The use of anesthesia services in endoscopy -- both colonoscopy and upper gastrointestinal tract endoscopy -- has increased substantially in recent years, according to a new study in the March 21 Journal of the American Medical Association.
Especially noteworthy is the increase in anesthesia and sedation provided to low-risk patients with commercial (non-Medicare) health insurance, which might represent areas for potential cost savings, wrote researchers from research and analysis organization RAND.
"The continuous increase in spending on medical care has triggered a debate concerning which services and procedures provide adequate value and which do not, and therefore represent potential areas to reduce cost," Hangsheng Liu, PhD, and colleagues wrote in the article. "The use of anesthesiologists, nurse anesthetists, or both during gastrointestinal endoscopies has been identified as one such potential area."
Current payment guidelines stipulate that if intravenous sedation is needed during gastrointestinal endoscopies, such as colonoscopy or endoscopy, the endoscopist must administer it with the support of a nurse, and the sedation component is included in the professional fee. Involvement of an anesthesiologist or nurse anesthetist, which generally involves an additional payment, is justified only for procedures performed on high-risk patients, the article noted.
The study analyzed claims data for a 5% sample of Medicare fee-for-service patients (1.1 million adults) and a sample of 5.5 million commercially insured patients between 2003 and 2009, all of whom had either an outpatient upper gastrointestinal endoscopy or colonoscopy procedure. Overall, 26.6% of Medicare patients and 28.6% of commercially insured patients received anesthesia services.
The number of gastroenterology procedures per million enrollees per year remained mostly stable among Medicare patients (average, 136,718), but the number increased more than 50% in commercially insured patients, from 33,599 in 2003 to 50,816 in 2009.
The proportion of procedures using anesthesia services increased over the study period at a similar rate for commercially insured patients (from 13.6% to 35.5%) and Medicare patients (13.5% to 30.2%), the authors reported. Over the study period, payments for gastroenterology anesthesia services doubled among Medicare patients and quadrupled among commercially insured patients.
