I would not call 15% underpayment by 60% customers to be " a modest amount" if a company routinely had to settled 60% of its account payable with a 15% shave th

I would not call 15% underpayment by 60% customers to be " a modest amount" if a company routinely had to settled 60% of its account payable with a 15% shave those companies would go out of business very quickly Also in the Hospital context there are other factors that drive up the costs. Keep in mind that about 70-80% of all US Hospitals are non-profit