"From a business standpoint, it's a weird thing to accept," he says. "About 10% of our patients are self-pay, so do we accept that 10% of our patients won't pay us? Ford Motor Company wouldn't accept that. So it's a strange business practice. I'm not naïve; it's borne out of necessity with the current payment system."
From a 30,000- foot view, he says, it's easy to forget that these are actually people who are coming not out of choice but because their lives depend on it.
A little context is in order here. Cleveland Regional is the only hospital owned by New Directions Health Systems, LLC, a Louisville, KY-based for-profit company backed by private investors. It seeks to own hospitals in small towns across America. In fact, it bought Cleveland Regional, which lost $11 million last year, last October from Community Health Systems, another for-profit hospital company that owns rural hospitals nationwide.
Ayers spent the last 15 years of his career traveling around the country as a consultant, looking for rural hospitals for others to buy. "I believe that if given a chance, most people will pay for the healthcare they get," he says.
The jury's still out on that question, but he believes the price cut introduced at Cleveland Regional is a start.
"There's not tons we can do, even though that's not right," says Ayers. "It's crazy that nobody pays full price except the people least likely to pay," he continues. "We don't get money. They file bankruptcy. Our discount is not a huge discount, but it's not nothing."