Patient out-of-pocket costs increased 11% in 2017, analysis finds

Patients continue to take on more responsibility for the cost of their medical care and the trend shows no signs of let up.

Indeed, patients experienced an 11% increase in average out-of-pocket costs during 2017, rising from $1,630 in the fourth quarter of 2016 to $1,813 for the same period in 2017, according to a new TransUnion Healthcare analysis.

The report, released Monday at the 2018 HIMSS Conference, also revealed that in 2017, on average 49% of patient out-of-pocket costs per healthcare visit were below $500; 39% were $501-$1,000; and 12% were more than $1,000.

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The analysis is based on anonymous data estimates from thousands of providers, including hospitals and healthcare clinics from across the nation. The data points focus on patient payment responsibilities for key, commonly administered procedures. 

It found the costs for major procedures are also on the rise. Medical specialties with the highest out-of-pocket cost estimates for patients (above the $1,000 average across all specialties in 2018), included:

  • Orthopedics ($1,663)
  • Plastic surgery ($1,566)
  • Urology ($1,415)
  • Neurology ($1,241)

While the fact that healthcare costs are on the rise isn’t new, it’s growing at a much higher rate year-to-year than Jonathan Wiik, principal of healthcare strategy at TransUnion Healthcare, expected. If that double-digit rise continues each year, patients will be paying an additional $200 in 2018 and $220 in 2019.

Most Americans don’t have the income or savings for an unexpected medical expense, Wiik told FierceHealthcare during an interview prior to the release of the report.

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Part of the problem is the healthcare industry is guarded in terms of costs and out-of-pocket expenses. Wiik says providers must be more transparent about the costs of care and discuss options for payment with patients as early in the process as possible, such as prior to a procedure or hospital stay. The goal, he said, should be for patients to worry about getting better, not about how they are going to pay for the bill.

“It’s not about payment. It’s about engagement,” Wiik said.

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In order to allow patients to focus on getting the care they need, healthcare providers need processes and tools in place to help patients meet their financial obligations and to establish funding mechanisms that will benefit both the patient and provider. If patients knew in advance how much they would owe for a procedure, they might save more or seek out financing options with the hospital or healthcare organization.

Although it would take additional resources, Wiik said hospitals could have someone from their billing department reach out to patients to make sure they understand their coverage, the costs of care and how they would like to pay for it, Wiik said. And if patient was concerned about the payment, the billing representative could ask whether there is anything the organization can do to help.