Out-of-Pocket Costs and Potential Surprise Bills for Tracheostomy in Commercially Insured Patients

Tracheostomy involves complex, resource-intensive care. Yet, few data about the procedure-related cost burden for patients and their families are available. Passage of the No Surprises Act has been associated with changes in patient billing for certain healthcare services, but data on tracheostomy have not been investigated.

We conducted a retrospective cohort study using the Merative MarketScan database for commercially insured patients aged 18-64 who underwent tracheostomy from 2014-2022 in the United States. We estimated out-of-pocket (OOP) costs (sum of deductibles, copay, and coinsurance) and potential surprise bills (an out-of-network claim where both the primary surgeon and facility were in-network) within 30 days of surgery. Relationships between OOP costs, potential surprise bills, and patient- and system-level exposures were analyzed.

Among 8,950 patients who underwent tracheostomy, the mean (SD) age was 49.3 (12.7) years; most patients were male (61.8%) and had fee-for-service based insurance (79.8%). The mean (SD) total OOP cost attributable to tracheostomy was $1,423 (2,029), and coinsurance accounted for 62.8% of these costs. Potential surprise bills were present in 9.1% of surgical episodes overall and were associated with higher OOP costs (mean (SD) $1909 (2433) vs. $1444 (2021); p<0.001)). High-deductible health plans and fee-for-service based plans were the largest predictors for overall OOP costs (cost ratio 2.66 and 1.84, respectively; p<0.001 for both) and potential surprise bills (odds ratio 2.07 and 2.78, respectively; p<0.001 for both). The incidence of potential surprise bills diminished over the course of the study period.

Patients undergoing tracheostomy have significant exposure to OOP costs, predominantly attributable to coinsurance, with potential surprise bills representing an additional source of cost exposure. These findings highlight the need for financial counseling and policy reform to reduce patient cost burdens.