Health systems are collecting just 31% of patient billings on average as rising deductibles, higher out-of-pocket costs, and growing self-pay balances continue to reshape the economics of healthcare, according to a new PayZen survey of more than 200 healthcare revenue leaders nationwide.
The report highlights mounting pressure on providers as patients increasingly become the primary payer for care. Patient billings now account for roughly 12% of total net patient revenue, yet nearly a quarter of patient collections remain tied up in active payment plans, slowing cash flow and extending resolution timelines.
The findings are particularly notable for organizations tied to medical debt collections. The survey found most hospitals are still relying on financing structures built for smaller balances and lower deductibles. Nearly six in 10 hospitals cap in-house payment plans at 24 months or less, despite data showing the average patient can afford only about $82 per month toward medical bills. PayZen said it would take more than five years for a patient paying $82 monthly to resolve a $5,000 balance.
Visibility into repayment performance also remains limited. More than 72% of surveyed organizations said they do not know the default rates tied to their long-term in-house payment plans.
Revenue leaders appear increasingly focused on balancing collections with the patient experience. While 49% of respondents said increasing collections remains their top patient-balance priority, 41% said improving the patient financial experience is now a major focus, more than double last year’s level.
The report also found growing concern around Medicaid eligibility and uninsured patient growth. Nearly two-thirds of revenue leaders said they want Medicaid eligibility and financial screening to occur at scheduling, but only about 21% currently do so.
Meanwhile, hospitals are increasingly turning to artificial intelligence to manage revenue cycle strain. More than one-third of health systems reported already using generative AI in revenue cycle operations, primarily in denials management and appeals workflows. Larger systems are beginning to expand AI into patient access, scheduling, and financial assistance functions as providers search for ways to improve collections while reducing friction for patients.
