The healthcare industry is constantly changing – how hospitals and health systems deal with these changes can make the difference for a healthy bottom line and ability to continue servicing the communities in which they exist.
The statistics below are in reverse chronological order and updated on a regular basis.
Healthcare Spending and Medical Billing
Patient healthcare costs – including both deductibles and out-of-pocket maximum payments – have increased by almost 30% percent since 2015.
The average deductible is $1,820 and the average out-of-pocket maximum cost is $4,400.
83% of Physician Practices under five practitioners said the slow payment of high-deductible plan patients are their top collection challenge, followed by the difficulties that practice staff have at communicating patient payment accountability (81%).
77% of providers still use paper-based patient billing methods
52% of patients prefer to receive medical bills electronically
Source: Medical Group Management Association (MGMA)/Navicure® Digital Payment Progress Report™ Sept. 27, 2017
68% of patients failed to fully pay off medical bill balances in 2016, up from 53 percent in 2015, and 49 percent in 2014. This number is expected to climb to 95% by 2020
Source: Patients May be the New Payers, But Two in Three Do Not Pay Their Hospital Bills in Full, TransUnion Healthcare, June 26, 2017
Consumers are demanding more from healthcare
92% of consumers want to know payment responsibility prior to a provider visit
74% of consumers are confused by Explanation of Benefits (EOBs) and medical bills
73% of providers report that it takes one month or longer to collect from patients
Omnichannel payments are impacting healthcare
68% of consumers prefer electronic payment methods to pay their medical bills
80% of consumers prefer online payment channels to pay their health plan premiums
20% of online healthcare payments are made on a mobile device
Paper is hurting all healthcare stakeholders
86% of consumers receive paper medical bills
88% of providers report receiving paper checks and Explanation of Payment (EOPs) from one or more of their payers
85% of providers prefer ERA/EFT payments
Healthcare data is under attack
2016 saw more healthcare data breaches than any other year on record
90% of providers report that payment security is very important when collecting patient payments
59% of consumers have significant concerns regarding the security of making payments for both their medical bills and health plan premiums
Source: InstaMed, 2016 Trends in Healthcare Payments Annual Report, June 13, 2017
75% of adults are concerned with being able to pay for medical treatment if they get sick or are injured.
29% have “medical” debt
19% have skipped doses of medicine because of the cost
25% have avoided filling a prescription because of the cost
67% of adults are concerned with being able to pay for medical treatment if they get sick or are injured.
48% are not confident they could afford care if they become seriously ill.
40% have “medical” debt
43% had an unexpected healthcare expense in the past 12 months; and, for 63% of these, it caused serious financial hardship.
25% of U.S. adults have skipped a medical test, treatment or follow-up or avoided a visit with a doctor for a medical problem (28%) in the past 12 months because of the cost. Because of cost:
18% have skipped doses of medicine.
27% have avoided filling a prescription.
30% of the average healthcare bill now comes from the patient’s pocket.
90% of patients felt it was important to know their payment responsibility upfront.
U.S. health care spending increased 5.8 percent to reach $3.2 trillion, or $9,990 per person. The coverage expansion that began in 2014 as a result of in the Affordable Care Act continued to have an impact on the growth of health care spending in 2015. Additionally, faster growth in total health care spending in 2015 was driven by stronger growth in spending for private health insurance, hospital care, physician and clinical services, and the continued strong growth in Medicaid and retail prescription drug spending. Lastly, the overall share of the U.S. economy devoted to health care spending was 17.8 percent in 2015, up from 17.4 percent in 2014.
States who refuse to expand Medicaid are foregoing $423.6 billion in federal funds between 2013-2022. Hospital in these states will lose an additional $167.8 billion in Medicaid funding.
Source: What Is the Result of States Not Expanding Medicaid?, The Urban Institute & the Robert Wood Johnson Foundation, August 2014
75% of patients say that understanding their out-of-pocket costs improves their ability to pay for healthcare.
54% – More than half of insured Americans reported they were either sometimes or always confused by medical bills.
62% reported being either sometimes or always surprised by out-of-pocket costs.
Government only covering about two-thirds of estimated uncompensated care burden, leaving approx $26.3 billion on the table.
Source: Health care’s $85 billion challenge – uncompensated care in the Obamacare age, Washington Post, May 5, 2014
Healthcare premiums are growing at four-times the rate of inflation. Currently today – through both premium sharing and benefit costs – employees are paying 41% of the healthcare dollar. If the trend line continues over the next 3-5 years – employees will be paying more than 50%.
Source: Aetna CEO, Mark Bertolini at HIMSS 2014
The cost of uncompensated care has more than doubled in the past 10 years.
Source: American Hospital Association, Annual Survey of Hospitals, 2014
As of 2012, 75 million people reported problems paying their medical bills or were paying off medical debt, up from 73 million in 2010 and 58 million in 2005. An estimated 48 million people were paying off medical debt in 2012, up from 44 million in 2010 and 37 million in 2006.
U.S. hospitals provided $45.9 billion in uncompensated care in 2012, representing 6.1 percent of annual hospital expenses.
Source: American Hospital Association, “Uncompensated Hospital Care Cost Fact Sheet,” January 2014
Average Recovery Rates for Healthcare Providers
Hospitals – 15.3 percent.
Non-hospitals – 21.8 percent.
Average deductible on health care exchanges estimated to be between $3,000 and $5,000.
Source: On Health Exchanges, Premiums May Be Low, but Other Costs Can Be High, NY Times, December 9, 2013
The number of Americans under age 65 who did not have insurance at the time of interview in 2013 was 44.8 million, 39.6 million for ages 18-64 and 5.2 million for children under age 18.
In 2013, annual premiums for families covered by employer-sponsored health insurance were $16,351 and $5,884 for individuals. Family premiums rose 4 percent since 2012. Over the last 10 years, the average premium for family coverage has increased 80 percent.
The percentage of covered workers enrolled in a plan with a general annual deductible increased to 78 percent in 2013. More than half (58 percent) of covered workers at small firms with 3 to 199 employees now have a deductible of $1,000 or more.
Fifty-seven percent of covered workers are enrolled in PPO plans, which are the most common type. Twenty percent of covered workers are enrolled in an HDHP/SO plan, 14 percent have an HMO and 9 percent are enrolled in a POS plan. Enrollment in HDHP/SOs increased significantly between 2009 and 2011, from 8 percent to 17 percent of covered workers, but has plateaued since then. Enrollment distribution varies by firm size, for example, PPOs are relatively more popular for covered workers at large firms (200 or more workers) than smaller firms (62 percent vs. 47 percent) and POS plans are relatively more popular among smaller firms than large firms (16 percent vs. 5 percent).
In 2012, 41 percent of adults (ages 19-64) reported that they had medical debt or trouble paying medical bills. Of those who reported difficulties paying medical bills or paying off medical debt, 42 percent (32 million people) said they received a lower credit rating as result of unpaid medical bills.
In 2012, 43 percent of adults, or 80 million people, said they had skipped or delayed getting needed health care or filling prescriptions because of the cost. This is an increase from 75 million people who reported such problems in 2010, and 64 million in 2005. More than a quarter (28 percent) of adults with a chronic health condition said they had skipped doses or not filled a prescription for their health condition because of the cost.
Patients are responsible for nearly one-quarter of their medical bill on average through the cost of co-pays, deductibles, and co-insurance.
Source: 2013 National Health Insurer Report Card, American Medical Association (AMA).
60+% – The percentage of Americans who would prefer their bills and statements to be delivered either exclusively through electronic channels or a mix of physical and electronic channels.
Source: Right on Time? – Surviving the USPS Financial Crisis, BillTrust, 2013
No shows can cost the U.S. health-care system more than $150 billion a year.
Source: No-shows cost health care system billions, Pittsburgh Post-Gazette, February 23, 2013
The national average for bad debt is 3.31 percent, 2.13 percent for charity and 5.44 percent for total uncollectable accounts. The Southeast region of the U.S. had the highest percentage of total uncollectable accounts at 9.92 percent.
Source: The Hospital Accounts Report Analysis on Third Quarter 2013
The percentage of people without health insurance declined from 15.7 percent in 2011 to 15.4 percent in 2012. The total number of uninsured decreased only slightly from 48.6 million in 2011 to 48.0 million in 2012.
The number of people with health insurance increased to 263.2 million in 2012 from 260.2 million in 2011, as did the percentage of people with health insurance (84.6 percent in 2012, 84.3 percent in 2011.)
The proportion of the foreign-born population without health insurance in 2012 was about two-and-a-half times that of the native-born population. The uninsured rate declined for the foreign-born population between 2011 and 2012, while the 2012 rate was not statistically different from the 2011 rate for naturalized citizens and noncitizens.
Half of all workers on employer-sponsored health plans could be on high-deductible insurance within a decade.
The average medical practice needs to send out more than three paper bills before any payment is received.
Source: Perspectives in Patient Payments, MGMA, 2010
Most hospital bills are $500 or less but of those that were more than $3,000, 99 percent were not paid in full.
92 percent of insured consumers are both able and willing to pay their out-of pocket medical expenses for annual liabilities of less than $500 per year. Even when expenses top $500 per year, the research indicates that 54 percent of patients are both willing and able to pay.
Source: U.S. healthcare payments: Remedies for an ailing system; Patrick Finn, Thomas Pellathy, Shubham Singhal; McKinsey on Payments, No.4, April 2009
For individuals with greater levels of obesity, lifetime medical costs are higher, ranging from $15,000 to $29,000 more than for normal weight individuals.
Patient Engagement and Satisfaction
Patients say satisfaction outweighs loyalty. When patients are not completely satisfied with their healthcare provider:
91% look for other healthcare provider options.
88% are likely to switch healthcare providers.
74% delay seeing their healthcare provider.
Source: Prioritizing the Patient Experience, West Healthcare Study 2017
Over half-billion dollars in readmission penalties in 2017.
20% of discharged patients return within the 30 days.
Due to the significant growth of the 55+ population, and the fact the 75% of these patients return home, there is a huge opportunity to leverage technology and patient engagement tools to reduce the costs, penalties and numbers that lead to readmissions.
25% reduction in readmissions when utilizing patient engagement programs.
40% decrease in readmissions when using technology to record daily activities at home.
Source: Addressing post-acute readmissions, McKnight’s, July 10, 2017
80% of what doctors tell patients is forgotten by the time they reach the parking lot.
Source: Remembering what the doctor said: organization and adults’ memory for medical information. Department of Psychology, Allegheny College, Meadville, PA 16335, USA. email@example.com
Why Patients Remember Little Doctors Tell Them, Wall Street Journal, Sep 29, 2015
Over 80% of patients who are satisfied with their billing experience are likely to recommend your organization to their friends.
Source: Connance Consumer Impact Study, October 2012
76% of patients say technology has the potential to improve their health.
Source: “The ROI of Patient Engagement,” Healthcare Intelligence Network
Of 64 percent of patients who are not portal users, 35 percent did not know a portal was available to them, and 31 percent stated that their providers had never mentioned the technology to them.
Source: Annual Xerox EHR Survey, 2014
Although U.S. primary care doctors’ use of electronic medical records increased from 46 percent in 2009 to 69 percent in 2012, the U.S. lags far behind other leading countries, where more than 90 percent of doctors use electronic records.
Close to two-thirds of respondents (60.6%) reported that the availability of digital services play an important role when choosing a physician, but more than one-third (37.4%) reported indicated that their physicians had not offered them one of the six services included in the study:
Health resources/educational material
Online test results or diagnoses
Secure online messaging
Online appointment scheduling
Online bill pay
Source: Technology Advice, Patients Value Digital Services When Choosing Physicians,