There’s a new payer in town. that payer is the patient. today’s providers find a larger portion of their revenues coming directly from patients, and that number is expected to increase by as much as 50 percent by 2019.1 insured patient responsibility has grown to nearly 27 percent for outpatients and more than 12 percent for inpatients.2 according to the mgma aca exchange implementation survey report, 75 percent of patients with insurance coverage through acas have hdhps.3 those patients now face deductibles of more than $2,000 a year, a 67 percent increase since 2010 and 255 percent since 2006.4 and $2,000 more in deductibles per patient means $2,000 more in receivables per patient. the impact to hospitals is growing. hospital bad debt is now growing at a rate of 30 percent per year.