Vancleave said the stark reality of high-deductible healthcare—though on the radar of Mosaic executives last year—really hit home during the first four months of this year.
The hospital, she said, stayed nearly full during that time, posting record census and gross revenue. But net revenue didn't budge an inch from the prior year period because patients weren't paying their growing share of the cost of care.
Patients' self-pay total—the amount not covered by insurance—was up 9% over the four months, she said.
That's put Vancleave on a quest for improvement.
Just a month ago, Mosaic brought in ClearBalance to offer patients financing options for their out-of-pocket costs.
ClearBalance and other healthcare financing companies such as HealthFirst Financial arrange loans with patients that hospitals typically customize. Often they include a no-interest option for 12 to 24 months but as long as 72 months depending on what hospitals require.
ClearBalance, which has been making patient loans since 1992, has 150,000 patients on credit at any one time at scores of hospitals, CEO Bruce Haupt said.
HealthFirst, whose customers include Trinity Health, has $71 million in patient loans at any one time at about 220 hospitals, physician offices and ambulatory surgery centers, said KaLynn Gates, the company's president.
Vancleave said Mosaic enlisted ClearBalance to recover more of the out-of-pocket costs owed by patients and offer them a financing option.
Vancleave, who joined Mosaic a year ago after years at revenue-cycle giant Conifer Health Solutions, said the small-town hospital had tried a previous payment plan for patients. But it could only collect 20% to 30% of what patients owed. That was because of the hassle of sending out monthly bills and the difficulty of employees trying to collect from their neighbors.
Since outsourcing the job to ClearBalance, the hospital has already received a seven-figure check from ClearBalance for outstanding out-of-pocket bills, Vancleave said.
Both ClearBalance and HealthFirst are "recourse" lenders, which means they pay the hospital upfront for the outstanding bills of patients who sign up for a loan.
But the hospital guarantees the money and repays the lender if patients default on their credit lines. The finance companies make their profit by getting a 10% to 15% fee for the outstanding amount of the loan.
Vancleave said the fee is worth the much higher rate of recovery that the hospital has gotten on out-of-pocket receivables.