Healthcare organizations have aggressively expanded digital payment options for patients in recent years, striving to meet modern consumer expectations for convenience and flexibility. However, according to a new comprehensive survey released by Elavon, a wholly owned subsidiary of U.S. Bank, the complex systems operating behind these digital transactions are failing to deliver matching gains in overall financial performance. The findings highlight a striking disconnect between front-end consumer-facing modernization and the back-end administrative reality that continues to strain healthcare institutions.
The survey, which polled 150 enterprise healthcare leaders, sheds light on how fragmented payment processes and administrative burdens are actively impacting staff efficiency and disrupting financial predictability. Elavon’s specialized payment technology and industry expertise form a core component of U.S. Bank’s broader corporate commitment to helping healthcare providers modernize their financial operations, streamline workflows, and deliver more cohesive, connected payment experiences. The full insights and data have been published in a new report titled, “The hidden constraint on healthcare performance: Why complexity is limiting predictability, scalability and growth.”
While the push toward digital transformation has successfully broadened payment choices for patients, the administrative infrastructure supporting these initiatives remains heavily siloed. According to the survey, 68% of enterprise healthcare leaders report that they now offer nearly all the payment channels and options that patients desire. Yet, despite this high level of front-end adoption, a mere 15% of respondents rate their organization’s end-to-end revenue cycle performance as excellent. This massive gap underscores the lingering inefficiencies that plague the healthcare billing landscape.
Respondents pointed to persistent operational barriers, including fragmented workflows, disconnected systems, and a heavy reliance on manual intervention. Rather than reducing administrative friction, the rapid addition of disparate digital payment channels has often exacerbated complexity behind the scenes. This operational strain consumes valuable resources and distracts staff from higher-value patient care and strategic initiatives.
The financial and operational toll of this complexity is substantial. More than three-quarters of the surveyed leaders—specifically 76%—reported that their staff spends anywhere from 5% to 20% of their working hours managing exceptions, investigating payment discrepancies, or correcting errors. This ongoing drain on human resources limits organizational productivity and increases the cost of collecting patient revenues.
The repercussions of these broken workflows extend far beyond daily administrative tasks, bleeding directly into broader financial accounting and reporting cycles. Eighty-three percent of survey respondents indicated that persistent payment errors, data mismatches, or reconciliation delays negatively impact their monthly close processes at least 25% of the time. For large healthcare enterprises, these routine delays in financial reconciliation hinder accurate forecasting, obscure real-time financial visibility, and complicate long-term budgeting.
Wally Mlynarski, CEO of Elavon, emphasized the urgency of addressing these foundational integration gaps within the healthcare sector. Despite significant investments by providers to introduce multiple ways for patients to pay, Mlynarski noted that integration gaps and fragmented workflows continue to persist. These issues ultimately delay patient collections and place undue pressure on vital revenue cycle operations. He added that Elavon is positioned to address these challenges by bringing end-to-end payment processing and servicing at scale, effectively connecting front-end payment acceptance with back-end receivables, automated reconciliation, and comprehensive reporting. By bridging these gaps, the organization aims to help providers significantly reduce manual labor, enhance financial visibility, and establish greater predictability in patient collections.
As healthcare executives search for viable pathways to simplify their operations, improve financial predictability, and build internal capacity for sustainable growth, many are looking toward advanced technological solutions. Artificial intelligence has quickly emerged as a primary vehicle for modernization. Nearly all surveyed leaders indicated active plans to explore the integration of generative or agentic AI within their patient payment operations. This widespread interest is largely fueled by ongoing operational pain points, including delayed collections, complex exception management, and overwhelming administrative burdens that traditional software has struggled to resolve.
In addition to exploring artificial intelligence, healthcare organizations are carefully evaluating the strategic criteria they use to select third-party vendors and financial partners. The survey revealed that 56% of healthcare leaders identify scalability as the single most important factor when evaluating strategic partners. This finding illustrates a broader, strategic shift across the industry toward operating models and technologies that possess the inherent flexibility and capacity to adapt and improve performance even as administrative complexity continues to expand.
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