How a Large Healthcare System Turned a Multifaceted PTO Problem Into $4 Million of Employee Value.

Not every organization's PTO challenge is a single problem with a single fix. For one large healthcare system employing thousands of people across hospitals, medical centers, and outpatient facilities, the challenge touched HR, Finance, and employee wellbeing all at once, and needed a solution flexible enough to address all three.

The Challenge

By 2021, this healthcare system was facing a PTO liability problem that was growing every year, as employees accrued large balances that translated into millions of dollars of financial risk on the books, and a missed opportunity to reinvest that capital into higher-value benefits.

The picture was more complicated than a single balance sheet line item, though. HR leaders were beginning to roll out an unlimited PTO model for a subset of employees, which introduced a new layer of complexity around managing accrued leave during the transition. At the same time, there was strong internal interest in modernizing financial wellness resources, and Finance was actively looking for ways to better allocate benefit dollars without increasing overall spend.

None of these challenges existed in isolation, they intersected across departments, which meant the organization needed a single solution that could balance operational efficiency with employee engagement, rather than a patchwork of point solutions.
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The Solution

This healthcare system partnered with PTO Exchange to address all of these needs in one flexible platform. Employees became eligible to exchange PTO once they crossed an 80-hour threshold, with no cap on how much they could convert, giving the organization's largest PTO balances a meaningful outlet while still preserving a baseline of time off for rest and recovery.

The platform also gave employees choice in how they used their exchanged value, from everyday financial support to more specific uses like travel.

The Impact

In 2025 alone, employees at this organization exchanged:

•    $4+ million in PTO value
•    95,000+ PTO hours
•    2,500+ individual exchanges

Adoption has scaled significantly since launch. Of roughly 15,000 active employees, more than a third (34.17%) are eligible to exchange PTO, just over a fifth (21.24%) have registered for the platform, and 979 employees made at least one exchange in 2025. On average, each exchange converted just under 41 hours into $1,752 in value, with nearly 180 employees using the platform in a typical month.

The organization's approach shows how a single flexible platform can absorb a genuinely complex set of needs, reducing balance sheet liability, easing the transition to unlimited PTO for part of its workforce, and giving Finance a cost-neutral way to expand financial wellness offerings, all without adding operational burden
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In Their Words

"Building a PTO exchange program was a smart move and a great added benefit without having to add another budget line item. HR is happy. Finance is happy. And our employees are happy."

Why It Works for Healthcare Systems

This organization's results reflect what many large, multi-site healthcare systems are discovering: PTO liability isn't just a Finance problem or an HR problem, it's both at once, and it touches nearly every employee. By giving employees a flexible way to convert unused time into real financial value, this healthcare system turned a growing risk into a benefit its workforce actively uses.

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