The result is a revenue cycle that leaks at multiple points and adds a burden that falls on the shoulders of administrative staff. In fact, according to J.P. Morgan Payments’ 2025 Trend in Healthcare Payments report, 71% of providers indicate it takes over 30 days to collect payments after a patient encounter. It’s no surprise that patient collections are the primary revenue concern for providers.
Payment Channel Fragmentation: Meeting Patients Where They Actually Pay
Patients in 2026 do not pay bills the way they did a decade ago, represented by a 243% increase from 2016 to 2024 in the use of eStatements as the main method for patient collections. The problem for many practices is that their payment infrastructure hasn’t kept pace. Every unavailable payment channel increases friction that can delay or reduce collections.
Practices that enable patients to pay across multiple touchpoints — at checkout, through a portal, by text, or on a recurring plan — tend to collect more, collect faster, and spend less staff time chasing balances. An ISV whose payment layer requires a separate login or redirected page has handed off the moment of highest intent to a system they don’t control. If patients have to go somewhere else to pay, some of them won’t.
High-Deductible Plans Shift the Financial Responsibility to Patients
Under a high-deductible health plans (HDHP), the patient is responsible for the full cost of care until a deductible is met. In 2024, the median annual deductible for private industry workers in HDHP plans was $2,750. At this point, healthcare often becomes an affordability issue for patients. Sometimes the deductible lands on a credit card, but many times, it cannot. In fact, patient collection rates from commercially insured patients fell from 37.6% in 2023 to 34.4% in 2024, according to Kodiak Solutions data.
Payment plan tools and ACH can address this structurally. A patient who cannot put $600 on a card at checkout may readily commit to $60 per month on an auto-drafted plan. As a shift takes place toward high-deductible health plans (HDHP), practices that offer structured payment options at the point of service collect more of what they’re owed and reduce the volume of balances that age into bad debt.
Manual Reconciliation: Disconnected Systems Create Risk
Behind the patient-facing payment experience sits a back-office process that consumes significant staff time: reconciling what was collected against what was billed, matching deposits to records, producing reporting for finance and practice administrators. When payment systems and practice management software operate independently, that process is largely manual.
A September 2025 HFMA survey of 241 healthcare executives found that 72% described their reconciliation processes as only partially automated, and just 3.5% reported full automation. The top challenge, cited by 44% of respondents, was payment posting and reconciliation to the EHR — the exact seam that disconnected payment systems leave exposed. For ISVs, integrated reporting is a retention argument: the practices most likely to churn are the ones whose administrative burden is growing faster than the platform can absorb it.
Compliance Friction: The Gap Between PCI Compliant and Healthcare-Ready
When a patient makes a payment through a portal that includes information about their visit, both PHI and payment card data may be collected simultaneously — requiring compliance with both HIPAA and PCI standards. One of the costliest assumptions a healthcare organization can make is that compliance with one standard automatically satisfies the other. Processors without healthcare experience may handle PCI adequately while leaving exposure on the PHI side, and the business itself remains on the hook for any fines, loss of merchant accounts, or civil action that follows.
Healthcare-aware payment infrastructure handles both sides. Point-to-point encryption, hosted payment pages that keep cardholder data out of the ISV’s systems, and tokenization for stored credentials are baseline requirements for a processor that understands the vertical.
Closing the Gap: What Changes When the Payment Layer Works
The gap in healthcare payments has persisted in part because often payment infrastructure was built for simpler verticals and adapted to healthcare rather than designed for it. Multi-channel collection, structured payment plans, integrated reconciliation, and compliant data handling are not individually difficult problems. The difficulty has been finding them in one place, inside the software workflow that practices already use.
For both providers and software platforms, the organizations that succeed will be those that take a structured approach to improving patient payments in healthcare practices across every touchpoint.
ISVs that close that gap — not by adding a payment link to their platform, but by embedding a payment layer that understands how clinical practices actually operate — stop functioning as software vendors and begin functioning as infrastructure. That is a different competitive position, and a considerably more durable one.
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