10 Places Real Estate Pros Are Safe From AI

10 Places Real Estate Pros Are Safe From AI

AI will effect the serious estate market and strengthen performance in several parts. Having said that, there are sure facets of the business that will continue to be unchanged.

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Recent instruments like ChatGPT, Jasper.ai, Compose.ai and other individuals have introduced a lot buzz about synthetic intelligence (AI).  I believe we as an market will need to embrace ahead-leaning engineering.  While numerous see it as the demise of the actual estate agent, I disagree.  We have weathered “the sky is falling” predictions for several years.  Here are ten locations authentic estate experts are protected from AI.

Individual relationships

AI are unable to substitute the value of individual relationships in the actual estate marketplace. Making trust and rapport with shoppers is a vital factor of real estate. The human element is a thing that AI is not capable to replicate. It is extra significant than at any time to double down on investing in driving depth and loyalty with individuals.

Inventive marketing and advertising

Chat GPT can support with qualified promoting strategies based mostly on the audience, the voice, the tone and the marketer. Dall-E can produce very in depth custom artwork for the advertisements.  Nevertheless, it just can’t swap the need to have for imaginative, human-driven advertising techniques. AI depends on collective knowledge. Serious estate teams will nevertheless depend on human creative imagination for new, breakthrough suggestions. 

Negotiation techniques

The AI valuations developed into NARRPR or Redfin’s tech can help with selected aspects of negotiation, like facts investigation. But it simply cannot change the want for potent negotiation capabilities. Expert negotiators carry true and tangible value to their consumers.

Adaptability

AI can examine facts and make tips centered on past tendencies. It is not capable to adapt and reply to unforeseen “Black Swan” situations.  This was viewed not too long ago in the unexpected housing increase in the midst of a pandemic.  Human beings can answer with creativeness and by investing in the frontiers of new know-how and technologies. Real estate groups will want to carry on to be agile and adaptable. 

Psychological intelligence

ChatGPT-driven chatbots can cope with regime customer inquiries, streamlining client provider. But lacks the means to switch the worth of psychological intelligence in the authentic estate marketplace. Developing believe in and rapport with shoppers needs empathy and being familiar with. Qualities that AI does not possess.

Certain understanding

AI can analyze data and supply insights into traits. It will hardly ever exchange the significance of understanding in the serious estate sector. Actual estate agents have deep information of their regional industry. This delivers valuable insights and advice to clientele. AI does not know how to adjust benefit thanks to wall-to-wall avocado shag carpet.

Authorized defense

Synthetic Intelligence won’t be ready to give the very same security as a license does. AI can automate substantially of the paperwork. But it can’t safeguard or guidebook a shopper in the scenario of a dispute. The dimension of the investment of real estate requires a layer or two of liability security. At the close of the day, AI simply cannot exhibit up in court docket and discuss to a choose.

Networking

AI can help with certain elements of networking, these kinds of as pinpointing possible leads. For instance, you can inquire AI to record the top rated businesses in your region and give you the HR speak to data for each and every one.  However, it just can’t do the function of the worth of human connections in the genuine estate field. Developing a powerful community of contacts is critical for achievements in real estate. Your own ebook of small business, and how you treatment for it is a safe and sound haven from AI.

Physical existence

AI chatbots and resources like Google Assistant can timetable viewings. They just can’t display up. Real estate industry experts will even now want to meet with consumers in particular person. Attempts to defer things like exhibiting the assets to a tech organization have ended in failure. True people today want to go to the dwelling they are likely to dwell in. The breeze, smells and appears are all items that can’t be captured in a virtual tour.

Dilemma-fixing

AI is equipped to assist with analyzing knowledge and making suggestions. It won’t change the need for human difficulty-fixing in the genuine estate business. Actual estate pros will even now want to be equipped to believe creatively. Every transaction has issues. Clients will even now need to have a skilled to resolve troubles and overcome worries.

AI will effect the real estate field and improve efficiency in lots of areas. Nevertheless, there are sure aspects of the marketplace that will keep on being unchanged. The relevance of individual associations will only be amplified. Negotiation skills, adaptability, and dilemma-resolving will carry on to be crucial sites of benefit. The authentic human element can’t be replaced by AI.

Chris Pollinger, CEO of RE Luxe Leaders, is the income whisperer to the management elite in the company of luxury genuine estate. He is a senior profits and operational govt proficient in strategic management, driving financial gain, organization preparing, revenue, internet marketing, acquisitions, functions, recruiting and culture making.

Asia’s most underrated places | CNN

Asia’s most underrated places | CNN

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CNN
 — 

Comprising more than 40 countries, Asia can’t be summed up easily.

The classics are classics for a reason – from the awe-inspiring architecture of Angkor Wat and the Taj Mahal to the buzzy metropolises of Tokyo and Hong Kong and the beaches of Bali and Phuket, it’s impossible for any traveler to find something not to their liking.

But for the travelers who are fortunate enough to have time to dig a little bit deeper, there are less-crowded, equally-rewarding treasures to be found.

CNN Travel tapped into our network of colleagues and contributors to ask them where the locals go. Here’s what they had to say.

When it comes to great Malaysian food cities, most people think of Penang. But that’s only because they haven’t been to Ipoh.

The capital city of Perak state, Ipoh’s location between Kuala Lumpur and Georgetown makes it an ideal stop for any Malaysian road trip. It’s also the gateway to Cameron Highlands, a district known for its cool weather and tea plantations.

Ipoh’s food and world famous white coffee are enough reasons to visit but there are also magnificent limestone hills and caves that are home to unique temples as well as amazing hidden bars.

Visit the Chinese temples of Perak Tong, Sam Poh Tong and Kek Lok Tong and be blown away by intricate stone carvings and bronze statues of Chinese deities surrounded by stalactites and stalagmites. Ipoh’s colonial legacy is also evident in its architecture: from its Railway Station to the Birch Clock Tower, town hall and the Old Post Office.

– Heather Chen, Asia writer

As popular as Thailand is among international tourists, the country’s northeast – collectively referred to as Isaan – is usually overlooked.

But for those in search of a less-traveled destination that includes historic architecture, dramatic landscapes and culinary delights, Isaan ticks all the right boxes, and then some.

Visitors will find it’s one of the most welcoming destinations in Asia and easily accessible, thanks to excellent infrastructure that includes several domestic airports offering daily flights to Bangkok and a range of upmarket hotels.

The only challenge is deciding which highlights to experience. Made up of 20 provinces, Isaan shares borders with Laos and Cambodia, and their influences can be found in the region’s cuisine, language, historic sites and festivals.

Attractions include the ancient Khmer ruins of Phenom Rung in Buriram, mountainous national parks in Loei, the 75 million-year-old “Three Whale Rock” in Bueng Kam and Bronze Age artifacts in the UNESCO-listed Ban Chiang Archeological Site in Udon Thani.

And then there’s the food. Isaan cuisine, now prevalent on menus in Thai restaurants around the world, includes refreshing som tom (payaya salad), tangy Sai Grok Isaan (northeastern sausage) and larb, a flavorful minced-meat salad.

– Karla Cripps, senior producer, CNN Travel

Most people travel to Leshan city for the sole purpose of visiting the Giant Buddha. The world’s biggest and tallest ancient Buddha statue is indeed stunning, but this Sichuan city deserves much more than a side trip from Chengdu.

The Mount Emei scenic area – home to the Giant Buddha – is also of great spiritual and cultural importance as the birthplace of Buddhism in China. Many ancient temples are scattered and ingeniously built on the cliffs of the pristine dense forest.

On top of sightseeing, Leshan is a hidden foodie paradise with local Sichuanese saying “eating in Sichuan, tasting in Leshan.” This city is where Chengdu residents come for authentic bites of iconic Sichuan cuisine: chilled bobo chicken, jellied tofu, Qiaojiao beef, steamed meat with rice powder and more.

– Serenitie Wang, producer, video programming

Skardu district, in Pakistan’s Gilit Baltistan region, is a land of stark gigantic beauty, with many of the highest mountains on the planet – most famously K2 – concentrated in this one area.

Deosai National Park sits on the second highest plateau in the world. It is a riot of color, alive with birds and butterflies. With no ambient city lights the stars are exceptionally bright, with the milky way looking so close it could be plucked out from the sky.

In contrast, there’s the Sarfaranga Desert. The world’s highest cold desert, it’s filled with diamond-white sands and ebony mountains.

Skardu has been inhabited for centuries and is studded with ancient Buddhist stupas and carvings, beautifully preserved mosques from the Middle Ages and shrines of Sufi saints.

The Serena hotel chain has transformed the stunning Shigar Fort and Khaplu Palace into two of the country’s best kept hotels. Both are filled with gardens and climate friendly wooden architecture while serving regional food like Mamtu dumplings and grilled trout.

– Sophia Saifi, producer, Pakistan

Nikko is famous for the waterfalls in its national park.

Nikko is just 150 kilometers (93 miles) north of Tokyo, but it feels like another world.

This small city is one of the most important sites in Japan for Shinto culture, with the ornate, gold-dripping Toshogu Shrine – a UNESCO World Heritage site – its centerpiece.

If peace is what you’re after, Nikko is the place to find it. Nikko National Park comprises 443 square miles across three prefectures, with dramatic waterfalls, groves of fir and cedar trees, finely carved gates and rocky outcroppings among the things to experience.

The park is also home to some of Japan’s famous natural hot springs, making Nikko an ideal autumn or winter destination.

While the area has long been popular with Tokyo urbanites looking for a bucolic weekend escape, Nikko is beginning to land on the radar of more international tourists – a Ritz Carlton opened there just before the pandemic.

– Lilit Marcus, digital producer, CNN Travel

With its fresh mountain air and pine forests in the Central Highlands of Vietnam, Dalat is a popular destination for local Vietnamese that isn’t as well known among international travelers.

At 1,500 meters above sea level, the city’s cooler weather is a welcome reprieve from the tropical humidity found elsewhere in the Southeast Asian country.

Centered around the romantic Xuan Huong Lake, Dalat boasts everything from French colonial architecture – a holdover from its days as a hill station – to the “Crazy House,” the Seussian creation of architect Đặng Việt Nga, with its twisting stairwells and whimsical sculptures. Plentiful waterfalls and a vibrant flower industry mean that delights abound in the city for honeymooners and nature lovers.

– Dan Tham, producer, Global Features

Urban Davao City is beloved for its night market.

Davao City is more than just a provincial capital of the southernmost part of the Philippines — it’s a true mosaic of Filipino cultures seen nowhere else across the country.

There’s food for everybody at the Roxas Night Market, which is lined with barbecue and grilled seafood, along with humble yet complex delicacies such as the fresh seaweed salad called lato and hearty law-uy vegetable soup. Nothing represents Davao more than pungent durians, which grow in abundance across the region as well as pineapples, bananas and sugarcane – served in all forms from shakes to pies.

The city takes pride in its indigenous roots and celebrates the Kadwayan Festival in August to showcase local textiles, woodwork, song and dance from 11 tribes that reign from the mountains and its surrounding sea.

A ferry ride away from the city will transport you to luxurious Samal Island, best known for its pristine beaches and pearl farms. Take a roadtrip along the palm tree-lined paths that lead to the surfer spot of Mati, or perhaps a detour to Mount Apo, the highest mountain and volcano in the Philippines.

– Kathleen Magramo, breaking news writer

The northeast Indian state of Meghalaya, which translates to “abode in the clouds,” boasts some of the country’s most peaceful and lush landscapes. As it requires a permit, it can be challenging to visit. But it’s worth it.

Meghalaya is home to the towns of Cherrapunji and Mawlynnong. Both hold records for being the wettest places on Earth, having received nearly 12,000 mm (472 inches) of rain a year. The results are verdant, leafy forests with rivers and creeks running through that can be explored through crossing the state’s famous bridges.

Built by locals out of the roots of ficus trees, some are as old as 500 years and symbolize the self-sufficiency of the Khasi indigenous tribe and their relationship with the forest. The living root bridges, known as “jingkieng jri” in the Khasi language, can be found in over 70 villages and continue to be used and nurtured by locals to keep them alive for future generations.

In 2022, they were added to UNESCO’s tentative list of World Heritage sites. The most famous living root bridges are the Umshiang Double Decker root bridge in Nongriat village, south of Cherrapunji, and one in Riwai near Mawlynnong, certified as the “cleanest village in Asia” since 2003 by UNESCO.

– Manveena Suri, freelance producer

Palau Ubin is just a short ferry ride away from mainland Singapore.

Thought Singapore was all about parties and skyscrapers? Think again. Located offshore from its northeast Changi region is Pulau Ubin (Malay for “granite island”), a nature lover’s paradise with jungle trails, mangrove wetlands and majestic quarries.

Getting around the island is a breeze: In true Singaporean style, everything is well-marked, from jungle trails to concrete footpaths, but the island still remains very untouched.

Mountain biking is particularly popular, especially on weekdays when crowds are few. But Ubin really comes to life on weekends – when families, couples and nature lovers descend, hoping to catch a glimpse of old Singapore.

One of the most popular attractions on the island is Chek Jawa, a saltwater mangrove wetland rich in marine life. A well-built wooden boardwalk runs through the mangrove, allowing visitors to observe plant and marine life such as sea sponges, octopuses, starfish and cuttlefish, at close range.

– H.C.

Indonesia is comprised of several thousand islands – and, in the case of Samosir, an island on a lake within an island.

Samosir Island is a volcanic island in North Sumatra’s Lake Toba. one of the world’s largest crater lakes.

The Batak tribe calls this land their home, and you can meet these locals as they sell handicrafts from their villages along the waterfront, where their houses are built from wooden beams lashed to stones and have tall red roofs that resemble a ship’s sails.

As Samosir is several hours’ drive and ferry ride from the closest airport, opt to spend the night in a homestay and support the community by purchasing ulos, a UNESCO-recognized woven, naturally dyed cloth that is used in every important facet of Betak life.

– L.M.

Northern Laos – home to elegant Luang Prabang and adventure-loving Vang Vieng – get the lion’s share of attention. But head south for a different kind of experience in Pakse, where two rivers converge in the country’s second biggest city.

Pakse is diverse, pulsing and modern. It has buildings left over from the days of French colonialism, but these days Vietnamese and Chinese communities bring their foods, traditions and references alongside the existing Lao presence.

While in town, head up to the giant gold Buddha at Wat Pho Salao, stroll along the Mekong at sunset, and then go off to the Bolaven Plateau to get deeper into jungle.

– L.M.

India casts a long tourism shadow over its neighbors, including Bangladesh. But this smaller nation has outsized offerings many travelers to South Asia might not realize. This is especially true in architecture, history, nature and food.

In the capital of Dhaka, the Ahsan Manzil is an ornate, stunning vision in pink. Set on the banks of the Buriganga River, it was finished in 1872 during the British colonial era as a palace for the local rulers of the time. It is now a popular museum.

For a sample of Mughal Empire architectural splendor, check out the incomplete Lalbagh Fort.

And if you’d like to visit a mosque, consider the exquisite Star Mosque (Tara Masjid), renowned for hundreds of blue stars on its gleaming white domes.

– Forrest Brown, freelance writer and producer

Lijiang's old town, in Yunnan province, is popular with Chinese domestic travelers.

Even though China is still closed to international tourists, Yunnan province has already welcomed about 350 million domestic visitors in the first half of 2022 alone.

If you’d like to see the historical Yunnan like an experienced local, head to Tengchong.

Bordering Myanmar in the west of Yunnan, Tengchong has been a critical trading stop on the historic Silk Route and Tea Horse Road in the past.

Today, many local travelers first visit Heshun, an old town built surrounding a mountain and a lake. The Double Rainbow stone arch bridges, the Laundry Pavilion and the 98-year-old Heshun Library – the biggest rural public library in China – are some of the must-sees when visiting the cozy village.

Yinxing (Gingko) Village in the northern side of Tengchong is known for its thousands of ginkgo trees, turning the village golden yellow every autumn.

– Maggie Hiufu Wong, freelance CNN Travel writer

The Gogunsan islands – meaning “an archipelago of mountains” in Korean – have been a popular summer destination for locals seeking a break from city life.

A group of 63 islands on South Korea’s west coast, the islands offer a picturesque view of verdant hills scattered amid gentle waters.

The world’s longest seawall and a series of bridges connect the islands to the mainland, making them an especially attractive destination for those behind wheels. The landscape invites visitors to light hikes and swim afterwards.

– Jake Kwon, newsdesk producer

Lan Ha Bay is a less-visited waterwat in northeastern Vietnam.

Ha Long Bay in northern Vietnam is no secret – the UNESCO-listed waterway has long been popular with backpackers and luxury travelers alike.

But visitors who want to ply the waters with a lot fewer neighbors should head to Lan Ha, south of Ha Long Bay. Like its more famous sibling, Lan Ha Bay is a stretch of shimmering water broken up by limestone (karst) islands that can be enjoyed by day trip (kayak, canoe) or overnight (cruise ship, junk boat).

Most travelers get here by bus or car from Hanoi or Haiphong, and it’s easy to set up door-to-door service with tour companies in advance.

Leave from Cat Ba Island to explore Lan Ha Bay’s grottoes, caves and white-sand beaches.

– L.M.

On the southern tip of Taiwan lies Kenting, a sunny, laid back peninsula known for its white sandy beach, boisterous night market and chill vibe.

Take a dip at Baishawan (White Sand Bay); scenes from the “Life of Pi” were filmed here on Wanlitong Beach, a hotspot for snorkeling teeming with marine life.

Take a stroll at the Eluanbi Park, where a towering lighthouse stands – one of the top eight iconic landmarks on the island – and walk down to the southernmost tip of Taiwan, a perfect spot to watch the sunset.

No visit to Kenting is complete without a stop at Longpan Park. Take in the panoramic view of the rugged coastline, the majestic cliffs and the grassy hills that together form a jaw-dropping landscape. Given the open space and the lack of lighting, the park is also popular with sunset watchers and stargazers.

– Wayne Chang, China news desk producer

Nestled under a canopy of trees, the temple ruins of Banteay Chhmar offer a glimpse into the might of the Khmer Empire – without the hordes of tourists.

Completed in the late 12th century by Jayavarman VII, the “Citadel of Cats” is in northwest Cambodia, a few hours’ drive from Siem Reap, home to Angkor Wat. Banteay Chhmar is located 20 kilometers from the Thai border and is accessible by taxi from Sisophon, the fourth largest city in Cambodia.

The massive complex comprises eight temples, featuring stone-faced towers adorned with mysterious smiles. There are also remarkably well-preserved bas-reliefs, depicting religious and military stories. Visitors to this remote, less-traveled part of Cambodia are rewarded with a sense of adventure and quiet.

– D.T.

Most foreign tourists head to Sri Lanka’s beautiful south coast or into its central tea country, both of which are fairly easy to reach from the main city of Colombo and beloved by Instagrammers who come to ride the famous rails.

But the northern patch of the island is worth the sometimes-challenging car or bus trip to get there.

Jaffna is the primary home of the country’s Tamil-speaking population and still has glimmers of its Indian and Dutch colonial past, resulting in a fascinating, complex culture.

Start with architecture: the ornate, bright gold Nallur Kandaswamy Kovil Hindu temple and sprawling white Colonial-era Jaffna Library are both exceptional.

Then, indulge in the food: bananas and mangoes fresh off the trees combine with curries, pickles and rice dishes for filling, inexpensive meals.

– L.M.

Hospitals often reap profits in places where many patients carry medical debt : Shots

Hospitals often reap profits in places where many patients carry medical debt : Shots

Aerial view of downtown Fort Worth, Texas. Some hospitals in Texas and around the U.S. are seeing high profits, even as their bills force patients into debt. Of the nation’s 20 most populous counties, none has a higher concentration of medical debt than Tarrant County, home to Fort Worth.

Jupiterimages/Getty Images


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Jupiterimages/Getty Images


Aerial view of downtown Fort Worth, Texas. Some hospitals in Texas and around the U.S. are seeing high profits, even as their bills force patients into debt. Of the nation’s 20 most populous counties, none has a higher concentration of medical debt than Tarrant County, home to Fort Worth.

Jupiterimages/Getty Images

PROSPER, Texas — Almost everything about the opening of the 2019 Prosper High School Eagles’ football season was big.

The game in this Dallas-Fort Worth suburb began with fireworks and a four-airplane flyover. A trained eagle soared over the field. And some 12,000 fans filled the team’s new stadium, a $53 million colossus with the largest video screen of any high school venue in Texas. Atop the stadium was also a big name: Children’s Health.

Business has been good for the billion-dollar pediatric hospital system, which agreed to pay $2.5 million to put its name on the Prosper stadium. Other Dallas-Fort Worth medical systems have also thrived. Though exempt from taxes as nonprofit institutions, several, including Children’s, notched double-digit margins in recent years, outperforming many of the area’s Fortune 500 companies.

But patients aren’t sharing in the good times. Of the nation’s 20 most populous counties, none has a higher concentration of medical debt than Tarrant County, home to Fort Worth. Second is Dallas County, credit bureau data show.

The mismatched fortunes of hospitals and their patients reach well beyond this corner of Texas. Nationwide, many hospitals have grown wealthy, spending lavishly on advertising, team sponsorships, and even spas, while patients are squeezed by skyrocketing medical prices and rising deductibles.

A KHN review of hospital finances in the country’s 306 hospital markets found that several of the most profitable markets also have some of the highest levels of patient debt.

Overall, about a third of the 100 million adults in the U.S. with health care debt owe money for a hospitalization, according to a poll conducted by KFF for this project. Close to half of those owe at least $5,000. About a quarter owe $10,000 or more.

Many are pursued by collectors when they can’t pay their bills or hospitals sell the debt.

“The fact is, if you walk into a hospital today, chances are you are going to walk out with debt, even if you have insurance,” said Allison Sesso, chief executive of RIP Medical Debt, a nonprofit that buys debt from hospitals and debt collectors so patients won’t have to pay it.

A community shadowed by debt

Across the Dallas-Fort Worth metro area — the nation’s fourth-largest — the impact has been devastating.

“Medical debt is forcing people here to make incredibly agonizing choices,” said Toby Savitz, programs director at Pathfinders, a Fort Worth nonprofit that assists people with credit problems. Savitz estimated that at least half their clients have medical debt. Many are scrimping on food, neglecting rent, even ending up homeless, she said, “and this is not just low-income people.”

David Zipprich, a Fort Worth businessman and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Zipprich, 64, had spent a career in financial consulting. He owned a small bungalow in a historical neighborhood near the Fort Worth rail yards. His daughters, both teachers, and his four grandchildren lived nearby. He had health insurance and some savings, and he’d paid off his mortgage.

Then in early 2020, Zipprich landed in the hospital. While driving, his blood sugar dropped precipitously, causing him to black out and crash his car.

Three months later, after he was diagnosed with diabetes, another complication led to another hospitalization. In December 2020, covid-19 put him there yet again. “I look back at that year and feel lucky I even survived,” Zipprich said.

David Zipprich, a Fort Worth financial consultant and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Laura Buckman for KHN and NPR


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Laura Buckman for KHN and NPR


David Zipprich, a Fort Worth financial consultant and grandfather, was forced out of retirement after hospitalizations left him owing more than $200,000.

Laura Buckman for KHN and NPR

But even with insurance, Zipprich was inundated with debt notices and calls from collectors. His credit score plummeted below 600, and he had to refinance his home. “My stress was off the charts,” he said, sitting in his neatly kept living room with his Shih Tzu, Murphy.

Overall in Tarrant County, 27{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502} of residents with credit reports have medical debt on their records, credit bureau data analyzed by KHN and the nonprofit Urban Institute shows. In Dallas County, it’s 22{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502}.

That’s more than five times the rate in the largest counties in New York, data shows. The Texans also owe a lot more — the median amount of medical debt on credit records in Tarrant and Dallas counties is nearly $1,000, compared with $400 or less in New York.

Last year, Zipprich returned to work, taking a job in New Jersey that required he commute back and forth to Texas. He recently quit, citing the strain of so much travel. He’s now job hunting again. “I never thought this would happen to me,” he said.

Who is responsible?

Even small debts can have potentially dangerous consequences, discouraging patients from seeking needed care. Angie Johnson, a 28-year-old schoolteacher, cut short her honeymoon so she and her husband could pay off more than $1,100 she owed a physical therapy center owned by Baylor Scott & White, a mammoth Dallas-based hospital system.

Johnson said the center, where she’d gone after a knee injury, initially said her visits would cost $60. “Then they billed me hundreds,” she said. “I don’t go to the doctor unless I absolutely have to because it’s so expensive.”

Angie Johnson of Waxahachie, Texas, says the physical therapy center she went to after a knee injury initially told her visits would cost $60. “Then they billed me hundreds,” she says.

Laura Buckman for KHN and NPR


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Laura Buckman for KHN and NPR


Angie Johnson of Waxahachie, Texas, says the physical therapy center she went to after a knee injury initially told her visits would cost $60. “Then they billed me hundreds,” she says.

Laura Buckman for KHN and NPR

Hospital industry leaders blame the patient debt on health insurers, citing the rise of high-deductible plans and other efforts that limit coverage. “The last thing that hospitals want is for their patients to face financial barriers,” said Molly Smith who leads public policy at the American Hospital Association. “Hospitals are in there trying to work on behalf of patients.”

Despite repeated requests from KHN, none of the medical systems around Dallas-Fort Worth would discuss their finances or the debt carried by patients.

But Smith and other hospital leaders point to billions of dollars of free or discounted care that hospitals nationwide provide every year. “Hospitals have been pretty darn generous,” said Stephen Love, president of the Dallas-Fort Worth Hospital Council. “If other parts of the community did as much as hospitals, we wouldn’t be in this problem.”

Unlike drug companies, device makers, and many physician practices, most U.S. hospitals are nonprofit and must provide charity care as a condition of their tax-exempt status.

Regardless of tax status, medical centers in markets with high medical debt do provide more charity care, according to an analysis by KHN and the Urban Institute, a Washington think tank. That’s important, said Dr. Vikas Saini, president of the Lown Institute, a nonprofit that grades hospitals on their quality and community benefits.

But Saini asked: “Is a hospital truly serving its community if it’s pushing so many into debt?”

Around Dallas-Fort Worth, major medical systems frequently tout their commitment to the region and its patients.

When Texas Health Resources, a Dallas-based nonprofit system with more than $5 billion in annual revenue, opened a new hospital tower in Fort Worth earlier this year, Barclay Berdan, the system’s chief executive, said the building “reinforces Texas Health’s long-standing commitment to the Fort Worth community.” The nine-story, $300 million tower is one of more than a half-dozen new hospitals and major expansions around the Dallas-Fort Worth area since 2018.

The big building spree has been accompanied by big bottom lines.

From 2018 to 2021, Texas Health, which owns hospitals in North Texas, had an average operating margin of almost 6{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502}, according to a KHN analysis of publicly available financial reports.

Other major systems in the area, including Baylor, Children’s Health, and HCA, the nation’s largest for-profit hospital company, did even better, KHN found. Cook Children’s, the region’s second major pediatric system, had an average operating margin of nearly 12{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502}.

By comparison, profits at most of the 25 Fortune 500 companies based around Dallas-Fort Worth, such as ExxonMobil, were less than 6{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502} in 2019, according to Fortune data.

Approaching a tipping point

Hospitals have thrived in other markets with high patient debt, KHN found.

In Charlotte, N.C., where a quarter of residents have medical debt on their credit reports, hospitals recorded an average operating margin of 13.6{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502} from 2017 to 2019.

The average margin at hospitals in and around Gainesville and Lakeland, two central Florida markets where a quarter of residents also carry medical debt, topped 9{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502}. In Tulsa, Okla., which has the same level of debt, margins have averaged 8.5{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502}.

Overall, U.S. hospitals recorded their most profitable year on record in 2019, with an aggregate operating margin of 6.5{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502}, according to the federal Medicare Payment Advisory Commission. Total margins, which include income from investments, were even higher.

“You might think that hospitals in communities where patients have a lot of debt would be less profitable, but that doesn’t seem to be the case,” said Anuj Gangopadhyaya, a senior Urban Institute researcher who worked with KHN on an analysis of hospital finance and consumer debt data in U.S. hospital markets.

In fact, the analysis found, there is no apparent relationship between the profits of hospitals in a market and how much medical debt residents have. So while hospitals in places like Charlotte and Tulsa may be comfortably in the black, in other places with high patient debt such as Amarillo, Texas, and Columbia, S.C., hospitals are struggling, data shows.

Industry experts say the most profitable medical centers — like those around Dallas-Fort Worth — have developed business models that allow them to prosper even if their patients can’t pay.

One key is prices. These hospitals maximize what they charge for everything from a complex surgery to a dose of aspirin. Most of those charges are picked up by health insurers, which still pay a much larger share of hospital bills than patients do, even those with the highest deductibles.

Across the country, many medical systems have strengthened their market power in recent years by consolidating, buying up smaller hospitals and physician practices, which enable the hospital systems to charge even more.

Dallas-Fort Worth has the highest medical prices in Texas, according to the Health Care Cost Institute, a nonprofit that tracks costs nationwide. And in a state where most markets have relatively low medical prices, in-patient care at Dallas-Fort Worth hospitals was 13{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502} more expensive than the national median in 2020.

In addition to charging more, the most profitable hospitals frequently squeeze more savings from their operations, holding down what they pay workers, for example, and securing better contracts from suppliers. “Hospitals have had to get leaner and meaner,” said Kevin Holloran, a senior director at Fitch Ratings who tracks nonprofit health systems for the bond rating firm.

It’s unclear how much longer this business model can endure.

Across the country, many small and rural hospitals have closed in recent years. Even some larger systems are now losing money, as inflation and rising labor costs put new pressure on bottom lines.

As bills rise, hospitals are having a harder time collecting. Last year, nearly 1 in 5 patient bills generated by hospitals for people with insurance topped $7,500, according to an analysis of hospital billing records by Crowe LLP, a Chicago-based accounting and consulting firm. That was more than triple the rate in 2018.

“These are bills that fewer and fewer patients out there can afford,” said Brian Sanderson, a senior Crowe health care consultant and former hospital executive. Indeed, hospitals manage to collect less than 17{515baef3fee8ea94d67a98a2b336e0215adf67d225b0e21a4f5c9b13e8fbd502} of patient balances that exceed $7,500, according to Crowe’s analysis.

“The rates at which patient balances are growing is just unsustainable for our health systems,” Sanderson said, predicting that most will never be able to collect bills of this size. “It’s trending to the ridiculous.”

Robert Earley, a former Texas state legislator who used to head Fort Worth’s public health system, compared today’s hospitals to shrimpers in the Gulf Coast district he once represented.

“They wanted to pull so much shrimp out of the bay that they didn’t think about whether there’d be any there long term,” Earley said, recalling his constituents’ struggles. “I worry that those of us in health care aren’t asking ourselves enough if this system is sustainable.”

Diagnosis: Debt is a reporting partnership between KHN and NPR exploring the scale, impact, and causes of medical debt in America.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. It is an editorially independent operating program of KFF (Kaiser Family Foundation).