Start of Main Content

Healthcare Insights

Top 25 hospitals with the highest bad debt ratios

Hospital bad debt is on the rise in the U.S. and more than half of active hospitals report unrecovered funds for 2021.

Bad debt refers to money that a creditor writes off, usually due to the debtor defaulting. For hospitals and healthcare systems, bad debt represents patient care charges the patient or payor cannot, or will not, cover. It is part of uncompensated care, which also includes hospital charity care costs for services where no payment is received. 

In this Healthcare Insight, we review hospitals with the highest bad debt ratios for 2021 using HospitalView data sourced from the Medicare Cost Report. Data used in this analysis is from the October 2022 Medicare Cost Report release.

U.S. hospitals with the highest bad debt to net patient revenue ratios

Rank Definitive ID Hospital name Hospital type Location Net patient revenue Bad debt Bad debt to net patient revenue ratio Explore dataset
829 Lehigh Regional Medical Center Short Term Acute Care Hospital Lehigh Acres, FL $45,366,925  $61,139,763  134.8% Explore
3980 Wilson N Jones Regional Medical Center Short Term Acute Care Hospital Sherman, TX $36,780,387  $44,163,749  120.1% Explore
3971 Freestone Medical Center Short Term Acute Care Hospital Fairfield, TX $13,692,541  $15,113,508  110.4% Explore
551805 Florence Hospital Short Term Acute Care Hospital Florence, AZ $19,268,197  $19,736,000  102.4% Explore
3950 Ennis Regional Medical Center Short Term Acute Care Hospital Ennis, TX $18,520,504  $17,781,984  96.0% Explore
4147 John Peter Smith Hospital Short Term Acute Care Hospital Fort Worth, TX $593,781,696  $505,587,946  85.1% Explore
3927 Dallas Medical Center Short Term Acute Care Hospital Dallas, TX $40,097,814  $34,066,318  85.0% Explore
48 Vaughan Regional Medical Center Short Term Acute Care Hospital Selma, AL $63,541,578  $48,277,811  76.0% Explore
575811 Advanced Diagnostics Hospital East Short Term Acute Care Hospital Houston, TX $33,262,263  $23,046,575  69.3% Explore
10 55 Riverview Regional Medical Center Short Term Acute Care Hospital Gadsden, AL $111,070,292  $75,884,587  68.3% Explore
11 1011 Higgins General Hospital Critical Access Hospital Bremen, GA $34,121,640  $23,041,804  67.5% Explore
12 4442 Welch Community Hospital Short Term Acute Care Hospital Welch, WV $8,885,924  $5,939,254  66.8% Explore
13 3982 CHRISTUS Good Shepherd Medical Center - Longview Short Term Acute Care Hospital Longview, TX $237,708,377  $151,625,653  63.8% Explore
14 3725 Jellico Regional Hospital Short Term Acute Care Hospital Jellico, TN $2,896,356  $1,705,561  58.9% Explore
15 4036 South Texas Health System Edinburg Short Term Acute Care Hospital Edinburg, TX $579,118,789  $337,020,776  58.2% Explore
16 1043 Atrium Health Floyd Polk Medical Center Critical Access Hospital Cedartown, GA $33,267,176  $19,137,245  57.5% Explore
17 3267 Choctaw Memorial Hospital Short Term Acute Care Hospital Hugo, OK $8,927,071  $5,124,062  57.4% Explore
18 963 Southern Regional Medical Center Short Term Acute Care Hospital Riverdale, GA $118,459,256  $67,843,525  57.3% Explore
19 53 Atmore Community Hospital Short Term Acute Care Hospital Atmore, AL $18,603,645  $9,941,790  53.4% Explore
20 979 Emory Hillandale Hospital Short Term Acute Care Hospital Lithonia, GA $94,610,171  $48,542,623  51.3% Explore
21 4076 Mid Coast Medical Center Central Critical Access Hospital Llano, TX $5,399,524  $2,769,580  51.3% Explore
22 4182 Doctors Hospital of Laredo Short Term Acute Care Hospital Laredo, TX $153,175,583  $78,493,962  51.2% Explore
23 3018 Person Memorial Hospital Short Term Acute Care Hospital Roxboro, NC $32,840,804  $16,822,364  51.2% Explore
24 3336 INTEGRIS Baptist Medical Center Portland Avenue Short Term Acute Care Hospital Oklahoma City, OK $92,704,472  $47,264,448  51.0% Explore
25 3931 Parkland Health and Hospital System Short Term Acute Care Hospital Dallas, TX $938,711,304  $476,946,596  50.8% Explore

Fig. 1 Data is from the Definitive Healthcare HospitalView product and sourced from the October 2022 Medicare Cost Report release. Accessed November 2022. 

Which hospitals have the highest bad debt ratios?

Lehigh Regional Medical Center in Lehigh Acres, Florida has the highest bad debt to net patient revenue ratio, followed by Wilson N. Jones Regional Medical Center in Sherman, Texas.

The top four hospitals on the list have a bad debt ratio of more than 100% of the hospital net patient revenue. Uninsured and under-insured patients needing care, issues with revenue cycle management, and changes in private insurer and government reimbursements affect these numbers.

Of the 25 hospitals on the list, 11 are in Texas. According to the Kaiser Family Foundation, Texas’ population has some of the highest uninsured rates for healthcare coverage. Most are short-term acute care hospitals but there are three critical access hospitals (CAHs) on the list.

What is considered as part of hospital bad debt?

Bad debt for hospital facilities represents the total amount of bad debt, as written off during the Medicare Cost Report reporting period, for balances owed by patients regardless of the date of service. All services, except for physician and other professional services, are included. For privately insured patients, bad debts that were the obligation of the insurer rather than the patient are not incorporated.

How much bad debt do hospitals have?

The average hospital bad debt amount across nearly 4,500 U.S. hospitals for 2021 is $11.5 million. The median figure is $4.3 million.

The average bad debt to net patient revenue ratio for these hospitals is 46.6% and the median is 15.7%.

In comparison, the top 25 hospitals on this list have an average bad debt of $85.5 million with a bad debt ratio average of 71.8%.

Learn more

Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.