Patient POS Collections Are Improving — But the Real Problem Is Just Beginning

Hospitals Are Getting Better — But Not Fast Enough

Hospitals and practices are improving their ability to collect patient responsibility at the point of service (POS). Communication is stronger, payment plans are introduced earlier, and teams are having more productive financial conversations with patients.

Yet, none of it is moving the needle on overall patient collection rates.

A new report from Kodiak Solutions highlights a growing reality in revenue cycle operations: POS collections are rising, but the remaining balances are becoming increasingly difficult to collect. The math is shifting — and not in the provider’s favor.

📊 POS Collections Are Up — But It Doesn’t Matter Enough

Kodiak’s latest data shows:

• 30.1%— POS collections as a % of patient payments (down slightly from 30.6%)
• 24.8%— POS collection rate (up from 22.7%)
• 50.2%— Medicaid POS capture
• 24.7%— Commercial POS capture
• 15.0%— Traditional Medicare POS capture

Providers are improving. Teams are communicating better. Payment plans are being offered earlier.

But the remaining balances — the ones that fall into self‑pay after insurance — are becoming:

• harder to collect
• more unpredictable
• more expensive to chase

This is the part of the revenue cycle that has quietly become the biggest drag on throughput.

⚠️ Why POS Gains Aren’t Solving the Problem

Kodiak’s VP of Revenue Cycle, Matt Szaflarski, puts it plainly:

“Providers need to invest in the patient financial experience — and there’s not a great AI tool to do that.”

He’s right about the front end. POS collections are human conversations requiring empathy, clarity, and trust.

But the real problem is what happens after insurance.

Even with better POS performance, the majority of patient responsibility still lands in the self‑pay bucket — and that bucket is getting heavier.

🧨 OBBBA Is About to Make Everything Worse

Szaflarski warns that the challenge is about to accelerate.

OBBBA is pushing large numbers of patients off Medicaid. Many will end up on high‑deductible exchange plans. Many will go uninsured. All of them will push more patient responsibility into the system.

Meaning:

• More balances
• Higher balances
• Less predictable payment behavior
• More strain on already‑stretched RCM teams

The self‑pay problem isn’t just growing — it’s compounding.

🛠️ The Industry’s Recommendations Are Good — But They Don’t Fix the Core Issue

Kodiak’s recommendations are smart and operationally sound:

• Introduce payment plans earlier
• Make POS conversations about affordability
• Strengthen the transition from POS to self‑pay
• Use third‑party solutions to stabilize cash flow
• Benchmark payment plan adoption

These are all good tactics.

But they don’t solve the structural problem:

Self‑pay after insurance is still almost entirely manual.

It still relies on staff. It still relies on phone calls. It still relies on follow‑up. It still relies on human bandwidth that is already maxed out.

And as patient responsibility grows, manual throughput simply cannot keep up.

🔚 The Last Mile Is Where the System Breaks

The industry has spent years optimizing the front end:

• Eligibility
• Estimates
• POS conversations
• Payment plans
• Financial counseling

But the last mile — the part after insurance — has barely changed in 20 years.

It’s still:

• EMR‑generated statements
• Batch runs
• Manual outreach
• Aging AR
• Staff chasing balances that slip away

This is the part of the revenue cycle that determines whether the work actually gets finished.

And it’s the part least equipped for what’s coming.

🚀 The Future of Patient Responsibility Requires a Different Approach

If patient responsibility is about to flood the system — and every indicator says it will — then the industry needs more than better POS conversations.

It needs a way to complete the work after insurance without:

• adding more staff
• adding more manual touches
• adding more friction

The last mile needs:

• Autonomy
• Consistency
• Predictability
• Throughput that doesn’t depend on headcount

Because the gap between POS and payment is where revenue is lost. And right now, that gap is widening.

🔍 The Bottom Line

POS collections are improving. Communication is improving. Payment plans are improving.

But the core problem —self‑pay after insurance— is about to get significantly worse.

The industry can’t solve tomorrow’s patient responsibility challenge with yesterday’s manual workflows.

The last mile needs a new model. And the organizations that modernize it now will be the ones that stay ahead of the wave that’s coming.

Source: Kodiak Solutions 2026 Revenue Cycle Report
Disclaimer: Data and quotations referenced under fair‑use for commentary.