The Patient Pay Problem – Consequences and Solutions

The Patient Pay Problem refers to the payment obligations of both an uninsured and an insured patient’s balance after insurance (BAI).

While the promise of the Affordable Care Act (ACA) is to significantly reduce the uninsured population, it has also accelerated the growth of high deductible health plans (HDHPs).

The ACA’s Bronze Plan sets the new HDHP standard – the insurer pays 60% of the cost while the consumer is responsible for the remaining 40% (with an average annual deductible of $4,300).  With the ever-increasing cost of individual healthcare procedures factored in, the combined result is that many organizations are projecting patient pay obligations (primarily from BAI) to grow at an annual rate of 20%[1].

The Consequences of the Patient Pay Problem

  • The revenue mix between insurance and patient pay is shifting (insurance lower, patient pay higher).
    • 2015 – 96.0% payer / 4.0% patient
    • 2020 – 91.7% payer / 8.3% patient (assumes annual growth in patient pay of 20%)
  • The cost to collect patient pay is significantly higher than the cost to collect insurance
  • The collection rate on patient pay is significantly lower than for insurance collections. On average:
    • 0% from payer
    • 0% from patients
  • Consumers are more price-conscious and are putting off care when they can’t “afford” the cost. This results in reduced volumes for in-patient non-emergent care and shifting volumes to the outpatient setting, all of which is putting downward pressure on overall revenue growth.

If the patient pay problem is left unaddressed by Quorum Health, using the above assumptions and Quorum Health’s publicly available financial data, bad debt due to patient pay will more than double in five years, dropping Quorum Health’s operating margin from -0.68% to -4.76%[2].

“The Problem” Effect of increasing HDHPs and Patient Pay AR

The Patient Pay Problem Effect of increasing HDHPs and Patient Pay AR Graph

The Potential Solution

Offering consumers a flexible, interest-free, revolving line of credit will attract consumers to your facility and drive higher net recoveries.

Key Solution Criteria

  • Provide a patient experience that encourages high levels of payment and satisfaction with Quorum Health, resulting in greater patient loyalty to Quorum Health and increasing census (new census that is collectible).
  • Provide superior collection rates.
    • Greater collections reducing bad debt and improving the bottom line
    • Competitive pricing (absolute value and how those prices translate to net cost)
    • Reduced internal costs
  • Provide high levels of adoption by patients who previously went to bad debt because they were
    willing but unable to pay using the options provided:

    • Easy for Quorum Health’s staff to offer while still meeting collection goals
    • Easy for patients to qualify, participate and complete their obligations
  • Accelerate cash flow, thereby increasing days cash-on-hand and reducing days in AR.


Potential Value for Quorum Health with the ClearBalance Solution

Quorum-Purchasing-Advantage-down-arrow patient pay problem BAD DEBT:  First-year reduction of over $2.0 million; a reduction of more than $15.3 million over five years.
Quorum-Purchasing-Advantage-up-arrow patient pay problem OPERATING INCOME: First-year increase of over $1.5 million; an increase of more than $11.8 million over five years.
Quorum-Purchasing-Advantage-up-arrow patient pay problem CASH FLOW: Patient balances will be funded, increasing first-year collections by more than $6.8 million and enabling your staff to meet and exceed collection goals.
Quorum-Purchasing-Advantage-down-arrow patient pay problem A/R DAYS:  Accelerating cash flow will reduce Accounts Receivable by 1.30 days.
Quorum-Purchasing-Advantage-up-arrow patient pay problem DAYS OF CASH ON HAND: Accelerating cash flow will increase days of cash on hand by 1.87 days.
Quorum-Purchasing-Advantage-up-arrow patient pay problem PATIENT SATISFACTION: Improved repayment options with all patients immediately qualifying for an affordable monthly payment solution minimizes patient’s financial concerns so they can focus on their health.
Quorum-Purchasing-Advantage-up-arrow patient pay problem EMPLOYEE SATISFACTION: Your staff will appreciate the opportunity to help patients pay their obligations with a truly patient-friendly option to pay over time that is easy to offer, set up and qualify.
Quorum-Purchasing-Advantage-up-arrow patient pay problem PHYSICIAN SATISFACTION: Your physician practices will appreciate the option for patients to combine bills into one easy payment managed by ClearBalance and receiving their cash up front.

[1] McKinsey Quarterly, “The Next Wave of Change for US Health Care Payments”; The Advisory Board Company “The  Future of Uncompensated Care” March 2014

[2] Definitive Healthcare (


Quorum Learning Institute Unveils New Online Education System For Hospital Leaders

Quorum Learning Institute unveiled a new online education portal to improve the education experience for users.  The platform provides hospital leaders with access to efficient and cost-effective education that can be paid for and watched online.

With education offerings spanning topics like strategy, reimbursement, quality, compliance and supply chain—the Quorum Learning Institute, part of Quorum Health Resources (QHR), gives the C-Suite a resource to develop staff on important and ongoing issues.

The new education portal boasts enhanced navigation, simplified program listings, access to course updates and materials and the ability to manage your profile; including tracking earned accreditations.  Many courses allow participants to earn continuing education credits from accrediting bodies such as: Tennessee Nurses Association, American Nurses Credentialing Center, American College of Healthcare Executives (ACHE) and the National Registry of CPE Sponsors (NASBA).

“We are excited to offer a new platform that allows hospital leaders to engage and immerse themselves into the learning experience—an important resource in today’s challenging healthcare environment,” said Robert A. Vento, President and CEO of QHR. “We are confident that this improved platform will allow people to quickly access the education they need, when they need it.”

Thirty-year veteran John Waltko, CPA and VP of Regulatory and Financial Reporting of QHR frequently provides education focused on the Medicare and Medicaid programs.  He has extensive knowledge of Critical Access Hospitals, Medicare payments; including prospective payment systems as well as Medicare program special payments and designations.  Many of Waltko’s educational programs are focused on evolving payment models, the health care law and value based purchasing programs.

Another sought after speaker, Erika Sundrud, MA, MBBLSS, Principal of Quality, Safety and Performance Improvement of QHR, regularly provides education for Quorum Learning Institute programs. She has overseen numerous projects focused on improving the patient care experience and transition in care, while stabilizing or reducing per capita cost.  She is a prominent authority on improving quality at hospitals and health systems of all sizes throughout the U.S.  Erika is a frequent speaker at major health care conferences on quality improvement, is a Master Black Belt, lean and Six Sigma seasoned professional and an advocate for implementing lasting positive change.

Live-delivery webinar programs are available starting at $199 and new program offerings are added throughout the year.  As always, Quorum-affiliated hospitals will receive complimentary access to our programs. Quorum Learning Institute also offers hands-on, classroom education programs. For more information or to create an account and register, please visit

New Quorum Health Resources Leadership Named

Brentwood, Tenn. (June 27, 2017) – Quorum Health announced that Robert A. Vento has been appointed as president and CEO of Quorum Health Resources (QHR). At the same time, John Maher was promoted to COO of QHR.

A national search was launched for QHR’s chief executive officer following the retirement of Mickey Bilbrey, former president and CEO in December 2016.

“I’m pleased to announce these leadership promotions at QHR,” said Tom Miller, president and CEO of Quorum Health. “Both individuals have a high caliber of leadership and experience that will further strengthen QHR’s capabilities allowing it to build on its successes.”

Vento has served as interim president of QHR since January 2017. Previously, Vento served as chief operating officer of QHR. With more than 35 years of healthcare experience, his career has been focused on performance improvement, innovation, hospital operations, turnarounds and mergers and acquisitions.

“I am honored to serve as president and CEO of QHR during an exciting, yet challenging time in healthcare,” said Robert A. Vento. “QHR is a place I care deeply for and I believe in its mission to create a sustainable future for healthcare organizations. I look forward to further developing our strengths as well as creating innovative strategies to help our clients succeed.”

Maher has more than 20 years of experience in healthcare, with extensive work in strategic planning, client engagement management, revenue and market expansion and financial management and improvement. Most recently, Maher served as QHR’s senior vice president of consulting.

“I am proud of all that we have achieved at QHR since I started here in 2014,” said Maher. “We are a team of experienced healthcare professionals who are dedicated to helping health systems achieve success in today’s healthcare environment.”

Two Quorum Health Resources Client Hospitals Recognized as Top Hospitals For Patient Experience

Brentwood, Tenn. (May 10, 2017)—Two Quorum Health Resources (QHR) client hospitals were recently recognized on Healthgrades’ 2017 list of top hospitals for patient experience including Newberry County Memorial Hospital (Newberry, SC) and Tidelands Waccamaw Community Hospital (Murrells Inlet, SC).  Patient experience recognition was awarded to organizations among the top 15 percent of hospitals with the highest patient experience scores in the U.S.

“These hospitals are continually making the right decisions, which enable high-quality care,” said Quorum Health Resources Interim CEO Robert A. Vento.  “I am proud to consistently see QHR clients hospitals recognized for their stellar focus on patient experience, even in today’s challenging healthcare environment.”

“We are honored to be named as a top hospital for patient experience as it reflects on our culture of excellence and our commitment to patients,” said Pam Maxwell, senior vice president and chief nursing officer at Tidelands Health. “The entire team at our hospital is dedicated to providing high-quality medical care in a safe, comfortable and friendly environment.”

According to Healthgrades, the group also identified a correlation between how hospitals scored on questions related to whether patients would recommend the facilities and whether nurses communicated well and the overall survey score.  “It’s not surprising that consumers are more satisfied with hospitals that prioritize communication between patients and staff.  It is a very important aspect of the provider-patient relationship and hospitals that invest in creating a highly communicative culture appeal to consumers,” said Healthgrades Chief Executive Officer Brad Bowman.


The annual awards recognize U.S. hospitals that excel in patient experience ratings or have low incidents of patient harm.  For the Patient Experience Award, Healthgrades awarded 443 hospitals, using the hospitals’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys.

iVantage Names Quorum Client Hospitals to Top 100 Rural Hospitals List

Brentwood, Tenn. (March 6, 2017)—iVantage Health Analytics named five Quorum Health Resources client hospitals to its “2017 Top 100 Rural & Community Hospitals” in the U.S. list including, Kalispell Regional Medical Center (MT), Knox Community Hospital (OH), Montrose Memorial Hospital (CO), Northwestern Medical Center (VT) and Tidelands Health Waccamaw (SC).

The hospitals named to this list are top performers in managing risk, achieving higher quality, securing better outcomes, increasing patient satisfaction and operating at a lower cost than their peers, according to iVantage.

“This significant achievement is a testament to the success of our hospital and better care for our communities,” said Steve Hannah MHA, CEO of Montrose Memorial Hospital.  “I’m proud of our employees and of the leadership from our board of directors.”

“We are proud to see several Quorum client hospitals recognized as top performers in the rural and community hospital category,” said Quorum Health Resources Interim CEO Robert A. Vento.  “These hospitals are leading the way in delivering individualized patient care, particularly in medically underserved, high Medicare population areas.”


“Healthcare organizations across the country are experiencing unprecedented transformation—making it more important than ever before for hospitals to continually strive to achieve higher quality and increased patient satisfaction,” added Vento.


The 2017 Top 100 Rural & Community Hospitals in the U.S. is based on The National Rural Health Association’s Rural Health Policy Institute, iVantage Health Analytics and The Chartis Center for Rural Health. The release of the top 100 rural and community hospitals this year expands on research presented as part of the 2017 Rural Relevance Study: Vulnerability to Value from The Chartis Group.