Trends in Medicare Utilization and Reimbursement of Tracheostomy From 2000 to 2022

Abstract

ObjectiveTo analyze the utilization and reimbursement for tracheostomy.Study DesignRetrospective Cross‐Sectional Study.SettingCenters for Medicare & Medicaid Services (CMS) Medicare Provider Utilization and Payment Data (2013 and 2021) and Part B Medicare Fee‐For‐Service National Summary Data (2000‐2022).MethodsUtilization, payment, and specialty breakdown were analyzed for planned tracheostomy (Current Procedural Terminology [CPT] codes 31600, 31601, 31610) and emergency tracheostomy (CPT codes 31603, 31605).ResultsFrom 2000 to 2022, there was a 48.9% decrease (40,754‐20,812) in number of planned tracheostomies and a 75.3% decrease (3277‐811) in number of emergency tracheostomies, leading to an overall decrease of 51%. Similarly, there was a 59.3% inflation‐adjusted decrease ($13.4‐$5.5 million) in total reimbursement for planned tracheostomies and an 82.1% inflation‐adjusted decrease ($1.1 million‐$205 thousand) in total reimbursement for emergency tracheostomies. There was a 20.3% inflation‐adjusted decrease ($329‐$262) in reimbursement per planned tracheostomy and a 27.7% inflation‐adjusted decrease ($349‐$252) in reimbursement per emergency tracheostomy. In our sample of 280 high‐volume tracheostomy providers in 2021 (28.2% otolaryngology, 28.2% general surgery, 14.6% thoracic surgery, 14.3% pulmonary disease, 6.4% critical care), the average provider performed 15.8 tracheostomies and was reimbursed $5362.ConclusionDespite significant declines in tracheostomy utilization and reimbursement, understanding trends for these lifesaving procedures are critical for otolaryngologists and other providers in delivering high‐quality care, and can be used by surgeons, hospital systems, and policymakers to guide future health care legislation.