Top 25 hospitals with the highest bad debt ratios
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|
|1||829||Lehigh Regional Medical Center||Short Term Acute Care Hospital||Lehigh Acres, FL||$45,366,925||$61,139,763||134.8%||Explore|
|2||3980||Wilson N Jones Regional Medical Center||Short Term Acute Care Hospital||Sherman, TX||$36,780,387||$44,163,749||120.1%||Explore|
|3||3971||Freestone Medical Center||Short Term Acute Care Hospital||Fairfield, TX||$13,692,541||$15,113,508||110.4%||Explore|
|4||551805||Florence Hospital||Short Term Acute Care Hospital||Florence, AZ||$19,268,197||$19,736,000||102.4%||Explore|
|5||3950||Ennis Regional Medical Center||Short Term Acute Care Hospital||Ennis, TX||$18,520,504||$17,781,984||96.0%||Explore|
|6||4147||John Peter Smith Hospital||Short Term Acute Care Hospital||Fort Worth, TX||$593,781,696||$505,587,946||85.1%||Explore|
|7||3927||Dallas Medical Center||Short Term Acute Care Hospital||Dallas, TX||$40,097,814||$34,066,318||85.0%||Explore|
|8||48||Vaughan Regional Medical Center||Short Term Acute Care Hospital||Selma, AL||$63,541,578||$48,277,811||76.0%||Explore|
|9||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|
Which hospitals have the highest bad debt ratios?
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%.
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