Kaufman Hall's October National Hospital Flash Report surveyed more than 1,300 hospitals on revenue and profitability. The report noted bad debt and charity care as a percentage of gross revenue and calendar days increasing in many regions.
"Bad debt and charity care remained elevated on a year-over-year basis," the report states. "This is partly attributed to the ongoing Medicaid redetermination process, which has resulted in at least 9.5 million people disenrolled."
As of Oct. 17, Kaiser Family Foundation reported 9% of Medicaid beneficiaries were disenrolled and 17% were renewed since March 2023. The majority, 70%, are in the renewals remaining category as states continue the redetermination process. Arkansas had the highest rate of disenrollment, at 3%, followed by Idaho at 32%.
Bad debt and charity per calendar day was up 8% in September compared with the same period last year, and up 4% for the first nine months of the year, according to Kaufman Hall. Hospitals with 26-99 beds saw a 4.9% increase in bad debt and charity care per calendar day for the first nine months of the year, while hospitals with more than 500 beds reported a 4% jump.
Will those numbers improve? That will depend on whether patients will be in a better position to pay their medical bills next year. A March report from Urban Institute found nearly 73% of adults with medical debt owed at least some to hospitals, and 28% owning only to hospitals. Just 35.7% of the adults with past-due hospital bills said they had a payment plan.
Bad debt and charity as a percentage of gross revenue was flat in September when compared with the same period last year, and down just 1 percent month over month. But for the nine-month's end, bad debt and charity as a percentage of gross revenue was down 4% year over year and 27% when compared with 2020.
Regionally, here is a breakdown of bad debt and charity care for the first three quarters of the year, compared with the same period last year:
West
Bad debt and charity care as a percentage of gross revenue: 6%
Bad debt and charity per calendar day: 16%
Midwest
Bad debt and charity care as a percentage of gross revenue: -4%
Bad debt and charity per calendar day: 1%
South
Bad debt and charity care as a percentage of gross revenue: -6%
Bad debt and charity per calendar day: 5%
Northeast / Mid Atlantic
Bad debt and charity care as a percentage of gross revenue:-5%
Bad debt and charity per calendar day: 0%
Great Plains
Bad debt and charity care as a percentage of gross revenue: -11%
Bad debt and charity per calendar day: -4%