Utilization of Anesthesia Services During Outpatient Endoscopies and Colonoscopies and Associated Spending in 2003-2009

Abstract

Context The frequency with which anesthesiologists or nurse anesthetists provide sedation for gastrointestinal endoscopies, especially for low-risk patients, is poorly understood and controversial. Objective To quantify temporal comparisons and regional variation in the use of and payment for gastroenterology anesthesia services. Design, Setting, and Patients A retrospective analysis of claims data for a 5% representative 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. Main Outcome Measures Total number of upper gastrointestinal endoscopies and colonoscopies, proportion of gastroenterology procedures with associated anesthesia claims, payments for gastroenterology anesthesia services, and proportion of services and spending for gastroenterology anesthesia delivered to low-risk patients (American Society of Anesthesiologists physical status class 1 or 2). Results The number of gastroenterology procedures per million enrollees remained largely unchanged in Medicare patients (mean, 136 718 procedures), but increased more than 50% in commercially insured patients (from 33 599 in 2003 to 50 816 in 2009). In both populations, the proportion of procedures using anesthesia services increased from approximately 14% in 2003 to more than 30% in 2009, and more than two-thirds of anesthesia services were delivered to low-risk patients. There was substantial regional variation in the proportion of procedures using anesthesia services in both populations (ranging from 13% in the West to 59% in the Northeast). Payments for gastroenterology anesthesia services doubled in Medicare patients and quadrupled in commercially insured patients. Conclusions Between 2003 and 2009, utilization of anesthesia services during gastroenterology procedures increased substantially. Anesthesia services are predominantly used in low-risk patients and show considerable regional variation.

656 Complications Following Colonoscopy With Anesthesia Assistance: A Population-Based Analysis

“…In recent years, administration of propofol for the performance of colonoscopy has increased (7,8). Whereas patients with complex medical problems and a known intolerance to conscious sedation are probably more appropriate for anesthesia involvement in procedures, much of the observed variation in the use of anesthesia presumably relates to physician discretion.…”

“…In patients without clear medical indications for deep sedation, the potential advantages of propofol include the rapid onset of sedation, faster recovery time, and improved patient and provider satisfaction. The major disadvantage of propofol administration that has been cited is the greater financial cost to the patient and health care system, which is approximately 20% higher (7,8).…”

“…Studies that have included physician surveys (5) and health claims data (6)(7)(8)(9) have documented an increasing use of propofol and/or anesthesiology services in colonoscopy practice. These studies have reported a marked rise in the use of anesthesiology assistance over time, increasing from 11% in 2000 to 23.4% in 2006 in a Medicare cohort (7), and from 13.6% in 2003 to 35.5% in 2009 in commercially insured individuals (8).…”

“…These studies have reported a marked rise in the use of anesthesiology assistance over time, increasing from 11% in 2000 to 23.4% in 2006 in a Medicare cohort (7), and from 13.6% in 2003 to 35.5% in 2009 in commercially insured individuals (8).…”

No Association Between Centers for Medicare and Medicaid Services Payments and Volume of Medicare Beneficiaries or Per-Capita Health Care Costs for Each State

“…Again, in the context of gastroenterology, the New York Times has described 4-fold price differentials depending on in which part of the country one receives a colonoscopy. 2 The scientific literature also has provided evidence to support large geographic cost disparities for colonoscopy, in large part owing to the varying utilization rates of propofol anesthesia, 3 and studies also have described significant regional variations in surveillance follow-up intervals. [4][5][6][7] One factor that is considered important in both reducing health care costs and reducing regional variations for equivalent services is to provide greater transparency surrounding these costs.…”