Question-and-Answer Session
Operator
(Operator Instructions). Your first question comes from the line of Shelly Knoll with Goldman Sachs.
Shelly Knoll - Goldman Sachs
Steve, can you remind us why the bad debt trends tend to show sequential improvement into the fourth quarter, and then specifically this quarter, what have you seen on patient mix and why that didn’t impact bad debts more in this quarter?
Steve G. Filton
I think, Shelly, we’re pretty consistent in encouraging people to look at bad debt and charity care and uninsured discounts in their entirety. I have to concede that sometimes I can’t explain the shifts between the various categories and I’m not sure frankly if they’re terribly important. I think we saw slight modest uptake in our uninsured volumes in the fourth quarter and that’s clearly reflected in an overall increase in again the total of bad debt, charity care, and uninsured discounts. So, even though bad debts looked like they were fairly low in the quarter, I think if you sort of normalize that, our adjusted revenue per admission was only 3.3% because of the high charity care. So, if you want to think about bad debts being higher and revenue per admission being a little bit higher, you can think about it that way as well, but clearly the overall trend of patient mix was a slight increase, not terribly dramatic but a slight increase in the number of uninsured, and I think that was reflected in a higher uncompensated care expense in the quarter.
Shelly Knoll - Goldman Sachs
And then as you think about the guidance for next year, mostly what we’ve heard from your competitors is an expectation that the rising unemployment is going to impact both admissions and bad debt expense, can you tell us what you’ve included in your forecast for bad debt for 2009?
Steve G. Filton
I think our best guess is that we’re likely to see the trends that we’ve experienced in the back half of 2008 continue into 2009, and right now I’m just talking about the acute care business, but I think we would expect in 2009 that our same store admissions would be flat to slightly down, 0% to 1% down, and that uncompensated care depending on again where you want to put it, but uncompensated care expense probably will rise by something like 50 to 75 basis points.
Shelly Knoll - Goldman Sachs
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