Average revenue per patient per day in the quarter, excluding the impact of Medicare Cap, was $207.12, which is 2.6% above the prior-year period. Routine home care reimbursement and high acuity care averaged $162.75 and $713.38, respectively, per patient per day in the first quarter of 2012. During the quarter, high acuity days of care were 8.1% of total days of care, 10 basis points lower than the prior-year quarter.
In the first quarter of 2012, VITAS recorded a positive revenue adjustment of $2.6 million due to the reversal of estimated Medicare Cap billing limitations recorded in the fourth quarter of 2011. This compares with a similar adjustment of $1.0 million for reversal of Medicare Cap in the first quarter of 2011.
Of VITAS’ 35 unique Medicare provider numbers, 31 provider numbers have a Medicare Cap cushion of 10% or greater during the first six months of the 2012 Medicare Cap year; two provider numbers have a Medicare Cap cushion between 5% and 10%; and two provider numbers have a cap cushion between 0% and 5%. VITAS generated an aggregate cap cushion of $207 million during the most recent twelve-month period.
The first quarter of 2012 gross margin, excluding the impact of Medicare Cap, was 20.4%, which is a decline of 108 basis points from the first quarter of 2011. This decline in margin is primarily the result of expansion of losses in start-up locations and increased costs associated with certification of new inpatient units.Selling, general and administrative expense was $19.7 million in the first quarter of 2012, which is an increase of 5.5% when compared to the prior-year quarter. Adjusted EBITDA totaled $35.5 million in the quarter, an increase of 6.8% over the prior-year period. Adjusted EBITDA margin, excluding the impact from Medicare Cap, was 12.7% in the quarter which was 99 basis points below the prior-year quarter.