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Payers point to 2004 joint statement
The three major gastroenterology associations released a statement in 2004 that said monitored anesthesia care (MAC) is not needed for routine colonoscopy procedures. In 2004, the working group from the American College of Gastroenterology (ACG), the American Gastroenterological Association (AGA), and the American Society for Gastrointestinal Endoscopy (ASGE) said, "The routine assistance of an anesthesiologist/anesthetist for average risk patients undergoing standard upper and lower endoscopic procedures is not warranted." (Editor's note: To access the 2004 statement, go to www.gi.org.)
Some payers have misinterpreted the statement, says Hector Vila, MD, anesthesiologist at M. Lee Moffitt Cancer Center, Tampa, FL. Vila points to the use of the word "routine." "They don't say 100% of the time you don't need an anesthesiologists," he says. "They don't say it's unwanted and unneeded by patients."
When an anesthesiologist or anesthetist does provide monitored care during a colonoscopy, propofol typically is administered. In a statement recently shared with Same-Day Surgery, the AGA said, "To date, the evidence has not consistently demonstrated an advantage with the use of propofol in average-risk patients undergoing standard upper and lower endoscopy." The health care practitioner, with the patient, should decide about the use and administration of sedation agents, the AGA said. "If an individual provider lacks appropriate competency in the administration of sedation, then it should not pose a barrier to the patient receiving quality care in a safe environment, and practitioners should be able to employ and be reimbursed for the use of an anesthesia professional," the association said.
The ACG recently contacted SDS to clarify its position as follows: "The physician is in the best position to decide when and where particular procedures should be done and what sedation agents are appropriate in a particular case. We oppose efforts to substitute judgment by insurance carriers or others."
Insurance companies are jumping the gun, according to Meena S. Desai, MD, president and CEO of Nova Anesthesia Professionals, Villanova, PA. Desai points out that in the 2004 joint statement, the groups stated further randomized clinical trials are needed in this setting. Additionally, the participants in the 2004 working group were not from geographic areas where propofol was commonly used at that time, she says.