It's not an easy battle, though. Carolinas HealthCare collects just 3% of all its patient revenue upfront, but not for lack of trying, Johnson said.
The health system has a staff of more than 30 people who reach out to all patients scheduled for inpatient care and high-cost outpatient care, such as surgeries, Johnson said.
Those patients are encouraged to pay any out-of-pocket responsibilities over the phone when they register and receive pre-hospital instructions, he said. "We ask how they plan to pay for service," Johnson said.
When registering patients for treatment, authorizing their insurance if they have it, estimating their out-of-pocket costs and billing them, hospitals increasingly are turning to software as a vital tool in the effort to get paid.
Carolinas HealthCare uses software by revenue-cycle vendor Recondo Technology to accurately estimate what the patient will owe out-of-pocket given his or her insurance and deductible status.
The system is not insensitive to patients' looming deductibles, which often run $3,000 or more, Johnson said.
But hospitals still face the reality that their bills must be paid. Failing to collect patients' out-of-pocket share costs hospitals nationwide billions of dollars, and the situation promises to get worse, said Eric Boggs, a principal at Crowe Horwath. According to the consulting firm, providers collect on average just 30% to 40% of all out-of-pocket medical costs incurred by patients.
Out-of-pocket costs represent 11% of total billable inpatient costs and a much larger 27% of outpatient costs, Boggs said.
In the short term, that's a double whammy for patients as they face higher deductibles and the industry's shift to promoting outpatient care. The delivery change will save healthcare systems money, he said.
But for now, unpaid bills from patients with insurance are "being amplified by the move to outpatient" care, Boggs said.
ZirMed, a revenue-cycle management and data analytics company that is merging with Navicure, is slightly more optimistic, finding that hospitals get paid about half what patients owe out-of-pocket, according to CEO Tom Butts.
In 2016, for the first time, more than half of all workers (51%) with single coverage faced a deductible of at least $1,000, according to the Kaiser Family Foundation/Health Research & Educational Trust. And 29% of workers were in high-deductible plans compared with 20% two years earlier.