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Patient Payments: Workflow Best Practices for Maximizing Collections
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Patient payments are getting messier — not always because patients won’t pay, but because the workflow is full of friction, surprises, and missed follow-through. In this episode, HST experts talk about what really works for top-performing ASCs: clearer upfront estimates, fewer handoffs, easier ways to pay, and the operational fixes that keep small balances from quietly aging into “never gets paid.”
You’ll also hear why many centers are seeing more partial payments even as total patient collections decline, and what that means for staffing, patient experience, and revenue cycle priorities heading into the year. In our data segment, we highlight insights from HST’s demographic benchmarking report: case volume and payment share don’t always line up by specialty — and that matters for more precise planning and forecasting.
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Resources mentioned:
HST Pathways Demographic Trends & Benchmarks for ASCs
Brought to you by HST Pathways.
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Transcript
Introduction to the Podcast and Episode Series
00:00:00
Speaker
Welcome to This Week in Surgery Centers. If you're in the ASC industry, then you're in the right place. Every week, we'll start the episode off by sharing an interesting conversation we had with our featured guest, and then we'll close the episode by recapping the latest news impacting surgery centers.
00:00:16
Speaker
We're excited to share with you what we have, so let's get started and see what the industry's been up to.
00:00:24
Speaker
Hi everyone, and welcome back to This Week in Surgery Centers. We're continuing our series on patient payments this week with a conversation that zooms in on the parts of the patient collections workflow that tend to break in real life.
00:00:36
Speaker
We're talking the handoffs, the exceptions, and the follow-through that happens after that initial estimate is sent. We talk about what's changing in patient responsibility, where teams tend to lose the most time and money, and the small workflow shifts that make payments feel simpler for patients and staff alike.
Shifts in Patient Financial Responsibility and Transparency
00:00:53
Speaker
I'm joined by two HST subject matter experts, Grant Duncan, our head of marketing and sales development, and Chris Pompilio, our lead sales product engineer, and someone who many of you may recognize from his decades of experience in the ASC space, including roles here at HST, spanning implementation, training, guidance, sales, and even a little bit of engineering.
00:01:15
Speaker
In this conversation, we talk about the spots where patient payments tend to get messy. What's changed as far as more financial responsibility shifting to patients? Why transparency and upfront estimates matter now more than ever?
00:01:27
Speaker
And what clean looks like operationally? Then, after the interview, we'll close with a quick data segment from our recent Demographic Trends and Benchmarking report, a reminder that case volume and payment share don't always line up perfectly by specialty, and why that can be a useful lens for planning and forecasting.
00:01:45
Speaker
I hope you enjoyed today's episode, and here's what's going on this week in surgery centers.
00:01:57
Speaker
All right, everybody. I'm so excited to be continuing our conversation on patient payments. And today I'm lucky to be joined by two HST subject matter experts. And I would love it if you both could just introduce yourselves really quickly. Grant, I'll start with you.
00:02:12
Speaker
Great. Well, hopefully I'm a familiar face as I help co-host this podcast, but as a refresher, I lead marketing sales development at HST and enjoy working at the intersection of healthcare care and technology and being able to pull insights from the 1800 plus customers we have and share those with you all.
00:02:33
Speaker
Yeah, thanks Grant. Chris Pompilio with HST. New to the podcast, but hopefully a familiar face and definitely a familiar voice to many of our the customers out there that have used HST in the past.
00:02:44
Speaker
Been in the ASC space for gosh, over 20 years now with HST since the beginning. So thanks for having me on the podcast, Alex and Grant and happy to be here.
00:02:55
Speaker
Amazing. Thanks for joining us. I'm really excited to get your insights on this topic. And as we get started, I thought it would be helpful to just take a quick look at the landscape and begin with some data. I was just looking through this recently. I did a data segment on it. um And looking at our state of the industry report, it looks like we're starting to see some interesting trends emerging on the patient payment side.
00:03:17
Speaker
Partial payments actually increased from patients in 2024. So it went from 41.2% to 56.2%. So the proportion of ASCs that are collecting something increased.
00:03:28
Speaker
But when you look at total patient collections, they actually went down 6% in 2024 from 25.8% to about 17%. So we're going to have our 2025 report soon, looking at the most recent 12 months of data. So we'll really get a sense of whether this trend is continuing in the same direction. But to start, I'd love to just get both of your thoughts on this. What do we think might be happening here? And what should ASC leaders be paying attention to?
Stages and Importance of Patient Payment Workflows
00:03:56
Speaker
Grant, I'll start with you. Sure. So those two metrics can move in opposite directions if more patients are paying something, but that something is smaller compared to what they owe, or it's not turning into a full payment later. So they're paying part, but not all.
00:04:19
Speaker
As to the forces behind this, I'm speculating here, but a couple of potential causes that come to mind would be one we're seeing That patient responsibility is growing over time as more people are choosing high deductible health plans.
00:04:39
Speaker
And that means there's more costs going to them. Another could be that ASCs are getting better at collecting something upfront. pre-date of service or on the date of service, but the follow through to the post-date of service, if there's still something to be collected there, may be an opportunity to be improved.
00:05:01
Speaker
That makes total sense. And Chris, you're talking to centers every day discussing problems just like this. Why do you think the current state is what it is right now? Yeah, I think some of it being just forced by a v the nature, as Grant mentioned, of the high deductibles and the larger patient cost with surgery centers and also by legislation, right? A lot of states have enacted the Surprises Act where patients need to be notified up front what they what their share is going to be.
00:05:29
Speaker
And because that share is larger, centers are realizing the the importance of really collecting that up front or afterwards because that is a a big chunk of the profit of the yeah the case itself. Absolutely.
00:05:42
Speaker
You know, my takeaway is that as we see these partial payments increase, it's not that patients don't want to pay necessarily. It's that there's something about how we're asking them to, right, it that isn't working. So let's talk about that. Let's talk about the workflow and what we're seeing.
00:05:56
Speaker
Chris, if you could just kind of take us through when we say patient payments workflow, what are those stages from start to finish that centers should be following, thinking about, designing? Yeah. Great question. Right. So I think one of the the first ones is understanding what that patient share is, that patient cost is, as I mentioned in the past, right? Years ago, you may, you may go to the the doctor for a procedure or for something done.
00:06:21
Speaker
You'd have a copay. maybe a ah small deductible on your account. So facilities and providers weren't that worried about collecting that money upfront, they'd bill you after the case.
00:06:32
Speaker
That's definitely changed as we talked about with that. So i think the patient payment workflow really starts with the center of fully understanding that what that patient share is going to be.
00:06:45
Speaker
Typically what we see now today is that patient share is probably around 25% of what the center is going to be collecting on that case. And that coincides right at the same level of the profitability of cases at a surgery center.
00:07:00
Speaker
Got it. And Grant, as you're thinking about this and the different stages of the workflow, there's before the surgery, the day of, after the surgery, we're seeing partial payments rise. We're seeing total collections decrease. What do you think matters more for centers right now to pay attention to? Is it the earlier stages, like getting the estimate right? Is it the collection tactics? What are your thoughts?
Challenges in the Payment Process and Solutions
00:07:24
Speaker
Yeah, I'd say probably the most important part is just making sure they are collecting in some fashion, whether it's pre, day of, or post. We're finding that it's best practice to do this before the surgery.
00:07:38
Speaker
So ultimately I'd say before is most important. I have to choose one area, but from an AOC perspective, Once you've collected that patient payment, there's also other factors to think about, like the time it's going to take to reconcile those patient payments in your billing system.
00:08:00
Speaker
With some like HSTs, this can be done automatically. you're doing with others, you that might add up to two to seven minutes of work per transaction, reconciling through the copying and pasting you have to do So it's a good area to think about, are you choosing a solution that can have an automated option?
00:08:22
Speaker
And that's going to be post surgery to think about that part of the workflow as well. Yeah. So where do you both, I'll ask you both this question, but where do you think ASCs are losing patients in this process? I know for myself coming from the patient perspective, i think it's the surprise bill, that additional bill that comes weeks or sometimes months after a procedure.
00:08:44
Speaker
But, you know, where do you think this is breaking down for patients? Is it before? Is it after? Is it just not knowing, you know, the exact amount that they owe? Chris, I'll start with you. Yeah. Yeah. Um, I think, that's a big part of it, right? they're not knowing what they're going to owe for that procedure in the ASC. And it's a little different than other retail, retail environments, right? If you think of it and if you're paying for a service or paying for a procedure, it's a retail environment.
00:09:09
Speaker
So if that procedure has already occurred, right, hopefully everything is great. We know we have great outcomes in ASCs. And then you get that bill. Uh, let's be honest, right? That, that, needness to pay goes down.
00:09:22
Speaker
on the the patient side. They can't take back the surgery, right? You can't you can't return it or have repossessed. So getting that money upfront, like i said, more and more important. And also i think that it really dovetails in with the operations of the surgery center. One of the issues that surgery centers deal with are cancellations, right? If they're collecting that money upfront in an easy way, that's going to cut down on their cancellations because the patient is going to ah have that procedure each procedure done. So It's not just the the best practices for ah payments. Payments really permeate all areas of that surgery center.
00:09:59
Speaker
Right. It's it starts much further up in the process, right? Getting that accurate estimate out in a timely fashion to make sure that people aren't surprised on the day of or the day before calling in and saying, hey, I can't afford this right now.
00:10:11
Speaker
Grant, what do you think? Yeah, to to build on what Chris was saying, if they've also paid beforehand, they're very likely to show up because they want the services to be delivered even more than they may have before.
00:10:27
Speaker
Even if that improves cancellations by reducing it 5% or something, that's still a meaningful impact in terms of volume. A couple other things that come to mind. One is that i think how easy it is to pay is a factor.
00:10:43
Speaker
where you may lose or keep patients. We're seeing it's best practice to be able to allow patients to pay from your website, having a link to click and pay, being able to text and email them with a link, with the estimate and with the ability to pay.
00:11:03
Speaker
Also offering this over the phone, which is easy if they're just going to call in. Technically they could do it in person too, although most people probably aren't going to show up early to pay in person.
00:11:15
Speaker
And then ah a second factor to think about is payment plans. Is this standard and is this available across those different mediums I was talking about? They're going to go to your website or get a text or even over the phone.
00:11:30
Speaker
Is this an option that they can be presented with so that it can be more piecemeal for them? That makes absolute sense. and Those are great considerations. So to back it up just a little bit, I'll i'll stick with you, Grant. If somebody is looking to overhaul their approach here, like they are seeing the same kind of trends in their total collections, they need to sharpen up days to bill, you know, how quickly they can actually get those bills out the door. But what would you suggest as kind of those initial organizing principles for getting started on this journey to to rethink their patient payments workflow?
00:12:05
Speaker
I suggest ASCs first understand the current state, look at their data, export some rap reports or look at dashboards to understand what the current state of affairs is and understand, okay, is this where we want to be or is there a more ideal future state?
00:12:25
Speaker
If it's not where you want to be, then determine what that gap is between your current state and your future state. And then when you understand that you can start to think about, okay, here's an area we want to improve. How do we want to approach that?
00:12:41
Speaker
A classic framework is to think about improving something through a people, process, technology, or data, or it could be a combination of those. So you're going to think about, okay, what are the areas that we can use to make this improvement?
00:12:57
Speaker
And then I'd suggest thinking about prioritizing those changes because you're probably going to think about multiple ideas, especially if you're doing this in a team setting. And one way to think about prioritizing is thinking about the effort to impact matrix.
00:13:15
Speaker
So it's like a two by two matrix. One axis, effort, other axis, impact. The best, easiest ones to focus on are the low effort, high impact items. So it's not going to take a lot of work, but it's going to take a lot of impact.
00:13:32
Speaker
Those are going to be great ones to focus on first. You kind of think of these as quick wins and impact can be defined by you. especially as you think about the current state versus future state, that might be an impact internally to your processes or externally for patients. I like that. That's a great framework to think about it. And then Chris is our resident technology expert who kind of sees this transformation and this journey that ASC has embarked on.
00:14:01
Speaker
What does this look like in terms of operational steps? Like what does the center actually do, you know, once they've determined that a change needs to
Effective Communication and Technology in Payment Processes
00:14:09
Speaker
be made? What you recommend? Yeah, I think evaluating your current tech stack, right? What you're using today for your software solution and workflow, because they like go handin hand in hand.
00:14:20
Speaker
And if it doesn't support what Grant was talking about, being able to provide the patient with that estimate, talking about before data service, easily and ah easily understandable, an easy way for that patient to pay.
00:14:32
Speaker
right there on their phone, who's not on their phone nowadays, making those those payments. And then, um like you said, I think a a great tool of that is giving them ah an option, kind of a payment plan option.
00:14:43
Speaker
I was thinking about just the other day, no matter where I am on the web, if I'm you know booking a flight or buying something on Amazon, there's always that other option to pay a monthly fee to instead of paying the whole thing.
00:14:56
Speaker
at once. So if your software doesn't allow you to do that today, i know HST does, but other ones out there may, that's something you should look at, right? Being able to make that, have that payment, patience, excuse me, have that easy link to pay or a accept a predefined payment plan and following that that payment plan logic, the ability then to go ahead and if it is a payment plan, automatically pull that payment into your system.
00:15:21
Speaker
to so the patient has less to do and from the workflow less to do, right? We spend a lot of time, a or centers spend a lot of time chasing money, right? And there's a lot of things for that. and there's a lot of cost to that. I see sometimes centers spending probably multiple person hours and materials and in statements post data service to collect a small amount that really now they're working against themselves. Right.
00:15:48
Speaker
They they've probably spent 50 to 100 dollars to collect 100 dollars. Absolutely. a negative ah ROI on the efforts. What about other technology considerations that teams should be thinking about?
00:16:02
Speaker
Right. Other capabilities that come with using like a purpose built software for this type of workflow? one One big part of it, right? We've mentioned it before, sort of a theme going through our talk today is understanding not only the patients understanding their their share, but the center's understanding their share.
00:16:20
Speaker
That's information that they need to get from a third party, right? The center needs to be able to communicate in this case with the payers and the payer contracts and other information to get that information.
00:16:31
Speaker
that I've seen in centers that process, as Grant mentioned, could take up to 15, 20, even 30 minutes per patient to try and get all that information before you even start the payment process. We're getting that payment from the patient.
00:16:45
Speaker
Automating that is is key, right? So making sure that your system can do that well and accurately, right? The payers aren't making it easy for everybody to get that information. So you need to have a way of doing it.
00:16:59
Speaker
Absolutely. Let's actually talk more about that. Let's talk about the timing of getting those estimates out to patients, because, you know, I think we understand patient behavior pretty well now in the context of consumer behavior, you know, as as the consumer convenience has risen out there, as you mentioned, and other ways that you can pay and all sorts of services out there that they go and procure that they have myriad ways to hand over money. Right.
00:17:24
Speaker
What does and doesn't work with engaging patients? Let's talk about that. So. Chris, what do you think is like a reasonable starting point for estimate timing based on some of the limitations with payers? What should centers be striving for to get those out to to patients to maximize the likelihood somebody is going to pay?
00:17:41
Speaker
Yeah, as far as timing goes, I think the sooner the better for that patient. We all have budgets. We all try to figure things out what we're doing. I know I need to have, you know, knee surgery and I'm going to have that, you know, next month.
00:17:52
Speaker
I need to start budgeting how that's going to work for me. If I can get that information as soon as possible. Hopefully, you know, very quickly after that case is scheduled, not yeah a few days before getting that information out there.
00:18:05
Speaker
And in an understandable way, healthcare care is, and healthcare care financing is very convoluted, right? And the average, the average person doesn't really understand a copay, a coinsurance, a deductible, ah hey other information, making that so they understand what's going on and how that works. And yeah, I think the earlier the better, just to go back to that.
00:18:25
Speaker
Absolutely. And also mentioning to them that anesthesia is a separate bill, right? I think that's something that that throws patients for a loop sometimes, that there is, you know, multiple line items, multiple providers, and making that as simple as possible for patients to to understand, like, everything's included here, or it's not, right? If it's not.
00:18:47
Speaker
Very clear about that for sure. No, a hundred percent. I sometimes have blinders on about the ASC world, but yeah, in the health healthcare bill, uh, represents several sources. You mentioned the physician themselves, the anesthesia, the, the ASC, the facility fee, and then maybe implants or things like that.
00:19:04
Speaker
So having a system that can, you know, generate that information for you and for the patient. whether or not the ASC is collecting it. Sometimes the ASC is not collecting that money.
00:19:16
Speaker
It would be the physician group or the anesthesia group, but letting the patient know, okay, it's not just this bill. You're also going to get a bill from ah these other groups. And then in many cases, the ASC is a joint venture and they are collecting that from the patient. Again, if your system can't do all those aspects, you need one that does.
00:19:34
Speaker
Absolutely. Yeah, that's a great point. AOCs are in this unique position where they they may not be collecting it, but they do have this obligation to make patients aware, right? Because that's how the patient's going to think about it. I went here to get the service. These are the people accountable for, know, whatever comes in the mail and making sure I understand this. Chris, continuing with you, let's talk about reminders and the need to communicate multiple times with patients to ensure that they're paying, that they've seen the information. What cadence have you found works best without annoying patients?
00:20:09
Speaker
Yeah, well, um that without knowing that's a good point. You definitely want to make sure that if you know they haven't paid in timely manner, assuming you've communicated with them early, what their responsibility is, that you're following up with that. And it's really important to have that transparency, have they made been made aware of it?
00:20:25
Speaker
um A lot of times centers will call, maybe leave a voicemail if they allow that, or they'll kind of do the old fashioned snail mail to the patient that that we see that more after the data service. but still exists out there and knowing, gosh, did goster the patient, they haven't paid yet. Did they see it?
00:20:44
Speaker
I don't want them to walk in the door and be surprised. So you also, again, with that system, you should definitely have the ability this to know if the patient has seen that estimate and they can communicate back if through their preferred method of communication, whether that be email or text or phone calls.
00:21:00
Speaker
Not overwhelming them, but also understanding that that patient share might change a little bit from the time that patient is scheduled, the time that procedure happens, right? Depending on the cadence of how long that is.
00:21:12
Speaker
They've maybe made some other medical payments in the meantime and letting them know that we know that, or we as a surgery center know that, and we're taking that into consideration. Absolutely. That's a great point that the ah initial estimate amount may change, you know, as additional information is gathered. So
Strategies for Managing Post-Surgery Balances
00:21:30
Speaker
making sure that that's really clearly communicated seems really important.
00:21:34
Speaker
And I want to talk a little bit about texting. We've talked about this before on the podcast in the context of pre-assessments and just how we communicate with patients in general. I do think patients are increasingly comfortable with it. It's kind of like in their workflow of where they spend time during the day. What are your thoughts on on this? i would love to just kind of hear your your philosophical thoughts about texting for this type of information. You know, is it part of a communications mix? And then, you know, let's talk about one-way versus two-way texting here. Grant, I'll start with you.
00:22:04
Speaker
Yeah, when you're trying to collect information, I believe texting or email is preferred over phone calls. Phone calls can be a plan B if they are repeatedly not responding or paying, especially if it's post date of service.
00:22:23
Speaker
Texting is a much easier lift and it can be automated through a technology. Whereas a phone call is going to need a human to make those calls. And that really adds up in terms of staff time and hours to that.
00:22:37
Speaker
In terms of one-way versus two-way texting, I think two-way texting can be a beneficial option so that patients can feel that are able to have a conversation with you.
00:22:51
Speaker
But I would advise against it for most ASCs unless they are prepped and staffed for it. Because otherwise, if you don't have people ready and dedicated to respond back, it's going to be a poor customer experience.
00:23:05
Speaker
But for most AACs, one-way texting is likely better. If you're prepared and ready, two-way can be a good option to consider. Yeah, that makes sense. What about you, Chris?
00:23:16
Speaker
Yeah. Yeah. I mean, ah to me, ah I'm a texter, right? I really just don't like talking on the phone to folks. I can be on the move and text and it it's much easier to ah to communicate. For me, sometimes centers will think there's an older demographic that isn't going to text.
00:23:31
Speaker
They do, right? I think just out even outside of the AAC, the studies show that over 80% of the population today is reachable via text. I think that may be a low number, but i do that I'll go with that.
00:23:42
Speaker
And the average text message too is, is I think read within four minutes of receiving it. And I, there's no other kind of communication. If you see my unread messages in my inbox, my email, ah you like it's probably like some of yours.
00:23:55
Speaker
ah No other method is is that, that instantaneous to communicate with them. And as long as it's not obtrusive, right? You text all the time and they're meaningful. think people definitely appreciate it.
00:24:07
Speaker
To Grant's point, absolutely with two-way texting, you need to make sure that your system is capable of having that response, whether be just an auto response. or maybe a targeted auto response based on what they were texting back in is great.
00:24:21
Speaker
And then the people to monitor that so patients are feeling like they're heard, I think is is super important. But yeah, if you don't have the ability to communicate electronically with your patients today, you are definitely behind the curve.
00:24:34
Speaker
Absolutely. And that's a great point about automated responses too. There's probably... several canned responses that can be prepared for common questions, because I'm sure a lot of the questions are the same. So something to consider for sure that two way texting can be both. It can be automated, but also human in the loop in case there are specific instances where people need to follow up or make that phone call or it needs more attention.
00:24:59
Speaker
So let's
Key Metrics and Advice for Improving Payment Workflows
00:25:00
Speaker
talk about the hard part, the after the surgery, where we're seeing a lot of those balances go uncollected or or age to the point where it's starting to cost the surgery center a lot of money to chase those down.
00:25:11
Speaker
What do you recommend as the most cost efficient and effective workflow for those partial balances after the surgery? Yeah, on that one, I mean, it it definitely aligns with the pre-surgery, but I think the most efficient way of doing that is ah payment plan or automation. If you're not getting that full that full balance upfront on that one.
00:25:33
Speaker
And like i was saying before, ASCs need to start thinking a little more like retail, like other businesses. i was kind of talking with a friend the other day, the days of getting that bill in the mail, right? Looking at the bill, writing a check, sitting a writing in check.
00:25:47
Speaker
And kids ask your parents what checks are because I don't even know where my checkbook is, for example. We have one somewhere. haven't used it in several years, but um so the centers are doing that.
00:25:59
Speaker
That is that you' that's antiquated, right? You need to be communicating electronically to patients, giving them the option to pay and setting up that reoccurring payment so that ah that money is coming in and nobody has to really chase after it. Now that's easier said than done. I get it, right? we can You need that other option. Grant mentioned that earlier.
00:26:19
Speaker
As a workflow standpoint, there is the technology and then there is the human workflow, right? So you need to make sure that you have the ability to track payments that are not following the normal, the hopeful normal course of events and follow up with those. And that may take some old school functionality.
00:26:34
Speaker
But yeah, if you're if you're not set up to automatically get that amount paid to you, whether it be the whole thing upfront or whether it be an automated payment plan so that that a the patient doesn't have to worry about it either. They don't need to worry about ah regret you know regretting that walk to the mailbox. So shoot, is there going bill in the mailbox for me today or not?
00:26:55
Speaker
And that's, that's a blind, you know, ah blind leading the blind. You don't know if the patient has seen it. They don't know what they need to pay. It's just a bad, a bad choice for centers to do.
00:27:06
Speaker
And it's tough, right? Everybody, nobody likes change and centers need to start changing for that, but they really need to kind of get on board with everything else works. Absolutely. Absolutely. And then Grant, on the comm side, how do you ah how do centers keep it patient-friendly while still being firm and making sure that they're doing what they can to collect those balances? do you have any recommendations?
00:27:31
Speaker
On the texting side, when you're getting that estimate and payment request, using the the standard automated messages should work well because vendors are sending these out on behalf of AOCs for hundreds of thousands or millions of patients.
00:27:48
Speaker
The messaging there has been standardized to what works well. In terms of when you're in person with someone coming in to the center on the day of surgery,
00:28:01
Speaker
If you use something like HST's patient estimate tool, you can share something in your standard talk track that they have viewed the estimate and today,
00:28:16
Speaker
They still owe X dollars. Now you're able to reference the kind of proof without it coming across as offensive or intrusive.
00:28:28
Speaker
Overall, it's being inclined and clear in your communication. Absolutely. That's a great point. You know, knowing that you have communicated up front and sent these communications kind of gives you a leg to stand on. Right.
00:28:41
Speaker
All right. So before we wrap up, I'd love to just like provide our listeners with some metrics that they should be tracking so that if they are interested in improving this process back at their own centers, they know what to start measuring.
00:28:53
Speaker
A couple that I would say, you know, from our research that seem really important, your upfront collection rate, of course, the percentage of the patient responsibility that you have collected before date of service, your day of service collection rate when, you know, they do show up for their procedure, how you know, what percentage of balances are being paid at that time and, you know, what percentage are now going to be partial balances you have to collect after the fact.
00:29:16
Speaker
And then your payment full versus your partial payment distribution, know, Who's totally resolved their balance? Who do you have on ah on a payment plan? Who do you have with a balance who's not on a payment plan? And just really understanding kind of what that that risk pool and distribution looks like for you.
00:29:32
Speaker
Grant, Chris, what would you add? Chris, I'll start with you actually. Yeah, I mean, they're definitely getting those payments upfront and having a great way to collect that payment in a timely manner. Post data service is going to lower those days in AR. That's that metric centers definitely track on that side of things. And one, um I actually forgot to mention.
00:29:52
Speaker
One issue I know I've heard from centers personally that why maybe they don't collect some of that money upfront or the full patient estimate upfront is the process of refunding patients that money is extremely arduous for centers, right? And figuring that out. I know one of the things with HST, for example, very simple, right? there' Now there's some logistics on the other side to make sure they're documenting that.
00:30:14
Speaker
But if that patient is paying upfront with that credit card or with that automated payments, refunding that money back to their source of payments is no brainer and being able to click a button and have that go back. So centers will worry about that a little bit. I know that they're always looking for walls and why they don't want to do this well. and And usually they're remembering one or two things that were difficult over a multi-year period. Refunds are an issue with centers.
00:30:40
Speaker
And having a way to automate that easily, like we do in HST is super important. That's a great point that there may actually be some hesitation to collect full balances only because you're not quite sure, right, what the final bill is going to be. But removing that obstacle.
00:30:56
Speaker
Exactly. And while patients may be slow to pay and respond to bills, ah you can bet they are not slow to respond to when you owe them more money. They're going to be at your door asking for that. So and definitely auto being that is ah is super important. Everybody's well-being.
00:31:12
Speaker
For sure. Grant, what about you? writing additional metrics you think should kind of be on that patient collections, patient payments dashboard? Yeah, you both mentioned great ones.
00:31:22
Speaker
One internal metric to consider would be tracking how much time is spent on the patient estimate and patient payment workflow by staff. And you could think about things like the time spent for data entry, for payment reconciliation, on the patient estimate side, how much time we're spending calling insurance companies.
00:31:45
Speaker
Then you could think about dividing that by the number of payments and understand your time spent per payment. And then as an AOC leader, they could think about how do we add more automation and documentation to consider things like automatic payment reconciliation.
00:32:03
Speaker
So that, that number improves over time. Yeah, I think that's a great point, Grant. And then mentioned earlier, again, to what we hear from certain surgery centers, well, gosh, that is, that is so-and-so's job, right? where We don't want to have yeah eliminate a job, eliminate FTE.
00:32:17
Speaker
Absolutely, 100%, no surgery center is overstaffed. They are much more tasks that can be performed. And let's be honest, tasks that are going to make that employee happier.
00:32:30
Speaker
Because nobody wants to you know make those phone calls and do collections. And it is not a joyous job. Being able to focus jobs that is on the line of patient satisfaction is definitely, again, helps everybody's morale.
00:32:43
Speaker
Excellent points all the way around. i absolutely agree that, you know, centers should be tracking their costs because that's where you get to the heart of profit, right? Okay.
Conclusion and Insights on ASC Payment Strategies
00:32:53
Speaker
So that brings us to our final question, my favorite to ask and one that we ask our guests on every episode. But what is one thing listeners can do this week to improve their surgery centers? It can be related to patient payments or not.
00:33:06
Speaker
I'll go first. I would suggest that you go shadow your team that handles the patient payments and watch them handle five or more transactions start to end.
00:33:18
Speaker
Then think to yourself, is this the optimal workflow or are there some areas for improvement based on what you heard? Doing this probably takes you less than an hour and can give you a lot of insights to see it for yourself.
00:33:33
Speaker
I love that. That's great. What about you, Chris? Yeah, that's excellent grant, right? I think sometimes folks, the folks making decisions on software and and and automation are not the ones that are doing those tasks. So they may not fully understand.
00:33:46
Speaker
um ah Great, great um exercise in general, right? Seeing that kind of thing. I would take it, make that one step further perhaps and say for, and I'll just stick on the payment side since our topic today, maybe map out forget what you're doing today.
00:34:01
Speaker
You know, forget the software you're using at for that moment. Map out what is, you know, what would be the the best way to get those payments in both pre-dated service and post-dated service. If you had a magic wand.
00:34:13
Speaker
What would that look like? And then maybe you take on what Grant was saying and and watch that process, what you do today and say, hmm, where can we improve that? And really for anything in the ASC, but take that time to sit down and go, if I had a magic wand, what would I want that workflow to look like?
00:34:29
Speaker
Whatever that workflow is. And then evaluate what you do today. Is that following that and where can you improve? That's great. I'll add kind of going back to the idea of, you know, treating your patients like consumers and taking some tips from consumer marketing, but I think creating some sort of touch point map of all the ways that you're currently communicating with your patients. How are you delivering estimates. How are you following up right now? What does that look like? Where might the points of confusion or drop off be rising and surfacing? So um getting a good handle. i think we're all in the same place where you have to really understand what you're doing today and where that might be breaking down. those are all excellent, excellent pieces of advice.
00:35:15
Speaker
Well, thank you both. I really appreciate having you on and getting the chance to kind of pick your brains on this topic. Thanks so much. Thanks, have everyone. Thanks, Alex.
00:35:32
Speaker
We're recording this week's data segment coming off of the busiest quarter and month for many ASCs. That time of year when schedules are packed, teams are running hot, and everybody's working as hard as they can to get as many cases done as they can before the calendar and many patient deductibles flip over on January 1. And it's a good reminder of something that's actually true all year long, which is that it's really easy to equate being busy with financially heavy, but they're not always the same thing.
00:36:00
Speaker
Late last year, we released a report called Who's on Your Schedule? Demographic Trends and Benchmarks for ASCs. In it, we analyzed over 5.3 million cases across 635 ASCs between Q1 of 2020 and Q2 of 2025 to look at really three different lenses. And that's case share, payment share, and OR minute share across specialties.
00:36:23
Speaker
And the headline is that revenue concentration ultimately differs from case mix. So in plain English, the specialties that keep you busy are not always the specialties that carry the biggest share of dollars. If you haven't already checked out the report, we'll do a quick level set on some terms, but I do encourage you to read it if you haven't.
00:36:41
Speaker
Case share is a specialty's percentage of total cases, and payment share is that specialty's percentage of total payments. So what does that look like operationally? The report points out that short-term specialties like GI, ophthalmology, and ENT tend to anchor case volume.
00:36:58
Speaker
And that tracks with real life. High throughput specialties can make your board look stacked, your day feel relentless, lots of turnovers, lots of movement, and lots of touches across multiple patients. But when you ship from cases to payments,
00:37:11
Speaker
the anchor specialties can change. On the payment side, the report calls out orthopedics, ophthalmology, and GI as major anchors, and this is really the key divergence. You can have specialties that represent a big slice of case share, while other specialties may represent a bigger slice of payment share.
00:37:28
Speaker
This is why we were slammed, it doesn't always map cleanly to our financial performance was driven by that volume. Because the question for leaders isn't just how many cases did we do, it's also what mix of cases did we do and what mix are we trying to build our center around ultimately?
00:37:45
Speaker
One more nuance the report flags is that total joint has gained economic weight in recent years. So even if your overall ortho volume stays relatively steady, if the composition of ortho shifts more toward total joint, your financial profile can shift with it.
00:38:00
Speaker
So here's a clean self-check you can do this week. No special tools required. Take a look at your top two specialties by case volume, and then look at your top two specialties by payment share. If they're the same, great. Volume and dollars are moving together in the same direction.
00:38:15
Speaker
And if they're different, that's not necessarily good or bad. It's simply a signal. Your schedule is telling you one story and your revenue concentration is telling another. And the takeaway is simple.
00:38:26
Speaker
Busy doesn't automatically mean economically heavy. So if you're not tracking both case mix and payment mix, it's easy to misread what's actually driving performance. And it could have the potential of quietly shaping the wrong decisions around block time, staffing, and specialty strategy.
00:38:42
Speaker
And that wraps up today's episode. I hope you enjoyed my conversation with Chris and Grant and be sure to come back next week for the third and final episode in our patient payment series. If you did find today's content helpful, please take some time to leave us a rating or a review on your favorite podcast platform.
00:38:59
Speaker
As always, I'm so grateful that of all the things you could do this week, you chose to spend a few minutes of it with us. I hope to see you again next time.