Tracheostomy-related durable medical equipment: Insurance coverage, gaps, and barriers.

Autor: Foran PL; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States., Benjamin WJ 4th; University of Michigan Medical School, Ann Arbor, MI, United States., Sperry ED; University of Cincinnati, OH, United States., Best SR; Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States., Boisen SE; Pediatric Intensive Care Unit, Seattle Children's Hospital, Seattle, WA, United States., Bosworth B; University of Cincinnati, OH, United States., Brodsky MB; Head and Neck Institute, Cleveland Clinic, Cleveland, OH; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States., Shaye D; Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School Massachusetts Eye and Ear, United States., Brenner MJ; Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, MI, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States., Pandian V; Center for Immersive Learning and Digital Innovation Johns Hopkins University School of Nursing, Baltimore, MD, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States. Electronic address: vpandia1@jhu.edu.
Jazyk: angličtina
Zdroj: American journal of otolaryngology [Am J Otolaryngol] 2024 Mar-Apr; Vol. 45 (2), pp. 104179. Date of Electronic Publication: 2023 Dec 12.
DOI: 10.1016/j.amjoto.2023.104179
Abstrakt: Purpose: Tracheostomy care is supply- and resource-intensive, and airway-related adverse events in community settings have high rates of readmission and mortality. Devices are often implicated in harm, but little is known about insurance coverage, gaps, and barriers to obtaining tracheostomy-related medically necessary durable medical equipment. We aimed to identify barriers patients may encounter in procuring tracheostomy-related durable medical equipment through insurance plan coverage.
Materials and Methods: Tracheostomy-related durable medical equipment provisions were evaluated across insurers, extracting data via structured telephone interviews and web-based searches. Each insurance company was contacted four times and queried iteratively regarding the range of coverage and co-pay policies. Outcome measures include call duration, consistency of explanation of benefits, and the number of transfers and disconnects. We also identified six qualitative themes from patient interviews.
Results: Tracheostomy-related durable medical equipment coverage was offered in some form by 98.1 % (53/54) of plans across 11 insurers studied. Co-pays or deductibles were required in 42.6 % (23/54). There was significant variability in out-of-pocket expenditures. Fixed co-pays ranged from $0-30, and floating co-pays ranged from 0 to 40 %. During phone interviews, mean call duration was 19 ± 10 min, with an average of 2 ± 1 transfers between agents. Repeated calls revealed high information variability (mean score 2.4 ± 1.5). Insurance sites proved challenging to navigate, scoring poorly on usability, literacy, and information quality.
Conclusions: Several factors may limit access to potentially life-saving durable medical equipment for patients with tracheostomy. Barriers include out-of-pocket expenditures, lack of transparency on coverage, and low-quality information. Further research is necessary to evaluate patient outcomes.
Competing Interests: Declaration of competing interest Drs. Brenner and Pandian serve as board of directors for Global Tracheostomy Collaborative (non-financial)
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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