Average revenue per patient per day in the quarter, excluding the impact of Medicare Cap, was $204.03, which is 1.5% above the prior-year period. Routine home care reimbursement and high acuity care averaged $162.90 and $706.19, respectively, per patient per day in the third quarter of 2012. During the quarter, high acuity days of care were 7.57% of total days of care, 15 basis points lower than the prior-year quarter.
VITAS did not incur any Medicare Cap billing limitations in the third quarter of 2012. The Medicare Cap 2012 fiscal year is based upon Medicare admissions from September 29, 2011, through September 28, 2012, and is compared to Medicare hospice billings from November 1, 2011, through October 31, 2012. Based upon admissions during this period, VITAS estimates there will not be any billing limitations for the 2012 Medicare Cap fiscal year.
Of VITAS’ 35 unique Medicare provider numbers, 29 provider numbers have a Medicare Cap cushion of 10% or greater during the 2012 Medicare Cap year; two provider numbers have a Medicare Cap cushion between 5% and 10%; and four provider numbers have a cap cushion between 0% and 5%. VITAS generated an aggregate cap cushion of $217 million during in the 2012 Medicare Cap fiscal year.
The third quarter of 2012 gross margin was 22.2%, which is equal to the gross margin in the third quarter of 2011 when you exclude the impact of Medicare Cap in the prior-year quarter.Selling, general and administrative expense was $20.1 million in the third quarter of 2012, which is an increase of 6.3% when compared to the prior-year quarter. Adjusted EBITDA totaled $39.8 million in the quarter, an increase of 5.2% over the prior-year period. Adjusted EBITDA margin, excluding the impact from Medicare Cap, was 14.8% in the quarter which is equal to the prior year.