Healthcare Insights
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.
| Rank | Definitive ID | Hospital name | State | Bad debt to net patient revenue ratio | Explore dataset |
|---|---|---|---|---|---|
| 1 | 963 | Southern Regional Medical Center | GA | 94.40% | Explore |
| 2 | 1011 | Higgins General Hospital | GA | 67.50% | Explore |
| 3 | 3982 | CHRISTUS Good Shepherd Medical Center - Longview | TX | 63.80% | Explore |
| 4 | 6349 | Crosbyton Clinic Hospital | TX | 59.60% | Explore |
| 5 | 1043 | Polk Medical Center | GA | 57.50% | Explore |
| 6 | 5558 | Calhoun Liberty Hospital | FL | 54.40% | Explore |
| 7 | 53 | Atmore Community Hospital | AL | 53.40% | Explore |
| 8 | 1018839 | Ascension Seton Bastrop | TX | 49.70% | Explore |
| 9 | 32 | Cherokee Medical Center | AL | 46.70% | Explore |
| 10 | 6188 | Palacios Community Medical Center | TX | 46.20% | Explore |
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.
| Rank | Definitive ID | Hospital name | State | Bad debt to net patient revenue ratio | Explore dataset |
|---|---|---|---|---|---|
| 1 | 551805 | Florence Hospital (FKA Florence Hospital at Anthem) | AZ | 102.40% | Explore |
| 2 | 3950 | Ennis Regional Medical Center | TX | 96.00% | Explore |
| 3 | 972395 | Crockett Medical Center | TX | 92.70% | Explore |
| 4 | 3927 | Dallas Medical Center | TX | 82.20% | Explore |
| 5 | 1011476 | Altus Lumberton Hospital | TX | 77.60% | Explore |
| 6 | 48 | Vaughan Regional Medical Center | AL | 76.00% | Explore |
| 7 | 4036 | South Texas Health System Edinburg (FKA Edinburg Regional Medical Center) | TX | 73.20% | Explore |
| 8 | 25 | Bullock County Hospital | AL | 68.50% | Explore |
| 9 | 3980 | Wilson N Jones Regional Medical Center (FKA Texas Health Presbyterian Hospital - WNJ) | TX | 68.30% | Explore |
| 10 | 3032 | LifeBrite Community Hospital of Stokes (FKA Pioneer Community Hospital of Stokes) | NC | 56.40% | Explore |
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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