10 hospitals with the highest bad debt to net patient revenue ratios in 2021

When examining a hospital’s finances, bad debt and net patient revenue (NPR) provide useful context into how well the facility is performing and to what degree its patients are able to pay their bills. These metrics can also be referenced together as a ratio for a high-level look into a hospital’s ability to generate profit—or excess revenue, in the case of nonprofit facilities.

Net patient revenue is a widely used indicator of a hospital or healthcare organization’s financial strength. NPR is calculated by totaling all patient revenues and subtracting patient discounts.

Bad debt is a designation for funds deemed unrecoverable when a patient cannot pay their hospital bills due to unemployment, bankruptcy or other extenuating circumstances. These unrecoverable funds are recorded as operating expenses, and thus the more bad debt a hospital has, the less profit it produces.

We’ve compiled lists below of the top 10 nonprofit and for-profit hospitals with the highest bad debt to NPR ratio. Keep reading to learn which hospitals have the highest ratios.

Top 10 nonprofit hospitals by highest bad debt to NPR ratios

Rank Definitive ID Hospital Name State Bad Debt to Net Patient Revenue Ratio
1 963 Southern Regional Medical Center GA 94.40%
2 1011 Higgins General Hospital GA 67.50%
3 3982 CHRISTUS Good Shepherd Medical Center - Longview TX 63.80%
4 6349 Crosbyton Clinic Hospital TX 59.60%
5 1043 Polk Medical Center GA 57.50%
6 5558 Calhoun Liberty Hospital FL 54.40%
7 53 Atmore Community Hospital AL 53.40%
8 1018839 Ascension Seton Bastrop TX 49.70%
9 32 Cherokee Medical Center AL 46.70%
10 6188 Palacios Community Medical Center TX 46.2%

Fig. 1 Data from Definitive Healthcare’s Hospitals & IDNs database. Annual Medicare data is from the Centers for Medicare and Medicaid Services (CMS) Medicare Standard Analytical Files (SAF). Accessed June 2022.

Overall, for-profit hospitals on our list maintained generally higher ratios of bad debt to NPR than their nonprofit counterparts. In other words, these for-profit hospitals are serving more patients who are ultimately unable to pay their bills, so they have to write off more bad debt.

According to a 2021 study from Ohio University and Case Western Reserve University, for-profit hospitals disproportionally served more vulnerable populations marked by higher county unemployment, uninsured rates and residents reporting poor health as compared with nonprofit facilities. 

Top 10 for-profit hospitals by highest bad debt to NPR ratios

Rank Definitive ID Hospital Name State Bad Debt to Net Patient Revenue Ratio
1 551805 Florence Hospital (FKA Florence Hospital at Anthem) AZ 102.40%
2 3950 Ennis Regional Medical Center TX 96.00%
3 972395 Crockett Medical Center TX 92.70%
4 3927 Dallas Medical Center TX 82.20%
5 1011476 Altus Lumberton Hospital TX 77.60%
6 48 Vaughan Regional Medical Center AL 76.00%
7 4036 South Texas Health System Edinburg (FKA Edinburg Regional Medical Center) TX 73.20%
8 25 Bullock County Hospital AL 68.50%
9 3980 Wilson N Jones Regional Medical Center (FKA Texas Health Presbyterian Hospital - WNJ) TX 68.30%
10 3032 LifeBrite Community Hospital of Stokes (FKA Pioneer Community Hospital of Stokes) NC 56.40%

Fig. 2 Data from Definitive Healthcare’s Hospitals & IDNs database. Annual Medicare Data is from the Centers for Medicare and Medicaid Services (CMS) Medicare Standard Analytical Files (SAF). Accessed June 2022.

Which hospitals had the highest bad debt to NPR ratios in 2021?

The nonprofit and for-profit hospitals with the highest bad debt to NPR ratio in 2021 were Southern Regional Medical Center in Riverdale, Georgia with 94.4% and Florence Hospital in Florence, Arizona with 102.4%, respectively.

All 20 hospitals on our lists are located in the southern United States. According to the Kaiser Family Foundation, patients in the South are more likely to live below the poverty line, live with chronic illness, experience poor health outcomes and be uninsured, as compared with the rest of the country. Compared to states in other regions, southern states have more for-profit hospitals (as a percentage of total facilities under all ownership models).

Interestingly, a 2020 study found that nonprofit and for-profit hospitals provide charity care as a percentage of total expenses at similar levels.

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