Feb 14
2025
Expanding Access to Patient Financing for High-Cost Care Episodes
By Meredith Kirchner, COO and chief client success officer, Curae.
Emergency rooms and specialty care facilities, like infusion and burn centers, serve millions of patients annually in urgent, often life-saving situations.
For many patients, however, these visits are accompanied by steep out-of-pocket expenses they are unprepared for, leaving them with overwhelming medical bills.
At the same time, healthcare systems bear the financial burden of these high-cost care episodes, as nearly 70% of emergency care services can go un- or under-compensated. This dual financial strain places immense pressure on healthcare leaders, who have no choice but to find ways to address both patient affordability and their system’s own financial sustainability.
The Emergency Medical Treatment and Labor Act (EMTLA) plays a significant role in this – enacted in 1986, EMTLA requires emergency departments to screen and stabilize patients regardless of their ability to pay or current insurance status. While this law does ensure access to critical care for all, it prevents physicians from discussing costs or payments until after stabilization. For many patients, this means they are largely unaware of their financial responsibility until the bill arrives, often weeks later.
This dynamic leaves both patients and healthcare systems vulnerable: patients face financial stress that impacts their well-being, while uncollected balances contribute to rising bad debt for health systems.
The impact of increased patient financial responsibility cannot be overstated. With health insurance plans shifting more costs onto patients through higher deductibles and coinsurance, many are left unable to pay their share of medical expenses.
In fact, individuals in the top 10% of healthcare spenders face average annual out-of-pocket costs of over $6,000, while those in the top 1% spend an average of nearly $25,000. Not only do these expenses result in financial stress, but they can also lead to delayed payments and avoidance of future care.
These unpaid balances, combined with the administrative cost of collections, put health systems in a difficult position. Revenue losses from high-cost care episodes limit the ability to reinvest in critical areas like staffing, equipment, and technology, further weakening the organization’s overall financial and operational stability.
Gaining Coverage – Eligible Patients for ACA Plans
Many patients diagnosed with significant diseases and conditions are underinsured or uninsured. A good first step for health systems is to check the patient’s eligibility for an Affordable Care Act (ACA) plan.
Health systems often have service providers and in-house patient advocates perform this work to help complete the enrollment. The coverage in a platinum plan will cover much of the cost of the care (e.g. in-patient stay, infusion therapy and drug cost, oncologist professional fees, etc..), however even if the patient is eligible for an ACA plan and enrolls, there are co-pays and deductibles as with any commercial insurance plan, which could be thousands of dollars for each infusion therapy or procedure.
With or without insurance coverage, patients need medical service financing for out-of-pocket costs over $1,000 and especially for large costs associated with more severe diagnosis and therapies and procedures.
Proactive Financing Programs
Patient financing programs offer a proactive solution to this growing issue. By providing flexible payment options at critical points of care, health systems can reduce the financial strain on patients, improve cash flow, and minimize bad debt. As high-cost care episodes continue to rise, adopting these programs is not just a strategy for maintaining access to care—it’s essential for ensuring the financial resilience of health systems.
In addition, the current economic and regulatory landscape is making patient financing programs more essential than ever. Rising interest rates make traditional payment plans less viable for both patients and health systems, while state laws are increasingly limiting how providers can pursue unpaid medical bills. In fact, many states now prohibit providers from selling patient debt or collecting from low-income individuals, leaving health systems to absorb the cost.
Patient financing programs can provide a compliant, patient-centric alternative that ensures financial stability while avoiding aggressive collection practices. These programs, often managed by third-party institutions, allow patients to cover their expenses over time, reducing immediate financial stress and improving payment adherence. Direct benefits of patient financing programs include:
- Improved Access to Payment Options: Patients can pay in manageable installments, reducing financial strain.
- Enhanced Financial Stability for Health Systems: Financing minimizes unpaid balances and strengthens cash flow.
- Increased Patient Satisfaction and Trust: Providing financial solutions builds confidence and encourages future engagement.
The Role of Technology in Patient Financing
Technology is a critical component of patient financing programs, enabling healthcare systems to manage the process efficiently and with precision. Eligibility for financing can be determined through integration with the electronic health record software (EHR) to provide a seamless workflow for the staff member to provide a financing application quickly to the patient, and then to quickly be able to satisfy the balance with that newly created line of credit.
Once eligibility is determined, these systems provide patients with clear and transparent repayment options. Interactive digital portals or mobile applications allow patients to view, select, and agree to financing terms directly from their devices. Tools like these simplify communication, ensuring patients fully understand their financial responsibilities and repayment timelines as quickly as possible.
The application and enrollment process itself is streamlined through automation, reducing paperwork and manual input. For example, once a patient is approved for financing, the system can automatically generate and process the necessary agreements, set up payment schedules, and send reminders for upcoming payments. Automation not only reduces administrative workloads but also minimizes errors, validates entered information, and therefore improves successful enrollment with speed.
These technologies can also enhance compliance with regulatory standards, such as financial disclosures and data security. Built-in safeguards can ensure that patient financial information is handled according to federal and state regulations, protecting both the patient and the healthcare system.
Looking to the Future
The challenges posed by high-cost care episodes require health systems to rethink how they approach financial engagement. Patient financing programs represent more than just a way to address unpaid balances—they are a means of strengthening trust between patients and healthcare systems. By attempting to alleviate financial stress, these programs may encourage patients to seek necessary care earlier, possibly leading to better outcomes and fewer costly complications.
As we look ahead, patient financing programs are essential to navigating the intersection of patient affordability and organizational sustainability. Systems that embrace these solutions are not just managing today’s financial pressures—they are setting the stage for a more equitable and resilient healthcare system. By prioritizing programs that balance financial stability with compassionate care, health systems can lead the way in creating a future where patients feel supported and organizations remain strong enough to meet the growing demands of their communities.
Patient financing is no longer just a solution for high-cost episodes; it’s a cornerstone of modern healthcare strategy—one that aligns the needs of patients with the priorities of health systems in a way that is both sustainable and forward-thinking.