The trend of costs increasingly being shifted onto patients continued in 2017 with average out-of-pocket costs hitting $1,813 in 2017, an 11 percent jump from the year before, according to an analysis released by TransUnion Healthcare at the HIMSS18 conference in Las Vegas.

Just fewer than half of all patients included in the analysis paid less than $500 on average per healthcare visit. Some 39 percent paid between $501-$1,000 while 12 percent paid more than $1,000. An earlier TransUnion study said 68 percent of patients with a bill of $500 or less couldn’t or didn’t pay it, which can increase a hospital’s bad debt.

TransUnion’s principal of healthcare strategy, Jonathan Wiik, has advocated for hospitals and providers taking a more proactive approach to talk to patients about those financial realities at the time of the care—not through sending a bill months later.

“Increasing healthcare costs and patient responsibility is a continuing trend that does not seem to be slowing anytime in the near future,” Wiik said in a press release. “Given the increased payment responsibility, being able to determine a patients’ ability to pay is increasingly important for hospitals. 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.”

Certain specialties reported average out-of-pocket estimates for patients above $1,000, with the most expensive being:

• Orthopedics: $1,663
• Plastic Surgery: $1,566
• Urology: $1,415
• Neurology: $1,241

To head off the possibility of bad debt, Wiik has said providers need to know how much the payer will cover—even if the patient doesn’t know their own benefits as well—and use predictive analytics to determine who has a high likelihood of payment or high likelihood of charity or is in the middle who might need help paying over time.

If options aren’t discussed with the patient, Wiik has said, hospitals will be putting their profitability at risk. In the long run, however, the larger issue of rising healthcare costs has to be dealt with, as he wrote about in his book “Healthcare Revolution: The Patient is the New Payer.”

“The book I wrote talks about how there’s going to be a revolution in healthcare of some sort because we can’t have $50,000 deductibles. That’s not insurance. Very few people have $50,000 in the bank laying around to pay for a hospital bill,” Wiik told HealthExec in a 2017 interview.