Medicare/Medicaid only pays a percentage of actual cost. Combine that with "self-pay" patients (which is an oxymoron) who pay very little if anything, but which you can partially write off to charity if the hospital is licensed properly, and then fill your facility with those patients, and you are loosing money on the service lines in the hospital. If you have a patient that shows up with Medicaid with a reimbursement rate of say 40%, they are admitted to a Telemetry bed for 7 days. If your lucky, they have Medicaid and in 6 months-year you receive a percentage of 40% of cost. If they are self-pay, you will most likely get a false address, false phone#, and a promise to pay $1 month. Oh. And now you have no beds to admit patients that actually pay. Thus you have a patient access issue.
And for the record. The biggest, as in most expensive, offenders of the self pay process are not the poor. They are the self-employed and illegal aliens.