Anesthesiologists add a billion to cost of U.S. screening: study

Tuesday, March 20, 2012

An image from a video on the proper use of anesthesia in an operating room setting, and procedures for dealing with complications - including cardiac arrest - is seen during Dr. Conrad Murray's involuntary manslaughter trial in Los Angeles October 19, 2011. The video was prepared by the prosecution, and shown during testimony by anesthesiologist Dr. Steven Schafer. REUTERS/Reed Saxon/Pool

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By Genevra Pittman
NEW YORK (Reuters Health) - A growing number of U.S. patients are being monitored by an anesthesiologist during endoscopies and colonoscopies, suggests a new study, a practice adding more than a billion dollars to health costs every year.
Researchers found that using an anesthesiologist or nurse anesthetist added hundreds of dollars to the cost of the procedures and the number of patients this applied to more than doubled between 2003 and 2009.
"If we keep going in this direction, we can't afford it," said Dr Lee Fleisher, an anesthesiology and critical care doctor from the University of Pennsylvania in Philadelphia, who wrote a commentary on the new study published on Tuesday in the Journal of the American Medical Association.
Under the U.S. system of fee-for-service healthcare, doctors who perform gastrointestinal, or GI, procedures are reimbursed by insurance companies or Medicare at the same rate, whether or not they give patients sedatives and painkillers themselves.
If an anesthesiologist or nurse anesthetist is involved to give sedation, however, this involves an extra fee.
Even with a designated person giving anesthesia, patients did not necessarily get more serious sedation - just another body in the room, one of the researchers of the study said.
"You get sedation in both cases, you just get sedation for an extra $500, and there may not be any difference in the sedation you get," said Dr. Soeren Mattke, from the RAND Corporation in Boston.
"You add a lot of cost, with no proven safety or patient experience benefit," Mattke said.
LACK OF EVIDENCE
Mattke and his colleagues tracked a sample of 1.1 million Medicare patients and another 5.5 million with private insurance who had endoscopies and colonoscopies between 2003 and 2009 - a total of more than nine million procedures.
Based on claims, the researchers calculated that insurance providers were billed for anesthesiologists on about 14 percent of GI procedures in 2003.
By 2009, 30 percent of procedures for Medicare patients and 36 percent for privately insured patients involved an anesthesiologist or a nurse anesthetist.
That added about $150 to the bill for each procedure when Medicare was paying, and $500 for patients with private insurance, according to the findings. Using that model, the researchers estimate the total cost for such anesthesia during the procedures amounted to $1.1 billion nationally in 2009.
All of those patients were low-risk, without heart or breathing conditions, meaning there was no medical reason for having an anesthesiologist monitoring their sedation.
Although they might get a different type of drug depending on who was doing the sedating, there was no evidence those patients did better when an anesthesiologist was involved, Mattke said.
Fleisher said that if patients really wanted deeper sedation from an anesthesiologist, that was still a valid option. He said he would not want them to avoid colonoscopies for cancer screening because they were afraid of not getting enough anesthesia.
Guidelines from the United States Preventive Services Task Force, a government-backed agency, call for regular colon cancer screening in people age 50 to 75, every ten years if they choose to screen with colonoscopy. One recent study found evidence that the procedure, during which precancerous polyps are removed, can halve a person's risk of dying from colon cancer.
Fleisher said that using an anesthesiologist during a GI procedure should not automatically mean more reimbursement from insurance companies or Medicare.
"There's probably some way … to make it a more rational, financial decision whereby for the appropriate patients it's utilized and ones in which it's not necessary it's not utilized," he said.
Mattke said that in a time when cutting health care spending was especially important, policy makers and doctors themselves had to look for ways to get rid of any "low-value services."
Patients could be involved too, he said, by knowing their different options and the medical evidence behind them. SOURCE: http://bit.ly/hwxtTL Journal of the American Medical Association, online March 20, 2012.
(Editing by Ivan Oransky, Michele Gershberg and David Brunnstrom)

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