That’s according to Chad Williams, CEO of Nashville-based Affiliated Creditors Inc. “We’re a traditional bad-debt collection agency that over the past 30 years has managed to work its way up through the revenue cycle. We specialize in healthcare, always have,” said Williams, whose father, Roy, founded ACI in 1981. On its client roster are Vanderbilt University Medical Center, Baptist Hospital, Saint Thomas Hospital, Middle Tennessee Medical Center, Sumner Regional, Maury Regional and a host of other hospitals and physician groups, both in and out of the state. ACI has 53 employees.

“People say to me all the time, ‘Boy, the economy is bad. Your business must be really good.’ But that’s not true,” Williams said. He said that while volume may be up, the percentage of debt collected is down.

“When people have hard times, it affects us as well,” he explained. “They have been making a $100 a month payment, and now they’re making a $50 a month payment, because they’re having to adjust their personal finances to meet their obligations.”

It’s today’s reality, Williams said, specialty collectors such as ACI must adapt, while representing their clients well and treating their clients’ patients with respect. “It’s all in how you treat the consumer, and that’s where probably we differ,” he said. “We handle the patients of our clients much as they would. We customize a strategy that follows their mission statement and vision as far as how they want their patients treated. … “You’re not going to do business with somebody for long if you’re tarnishing their reputation”

Williams said the bad-debt collection strategy is simple: “The typical American family has 12 to 14 bills a month, and our goal is just to get on that list.” He added that he sees a difference in the patients ACI deals with today – many more of those patients who are managing healthcare debt actually have health insurance. Yet, because employers are being forced to trim costs, scaled-down policies aren’t covering as much of the healthcare bill.

Williams predicted nothing less than a “paradigm shift” in the way healthcare is paid for in the future and the way providers collect. He noted that all his clients are working to collect more money from patients on the front end, before service is rendered, and new software programs are helping front-office employees determine available benefits and estimate costs. Providers are also offering discounts for up-front payments and setting up payment arrangements with patients early in the process. “That has definitely been very good for our clients, and it has not been so good for us,” he acknowledged.

There’s also change coming that doesn’t bode well for some consumers, Williams noted. “What we’re starting to see now is something that is a good thing for the future, but it’s not very good for the consumer right now, and that is the reconditioning of what it means to have good credit,” he said. “Good credit is now going to mean something again, because for the past 15 or 20 years, when a lender saw medical debt on a consumer’s credit report, the lender chalked it up to, ‘Oh, you didn’t mean to get sick. We’re not going to hold that against you.’ So it was kind of overlooked. That’s not going to happen anymore. People are going to be held to a higher standard on their credit.” In the long term, that could be a positive for debt collection, he said.

While just a decade ago, a 20 percent return on medical debt in the Davidson County area was a good return, today that percentage is more like 8 to 10 percent, according to Williams, who said the percentage isn’t quite as high in the doughnut counties around Nashville.

Through the years, ACI has developed a suite of services for its clients that goes beyond just collection of bad debt. In fact, the company even offers providers training on how to collect money from patients up front. ACI also provides services as an extension of a provider’s business office, calling patients and sending out letters in the provider’s name in early attempts at debt collection. ACI employees can also handle billing, accounts receivables data analysis, call center functions, insurance follow ups and much more.

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