Based on your IP address, the information provided, and as a guide only, is for the United States of America.

Tracheotomy Procedures: A payor’s perspective

In the United States alone, upwards of 150,000 tracheostomies are performed annually. This is a conservative estimate, and only of the adult population.

For many medical professionals, a tracheostomy procedure appears to be a rather simple, quick fix to assist patients in respiratory distress. It can indeed greatly simplify care of a patient requiring ventilation. In some cases, it has become a source of revenue for institutions. It is not uncommon for fees for this procedure and immediate respective care to exceed $250,000. This in itself raises alarm for many.

There is no question that at times, this procedure is not only necessary, but lifesaving.

However, what has become apparent is that tracheostomies have become too readily performed, despite their numerous and very serious complications which include risk of death, and need not have been performed.

For payor’s, careful scrutiny should be applied when approving such procedures for payment, and noTRACH can provide assistance to payor’s in recoupment of the costs of both the procedure and subsequent expense incurred if it has been deemed not clinically necessary. The type of assistance provided, whether as an external reviewer, or as an expert witness is provided at a rate of $25.00 per case.

Where noTRACH believes that a tracheotomy has been performed, and patient harm has occurred as a result, noTRACH may refer the matter for investigation which can result in a criminal prosecution by the State. noTRACH will make recommendation for investigation to the American Medical Association, HHS, FBI and the District Attorney where evidence that sufficient justification for the procedure has not been achieved and that harm has resulted.

For details of noTRACH guidelines, please refer to Tracheotomy Guidelines.