Revenue per Patient Day (RPPD)

Revenue per patient day (RPPD) is total hospice revenue divided by total patient days over a period, expressed as a single dollar figure per day of care. It is the core efficiency metric that shows what each day of care actually earns after level-of-care mix, tiering, and add-ons.

RPPD rolls up every payment source per day: the four Medicare per diems, the Service Intensity Add-on, wage-index adjustments, and any non-Medicare payer rates. Because Routine Home Care dominates most hospices' day counts, RPPD tends to sit between the FY2026 RHC rates of $230.83 (days 1–60) and $181.94 (day 61+), moved upward by SIA capture and any Continuous Home Care ($1,674.29/day), General Inpatient Care ($1,199.86/day), or Inpatient Respite Care ($532.48/day) days (CMS FY2026 Hospice Wage Index final rule fact sheet)^[1]. RPPD is effectively the blended per diem viewed as a performance indicator, and it is bounded on the low end by the RHC day 61+ rate for a census heavy with very-long-stay patients. Tracking RPPD over time isolates whether revenue changes come from rate updates, mix shifts, or capture problems, since the fee schedule is fixed within a year.

RPPD consolidates the revenue effects of clinical mix, level-of-care decisions, and billing documentation into a single per-day figure. A declining RPPD trend typically reflects a shift toward longer-stay patients in the day 61+ tier or reduced SIA capture rather than a change in the published fee schedule, because the schedule is fixed within a year. The metric is bounded below by the $181.94 RHC day 61+ rate: a census concentrated in long-stay patients produces a structural floor on realized revenue per day that cannot be raised by billing practice alone. Comparing RPPD across teams or service locations surfaces documentation and level-of-care differences that aggregate averages obscure.