Patient Payments: Workflow Best Practices for Maximizing Collections

Ep. 136: Patient Payments: Workflow Best Practices for Maximizing Collections

Here’s what to expect on this week’s episode. 🎙️

A pattern we’re seeing more often: more partial payments — fewer complete payments. 

That sounds small until you zoom out: it changes staff workload, follow-through, patient experience, and forecasting. 

Our latest episode with Grant Duncan and Chris Pompilio digs into what’s driving it and what to do about it — from upfront estimates to payment links to the unglamorous part most centers under-design: post-op follow-through. If your team is still chasing balances across portals, statements, and spreadsheets, this one’s for you.

Be sure to check out the full episode on YouTube or your favorite podcast platform! 

Episode Transcript

[00:00:24] Alex Larralde: Hi everyone, and welcome back to this week in Surgery Centers. We’re continuing our series on patient payments this week with a conversation that zooms in on the parts of the patient collections workflow that tend to break in real life. We’re talking the handoffs, the exceptions, and the follow through that happens after that initial estimate is sent.

We talk about what’s changing in patient responsibility, where teams tend to lose the most time and money, and the small workflow shifts that make payments feel simpler for patients and staff alike. I’m joined by two HST subject matter experts. Grant Duncan, our head of marketing and Sales Development, and Chris Pompilio, our lead sales product engineer, and someone who many of you may recognize from his decades of experience in the ASC space, including roles here at HST spanning implementation, training, guidance, sales, and even a little bit of engineering.

In this conversation, we talk about the spots where patient payments tend to get messy what’s changed as far as more financial responsibility shifting to patients, why transparency and upfront estimates matter now more than ever, and what clean looks like operationally.

Then after the interview, we’ll close with a quick data segment from our recent demographic trends and benchmarking report. A reminder that case volume and payment share don’t always line up perfectly by specialty and why that can be a useful lens for planning and forecasting.

I hope you enjoy today’s episode and here’s what’s going on this week in surgery centers.

[00:01:57] Alex Larralde: All right everybody. I’m so excited to be continuing our conversation on patient payments, and today I’m lucky to be joined by two HST subject matter experts and I would love it if you both could just introduce yourselves really quickly.

Grant, I’ll start with you.

[00:02:12] Grant Duncan: Great. Well, hopefully I’m a familiar face as I help co-host this podcast. But as a refresher, I lead marketing and sales development at HST and enjoy working at the intersection of healthcare and technology and being able to pull insights from the 1800 plus customers we have and share those with you all.

[00:02:33] Chris Pompilio: Yeah, thanks Grant. Chris Pompilio with HST, uh, new to the podcast, but hopefully a familiar face and definitely a familiar voice to many of our the customers out there that have used HST in the past, been in the ASC space for, gosh, over 20 years now, uh, with HST since the beginning. So, thanks for having me on the podcast, Alex and Grant, and happy to be here.

[00:02:55] Alex Larralde: Amazing. Thanks for joining us. I’m really excited to get your insights on this topic.

And as we get started, I thought it would be helpful to just take a quick look at the landscape and begin with some data. I was just looking through this recently. I did a data segment on it, um, and looking at our state of the industry report it looks like we’re starting to see some interesting trends emerging on the patient payment side.

Partial payments actually increased from patients in 2024, so it went from 41.2% to 56.2%. So, the proportion of ASCs that are collecting something increased. But when you look at total patient collections, they actually went down 6% in 2024 from 25.8% to about 17%. So, we’re going to have our 2025 report soon looking at the most recent 12 months of data.

So, we’ll really get a sense of whether this trend is continuing in the same direction. But to start, I’d love to just get both of your thoughts on this. What do we think might be happening here, and what should ASC leaders be paying attention to? Grant, I’ll start with you.

[00:03:57] Grant Duncan: Sure. So those two metrics can move in opposite directions if more patients are paying something, but that something is smaller compared to what they owe, or it’s not turning into a full payment later. So, they’re paying part, but not all. As to the forces behind this, I am speculating here, but a couple of potential causes that come to mind would be, one, we’re seeing that patient responsibility is growing over time as more people are choosing high-deductible health plans.

And that means there’s more cost going to them. Another could be that ASCs are getting better at collecting something upfront, pre-day of service or on the day of service, but the follow through to the post-day-of-service, if there’s still something to be collected there may be an opportunity to be improved.

[00:05:01] Alex Larralde: That makes total sense. And Chris, you’re talking to centers every day, discussing problems just like this. Why do you think the current state is what it is right now?

[00:05:11] Chris Pompilio: Yeah. I think some of it’s being just forced by the, the nature, as Grant mentioned, of the high deductibles and the larger patient cost, uh, with, uh, surgery centers and also by the legislation.

Right? Uh, a lot of states have enacted, No Surprises Acts where patients need to be notified upfront what they, uh, what their share is going to be. And because that share is larger, uh, centers are realizing the, the importance of, of really collecting that upfront or afterwards, because that is a, a big chunk of the profit of the, uh, the case itself.

[00:05:41] Alex Larralde: Absolutely. You know, my takeaway is that, as we see these partial payments increase, it’s not that patients don’t want to pay necessarily, it’s that there’s something about how we’re asking them to, right? That isn’t working. So, let’s talk about that. Let’s talk about the workflow and what we’re seeing. Chris, if you could just kind of take us through when we say patient payments workflow, what are those stages from start to finish that centers should be following, thinking about, designing?

[00:06:07] Chris Pompilio: Yeah. Great question. Right? So, uh, I think one of the, the first ones is understanding what that patient share is. That patient cost is, as I mentioned. In the past, right? Years ago, you may, you may go to the, uh, the doctor for a procedure or for something done, you’d have a copay, maybe a, a small, uh, deductible on, on your account.

So, uh, facilities and providers weren’t that worried about collecting that money, uh, upfront. Uh, they bill you after the case. Uh, that’s definitely changed, uh, as we talked about, uh, with that. So, I think the patient payment workflow really starts with the center, uh, fully understanding. That, uh, what that patient’s share is going to be.

Typically, what we see now today is that patient’s share is probably around 25% of what, uh, the center is going to be collecting on that case. And that coincides right at the same level of the profitability of cases at a surgery center.

[00:07:00] Alex Larralde: Got it. And Grant, as you’re thinking about this and the different stages of the workflow, there’s before the surgery, the day of, after the surgery, we’re seeing partial payments rise, we’re seeing total collections decrease. What do you think matters more for centers right now to pay attention to? Is it the earlier stages, like getting the estimate right? Is it the collection tactics? What are your thoughts?

[00:07:24] Grant Duncan: Yeah. I’d say probably the most important part is just making sure they are collecting in some fashion, whether it’s pre, day-of, or post. We’re finding that it’s best practice to do this before the surgery.

So ultimately, I’d say before is most important if, if I have to choose one area. But from an ASC perspective, once you’ve collected that patient payment, there’s also other factors to think about, like the time it’s going to take to reconcile those patient payments in your, billing system. With some like HST’s, this can be done automatically.

If you’re doing it with others you know, that might add up to two to seven minutes of work per transaction reconciling through the copying and pasting you have to do. So, it’s a good area to think about are you choosing a solution that can have an automated option. And that’s going to be post-surgery, to think about that part of the workflow as well.

[00:08:28] Alex Larralde: Yeah. So where do you both, uh, I’ll ask you both this question, but where do you think ASCs are losing patients in this process? I know, for myself, coming from the patient perspective, I think it’s the surprise bill that additional bill that comes weeks or sometimes months after a procedure. But, you know, where do you think this is breaking down for patients? Is it before? Is it after? Is it just not knowing? You know, the exact amount that they owe. Chris, I’ll start with you.

[00:08:54] Chris Pompilio: Yeah. Yeah. Um, I think that’s a big part of it, right?

The not knowing what they’re going to owe for that procedure in the ASC, and it’s a little different than other kind of retail environments, right? If you think about it, and it you’re paying for a service, you’re paying for a procedure, it’s a retail environment.

So, if that procedure’s already occurred, right? Hopefully everything is great. We know we have great outcomes in ASCs, and then you get that bill. Uh, let’s be honest, right? That, that neediness to pay goes down on the, the patient side. They can’t take back the surgery, right? You can’t, you can’t return it, or have it repossessed, so getting that money upfront, like I said, more and more important, and also, I think that it. Really dovetails in with the operations of the surgery center. One of the issues that surgery centers deal with are cancellations, right? If they’re collecting that money up front, uh, in an easy way, that’s going to cut down on their cancellations because the patient is going to, uh, have that procedure, uh, procedure done.

So, it’s not just the, the best practices for, uh, payments. Payments really permeate all areas of that surgery center.

[00:09:59] Alex Larralde: Right, it’s, it starts much further up in the process, right. Getting that accurate estimate out in a timely fashion to make sure that people aren’t surprised on the day of or the day before calling in and saying, ‘hey, I can’t afford this right now.’ Grant, what do you think?

[00:10:13] Grant Duncan: Yeah, to, to build on what Chris was saying, if they’ve also paid. Beforehand, they’re very likely to show up because they want the services to be delivered even more than they may have before. Even if that improves cancellations by reducing it 5% or something, that’s still a meaningful impact in terms of volume.

A couple other things that come to mind. One is that I think how easy it is to pay is a factor. Where you may lose or keep patients. We’re seeing it’s best practice to be able to allow patients to pay from your website, having a link to click and pay, being able to text and email them with a link with the estimate and with the ability to pay.

Also, offering this over the phone, which is easy if they’re just going to call in. Technically they can do it in person too, although most people probably aren’t going to show up early to pay in person. And then a second factor to think about is payment plans, is this standard and is this available across those different mediums I was talking about if they’re going to go to your website or get a text or even over the phone, is this an option that they can be presented with so that it can be more piecemeal for them?

[00:11:36] Alex Larralde: That makes absolute sense and those are great considerations. So, to back it up just a little bit, I’ll, I’ll stick with you. Grant. If somebody’s looking to overhaul their approach here, like they are seeing the same kind of trends in their total collections they need to sharpen up days to bill, you know, how quickly they can actually get those bills out the door, but what would you suggest as kind of those initial organizing principles for getting started on this journey to, to rethink their patient payments workflow?

[00:12:05] Grant Duncan: I would suggest ASCs first, understand the current state, look at their data, export some reports, or look at dashboards to understand what the current state of affairs is and understand, okay, is this where we want to be or is there a more ideal future state?

If it’s not where you want to be, then determine what that gap is between your current state and your future state. And then when you understand that, you can start to think about, okay, here’s an area we want to improve. How do we want to approach that? A classic framework is to think about improving something through people, process, technology or data, or it could be a combination of those.

So, you’re going to think about, okay, what are the areas that we can use to make this improvement? And then I’d suggest thinking about prioritizing those changes, because you’re probably going to think about multiple ideas, especially if you’re doing this in a team setting. And one way to think about prioritizing, is thinking about the effort to impact matrix.

So, it’s like a two-by-two matrix, one axis effort, other axis impact. The best, easiest ones to focus on are the low effort, high impact items. So, it’s not going to take a lot of work, but it’s going to make a lot of impact. Those are going to be great ones to focus on first. You kind of think of these as quick wins and impact can be defined by you, especially as you think about the current state versus future state.

That might be an impact internally to your processes or externally for patients.

[00:13:51] Alex Larralde: I like that. That’s a great framework to think about, and then Chris is our resident technology expert who, kind of sees this transformation and this journey that ASCs embark on. What does this look like in terms of operational steps?

Like what does this center actually do? You know, once they’ve determined that a change needs to be made, what do you recommend?

[00:14:10] Chris Pompilio: Yeah. I think evaluating your current tech stack, right? What you’re using today, uh, for your, software solution and, and workflow because they like go hand in hand.

And, and if it doesn’t support what Grant was talking about, being able to provide the patient with that estimate. Talking about before date-of-service easily and, uh, easily understandable, an easy way for that patient to pay, uh, right there on their phone, who’s not on their phone nowadays, making those, those payments.

And, and then, um, like you said, I think a, a great tool that is giving them an, an option, uh, kind of a payment plan option. I was thinking about just the other day, no matter where I am on the web, if I’m, you know, booking a flight or I’m buying something on Amazon. There’s always that other option to pay a monthly, uh, fee to instead of paying the whole thing, uh, at once.

So, if your software doesn’t allow you to do that today, I know HST does, but, uh, other ones out there may, that’s something you should look at, right? Being able to make that, have that payment patient, excuse me, have that easy link to pay or a, uh, accept a predefined payment plan and following that.

That payment plan logic, uh, the ability then to go ahead and if it is a payment plan, automatically pull that payment into your system to, so the patient has less to do. And from the workflow, less to do. Right. We spend a lot of time, uh, or centers spend a lot of time chasing money, right? And there’s a lot of things for that and there’s a lot of cost to that.

I see sometimes centers spending probably multiple person hours and, uh, materials and, and statements, post-date-of-service to collect, a small amount that really now they’re working against themselves, right? They, they’ve probably spent, you know, 50 to a hundred dollars to collect a hundred dollars.

[00:15:54] Alex Larralde: Absolutely. A negative ROI on the efforts. What about other technology considerations that teams should be thinking about, right? Like other capabilities that come with using like a purpose-built software for this type of workflow.

[00:16:09] Chris Pompilio: One, one big part of it, right. Uh, we’ve mentioned it before, sort of a theme going through our talk today is understanding not only the patient’s understanding their share, but the centers understanding their share.

Uh, that’s information that they need to get from a third party, right? The center needs to be able to communicate, in this case with the payers. Uh, and the payer contracts and other information to get that information. The, I’ve seen the incentives, that process as Grant mentioned, could take up to, 15, 20, even 30 minutes per patient to try and get all that information before you even start the payment process.

We’re getting that payment from the patient uh, automating that. Is, is key, right? So, uh, making sure that your system can do that well and accurately, right? Uh, the payers aren’t making it easy for everybody to get that information. So you need to have a way of doing it.

[00:16:59] Alex Larralde: Absolutely. Let’s actually talk more about that. Let’s talk about the timing of getting those estimates out to patients. Because, you know, I think we understand patient behavior pretty well now in the context of consumer behavior, you know, as, as. The consumer convenience has risen out there, as you mentioned, and other ways that you can pay and all sorts of services out there that they go and procure, that they have myriad ways to hand over money, right?

What does and doesn’t work with engaging patients? Well, let’s talk about that. So, Chris, what do you think is like a reasonable starting point for estimate timing based on some of the limitations with payers? What should centers be striving for to get those out to, to patients to maximize the likelihood somebody’s going to pay?

[00:17:41] Chris Pompilio: Yeah, as far as timing goes, I think the sooner the better for that patient. We all have budgets. We all try to figure things out, what we’re doing. I know I need to have, you know, knee surgery and I’m going to have that, you know, next month. I need to start budgeting, how that’s going to work for me.

Uh, if I can get that information as soon as possible. Hopefully, you know, very quickly after that case is scheduled not a few days before, uh, getting that information out there and in an understandable way, healthcare is, and healthcare financing is very convoluted, right? And the average, the average person doesn’t really understand a copay, a co-insurance, uh, deductible, uh, right.

Other information making that, so they understand what’s going on and how that works. And yeah, I think the earlier the better. Just to go back to that.

[00:18:25] Alex Larralde: Absolutely. And also mentioning to them that anesthesia is a separate bill. Right. I think that’s something, uh, that, that throws patients for a loop sometimes.

That there is, you know, multiple line items, multiple providers, and making that as simple as possible for patients to, to understand like, everything’s included here — or it’s not, right. If it’s not, I’m very clear about that for sure.

[00:18:49] Chris Pompilio: No, and then a hundred percent, I sometimes have blinders on about the ASC world, but yeah, in the health healthcare bill, uh, represents several sources.

You mentioned the physician themselves, the anesthesia, the ASC, the facility, uh, the, and then maybe implants or things like that. So having a, a system that can you know, generate. That information for you and for the patient, whether or not the ASC is collecting it. Sometimes the ASC is not collecting that money.

It would be the physician group or the anesthesia group, but letting the patient know, okay, it’s not just this bill. They’re also going to get a, a bill from, uh, these other groups. And then in many cases, the ASC is a joint venture, and they are collecting that from the patient. Again, if your system can’t do, all those aspects you need one that does.

[00:19:34] Alex Larralde: Absolutely. Yeah, that’s a great point. AOCs are in this unique position where they, they may not be collecting it, but they do have this obligation to make patients aware, right? Because that’s how the patient’s going to think about it. I went here to get this service. These are the people accountable for, you know, whatever comes in the mail and making sure I understand this. Chris, continuing with you, uh, let’s talk about reminders and, the need to communicate multiple times with patients to ensure that they’re paying, that they’ve seen the information.

What cadence have you found, works best without annoying patients?

[00:20:09] Chris Pompilio: Yeah. Well, um, that without annoying. That’s a, that’s a good point. You definitely want to make sure that if, you know, they haven’t paid in a timely manner, assuming you’ve communicated with them early, what their responsibility is, that you’re following up with that.

And it’s really important to have that transparency. Have they ma been made aware of it. Um. A lot of times centers will call, maybe leave a voicemail if, if they, if they allow that, or they’ll, they’ll, you know, kind of do the old fashioned, uh, snail mail to the patient that you, that we see that more after the date-of-service, but still exists out there and knowing did, gosh, did the patient, they haven’t paid yet, did they see it?

I don’t want them to walk in the door and be surprised. So, you also, again, with that system, you should definitely have the ability just to know if the patient has seen, uh, that estimate and can communicate back. Through their preferred method of communication, whether that be email or text or phone calls, not overwhelming them, but also, uh, understanding that, that patient share might change a little bit from the time that patient is scheduled to the time that procedure happens, right?

Depending on the cadence of how long that is, they’ve maybe made some other medical payments in the meantime and letting them know that we know that, or we as a surgery center know that and, and we’re taking that into consideration.

[00:21:21] Alex Larralde: Absolutely. That’s a great point that the, uh, initial estimate amount may change, you know, as additional information is gathered so making sure that that’s really clearly communicated seems really important. And I want to talk a little bit about texting. We’ve talked about this before on the podcast, in the context of pre-assessments and just how we communicate with patients in general.

I do think patients are increasingly comfortable with it. It’s kind of like in their workflow of where they spend time during the day. What are your thoughts on this? I, I would love to just kind of hear your, your philosophical thoughts about texting for this type of information. You know, is it part of a communications mix? And then, you know, let’s talk about one way versus two-way texting here.

Grant, I’ll start with you.

[00:22:04] Grant Duncan: Yeah. When you’re trying to collect, I believe texting or email is preferred over phone calls. Phone calls can be a plan B if they are repeatedly not responding or paying, especially if it is post-date of service. Texting is a much easier lift, and it can be automated through technology, whereas a phone call is going to need to human to make those calls, and that really adds up in terms of staff time and hours to that.

In terms of one-way versus two-way texting, I think two-way texting can be a beneficial option so that patients can feel that they are able to have a conversation with you, but I would advise against it for most ASCs, unless they are prepped and staffed for it. Because otherwise, if you don’t have people ready and dedicated to respond back, it’s going to be a poor customer experience.

So, for most ASCs, one way texting is likely better. If you’re prepared and ready, two-way can be a good option to consider.

[00:23:13] Alex Larralde: Yeah, that makes sense. What about you, Chris?

[00:23:16] Chris Pompilio: Yeah. Yeah, I mean, uh, to me, I, I’m a texter, right? I really just don’t like talking on the phone to folks.

I can be on the move and text and it, it’s much easier to, uh, to communicate, uh, for me. Sometimes centers will think there’s an older demographic that isn’t going to text. Uh, they do. Right? I, I think just out, even outside of the ASC, the studies show that over 80% of the population today is reachable via text.

I think that may be a low number, but I, that I’ll go with that. And the average text message too is, is I think read within four minutes of receiving it. And I, there’s no other kind of communication. If you see my unread messages in my inbox of my email, uh, it’s probably like some of yours. Uh, no other method is, is that.

That instantaneous to communicate with them. And as long as it’s not intrusive, right, you text all the time and they’re meaningful, I think people definitely appreciate it. To Grant’s Point, absolutely. With two-way texting, you need to make sure that your system is capable of, uh, having that response, whether it be just an auto response, or maybe a targeted auto response based on what, uh, they were texting back in is great. And then the people to, to monitor that. So patients are feeling like they’re heard, I think is, is super important. But yeah, if you don’t have the ability to communicate electronically with your patients today, you are definitely behind the curve.

[00:24:34] Alex Larralde: Absolutely. And that’s a great point about automated responses too. There are probably several canned responses that can be prepared for common questions, because I’m sure a lot of the questions are the same. So, something to consider for sure that two-way texting can be both. It can be automated, but also human in the loop in case there’s specific instances where people need to follow up or make that phone call or it needs more attention.

So, let’s talk about the hard part, the after the surgery where we’re seeing a lot of those balances go uncollected or, or age to the point where they’re starting to cost the surgery center, a lot of money to chase those down. What do you recommend as the most cost efficient and effective workflow for those partial balances after the surgery?

[00:25:20] Chris Pompilio: Yeah, on, on that one. I mean, it, it definitely aligns with the pre-surgery, but I think the most efficient way of doing that is, a payment plan or automation if you’re not getting that, that full balance upfront on, on that one. And like I was saying before, ASCs need to start thinking a little more like retail, like other businesses.

I was talking with a friend the other day the days of getting that bill in the mail, right? And looking at the bill, writing a check, sitting there, writing a check. And kids ask your parents what checks are because, I don’t even know where my checkbook is, for example. I’m sure we have one somewhere. I haven’t used it in several years, but, um. So, if centers are doing that, that is, that you’re, that’s antiquated, right? They need to be communicating electronically to patients, giving ’em the option to pay and setting up that reoccurring payment so that uh, that money is coming in and nobody has to really chase after it.

Now, that’s easier said than done. I get it right. We can’t. You need that other option. Grant mentioned that earlier as a workflow standpoint, there is that technology. And then there is the human workflow, right? So, you need to make sure that you have the ability to track payments that are not following the normal, the hopeful normal course of events and follow up with those.

And that may take some old school functionality, but yeah, if you’re, if you’re not set up to automatically get that amount paid to you, whether it be, the whole thing up upfront or whether it be, uh, an automated payment plan so that the a the patient doesn’t have to worry about it either, right?

They don’t need to worry about, uh, re you know, regretting that walk to the mailbox. Oh, shoot, is, uh, is there going to be a bill in that mailbox for me today or not? And that’s, that’s a blind, uh, you know, a blind leaving the blind. You don’t know if the patient has seen it. They don’t know what they need to pay.

Uh, it’s just a bad. A bad choice for centers to do. And it’s tough, right? Everybody, nobody likes change, and centers need to start changing for that. But they really need to, uh, kind of get on board with everything else works.

[00:27:15] Alex Larralde: Absolutely. Absolutely. And then Grant, on the comm side, how do you, uh, how do centers keep it patient friendly while still being firm and making sure that they’re doing what they can to collect those balances?

Do you have any recommendations?

[00:27:30] Grant Duncan: On the texting side, when you’re getting that estimate and payment request, using the, the standard automated messages should work well because vendors are sending these out on behalf of ASCs for hundreds of thousands or millions of patients. The messaging there has been standardized to what works well in terms of when you’re in person with someone coming into the center on the day of surgery.

If you use something like HST’s Patient Estimate tool, you can share something in your standard talk track that they have viewed the estimate and today, they still owe X dollars. Now you’re able to reference the kind of proof, without it coming across as offensive or intrusive overall, it’s being kind and clear in your communication.

[00:28:32] Alex Larralde: Absolutely. That’s a great point. You know, knowing that you have communicated upfront and sent these communications kind of gives you a leg to stand on, right?

All right, so before we wrap up, I’d love to just like provide our listeners with some metrics that they should be tracking so that if they are interested in improving this process back at their own centers, they know what to start measuring. A couple that I would say, you know, from our research that seem really important, your upfront collection rate, of course, the percentage of the patient responsibility that you have collected before date of service. Your day of service collection rate, when you know they do show up for their procedure, how, you know what percentage of balances are being paid at that time and you know, what percentage are now going to be partial balances you have to collect after the fact.

Um, and then your pay in full versus your partial payment distribution. Um. Who’s totally resolved their balance? Who do you have on a, on a payment plan? Who do you have with a balance who’s not on a payment plan? And just really understanding kind of what that, that risk pool and distribution look like for you.

Grant, Chris, what would you add? Chris, I’ll start with you actually.

[00:29:35] Chris Pompilio: Yeah, I mean they, they’re definitely getting those payments upfront and having a great way to collect that payment in a timely manner. Post data service is going to lower those days in AR that’s, that, that metric centers definitely track, uh, on that side of things.

And one, um, actually, I forgot to mention one issue. I know I’ve heard from centers personally that why maybe they don’t collect some of that money upfront or the full patient estimate upfront is the process of refunding patients that money is extremely arduous for centers, right?

And figuring that out. I know one of the things with HST, for example, very simple right there. Now there’s some logistics on the other side to make sure they’re documenting that, but if that patient is paying upfront with that credit card or with that automated payment, refunding that money back to their source of payment is a no-brainer. Being able to just click a button and have that go back. So centers who worry about that, uh, a little bit. I know that, uh, they’re always looking for walls of why they don’t want to do this. Well, and, and usually they’re remembering one or two things that were difficult over a multi-year period. Refunds are an issue with centers and having a way to automate that easily like we do, in HST is is super important.

[00:30:46] Alex Larralde: That’s a great point, that there may actually be some hesitation to collect full balances, only because you’re not quite sure, right, what the final bill’s going to be, but removing that obstacle.

[00:30:57] Chris Pompilio: Exactly. And while patients may be slow to pay and respond to bills, uh, you can bet they are not slow to respond to when you owe them more money. They’re going to be at your door asking for that. So absolutely, definitely automating that is, uh, is super important for everybody’s wellbeing.

[00:31:12] Alex Larralde: For sure. Grant, what about you? Are there any additional metrics you think should kind of be on that patient collections, patient payments dashboard?

[00:31:20] Grant Duncan: Yeah, you both mentioned great ones. One internal metric to consider would be tracking how much time is spent on the patient estimate and patient payment workflow by staff.

And you could think about things like the time spent for data entry for payment reconciliation on the patient estimate side, how much time we’re spending calling insurance companies, then you could think about dividing that by the number of payments and understand your time spent per payment.

And as an ASC leader, then you could think about, how do we add more automation and documentation to consider things like automatic payment reconciliation so that that number improves over time.

[00:32:05] Chris Pompilio: Yeah, I think that’s a great point, Grant. And, and I know you mentioned earlier again to what we hear from certain surgery centers, well, gosh, that is, that is so and so’s job, right? We, we don’t want to lose, have eliminate a job or eliminate FTE. Absolutely. 100%. No surgery center is overstaffed. There are much more tasks that can be performed and let’s be honest, tasks that are going to make that employee happier because nobody wants to, you know, make those phone calls and do collections. That is not a joyous job. Being able to focus jobs that is, uh, more on the line of patient satisfaction is definitely, again, helps everybody’s morale.

[00:32:43] Alex Larralde: Excellent points all the way around. I absolutely agree that, you know, centers should be tracking their costs because that’s where you get to the heart of profit, right?

Okay. So. That brings us to our final question. My favorite to ask and one that we ask our guests on every episode. But what is one thing listeners can do this week to improve their surgery centers?

It can be related to patient payments or not.

[00:33:06] Grant Duncan: I’ll go first. I would suggest that you go shadow your team that handles the patient payments and watch them handle five or more transactions, start to end. Then think to yourself, is this the optimal workflow or are there some areas for improvement based on what you heard today? Doing this probably takes you less than an hour and can give you a lot of insights to see it for yourself.

[00:33:32] Alex Larralde: I love that. That’s great. What about you, Chris?

[00:33:35] Chris Pompilio: Yeah, that’s excellent Grant. Right? I think sometimes the folks making decisions on uh, software and, and, and automation are not the ones that are doing those tasks, so they may not fully understand. Um, a great exercise in general, right?

Seeing that kind of thing. I would take admit that one step further perhaps, and say for, and I’ll just stick on the payment side and that’s our topic today. Maybe map out, forget what you’re doing today, you know, forget the software you’re using at that moment. Map out what is, you know, what would be the, the best way to get those payments in both pre-data service and post-data service.

If you had a magic wand. What would that look like? And then maybe take on what Grant was saying and, and watch that process, what you do today and say, ‘hmm, where can we improve that?’ And really for anything in the ASC, but take that time to sit down and go, if I had a magic wand, what would I want that workflow to look like?

Whatever that workflow is. And then evaluate what you do today. Is that following that? And where can you improve?

[00:34:36] Alex Larralde: That’s great. I’ll add, kind of going back to the idea of, you know, treating your patients like consumers and taking some tips from consumer marketing. But I think, creating some sort of touchpoint map of all the ways that you’re currently communicating with your patients. How are you delivering estimates? How are you following up right now? What does that look like? Where might the points of confusion or drop off, be rising and surfacing? So, um, getting a good handle. I think we’re all in the same place where you have to really understand what you’re doing today and where that might be breaking down. But these are all excellent excellent pieces of advice. Well, thank you both.

I really appreciate having you on and getting the chance to kind of pick your brains on this topic. Thanks so much.

[00:35:22] Grant Duncan: Thanks everyone.

[00:35:23] Chris Pompilio: Thanks Alex.

[00:35:31] Alex Larralde: We’re recording this week’s data segment coming off of the busiest quarter and month for many ASCs, that time of year when the schedules are packed, teams are running hot and everybody’s working as hard as they can to get as many cases done as they can before the calendar, and many patient deductibles flip over on January one.

And it’s a good reminder of something that’s actually true all year long, which is that it’s really easy to equate being busy with financially heavy, but they’re not always the same thing. Late last year, we released a report called ‘Who’s On Your Schedule? Demographic Trends and Benchmarks for ASCs.’

In it, we analyzed over 5.3 million cases across 635 ASCs between Q1 of 2020 and Q2 of 2025 to look at really three different lenses, and that’s case share, payment share, and OR minute share across specialties.

And the headline is that revenue concentration ultimately differs from case mix. So in plain English, the specialties that keep you busy are not always the specialties that carry the biggest share of dollars.

If you haven’t already checked out the report, we’ll do a quick level set on some terms, but I do encourage you to read it if you haven’t. Case share is a specialties percentage of total cases. And payment share is that specialty’s percentage of total payments. So what does that look like operationally? The report points out that short-term specialties like GI, Ophthalmology, and ENT tend to anchor case volume.

And that tracks with real life high throughput specialties can make your board look stacked, your day feel relentless. Lots of turnovers, lots of movement, and lots of touches across multiple patients. But when you shift from cases to payments, the anchor specialties can change. On the payment side, the report calls out Orthopedics, Ophthalmology, and GI is major anchors, and this is really the key divergence.

You can have specialties that represent a big slice of case share, while other specialties may represent a bigger slice of payment share. This is why, ‘we were slammed,’ it doesn’t always map cleanly to ‘our financial performance was driven by that volume.’

Because the question for leaders isn’t just how many cases did we do? It’s also what mix of cases did we do and what mix are we trying to build our center around, ultimately?

One more nuance the report flags is that Total Joint has gained economic weight in recent years.

So even if your overall Ortho volume stays relatively steady, if the composition of Ortho ships more toward Total Joint, your financial profile can shift with it.

So, here’s the clean self-check you can do this week, no special tools required. Take a look at your top two specialties by case volume and then look at your top two specialties by payment share.

If they’re the same, great volume and dollars are moving together in the same direction. If they’re different, that’s not necessarily good or bad. It’s simply a signal. Your schedule is telling you one story, and your revenue concentration is telling another. And the takeaway is simple. Busy doesn’t automatically mean economically heavy, so if you’re not tracking both case mix and payment mix, it’s easy to misread what’s actually driving performance, and it could have the potential of quietly shaping the wrong decisions around block time, staffing and specialty strategy.

And that wraps up today’s episode. I hope you enjoyed my conversation with Chris and Grant and be sure to come back next week for the third and final episode in our Patient Payments series. If you did find today’s content helpful, please take some time to leave us a rating or a review on your favorite podcast platform.

As always, I’m so grateful that of all the things you could do this week, you chose to spend a few minutes of it with us. I hope to see you again next time.