on Hand Days in AP Days in AR Debt to Equity Development to Return Ratio Development Signature Programs Direct Labor % of All Labor Direct Labor NPR Direct Labor PD Direct Patient Related Expenses NPR Direct Patient Related Expenses PD Facility Mix Percentage Facility Related Facility Team Patient Days Percent Indirect Labor Marketing Incentive Median Length of Stay Mileage Rate Net Operational Income Net Revenue PD Operational Costs Organizational Net Income % of Hospice Homecare Net Revenue Revenue to Payroll Dollar Segment Indirect Percent Net Revenue Segment Net Income The Role of Financial Reserves Total Indirect Volunteer Level of Activity What is Net Patient Revenue What is The Model