Use of anesthesia providers to monitor sedation during screening colonoscopies and other outpatient gastroenterology procedures more than doubled from 2003 to 2009 in the United States, with most of the increase among low-risk patients who may not need this service, according to a new RAND Corporation study.
The findings suggest that as much as $1.1 billion spent annually on anesthesia services for GI-related procedures may not be medically necessary, according to the study published in the March 21 edition of the Journal of the American Medical Association.
Researchers also found substantial regional variation in how often anesthesiologists or nurse anesthetists are used to administer sedation during GI procedures, ranging from 13 percent in the West to 59 percent in the Northeast.
"The use of anesthesia providers during outpatient GI procedures is growing rapidly, although there is no evidence that most patients are sick enough to justify the extra expense," said Dr. Soeren Mattke, the study's senior author and a senior scientist at RAND, a nonprofit research organization. "The growing use of anesthesia providers during GI procedures imposes significant costs on the American health care system at a time when concern is high about the cost of medical care."
Outpatient gastroenterology endoscopy procedures are common among adults in the United States, with more than 20 million procedures performed annually.
Under current treatment guidelines, intravenous sedation during such procedures can be safely administered by the physician doing the procedure, assisted by a nurse, unless the patient is at risk for anesthesia-related complications because of an illness such as advanced heart or lung disease. Anecdotal evidence suggests that anesthesia providers are being used more commonly to administer sedation to low-risk patients, a practice that increases costs while providing little or no benefit to the patient.
The RAND Health study is the first attempt to quantify spending on anesthesia service for outpatient GI procedures on a national level using a large sample of adult patients.
Mattke and his colleagues examined the care given from 2003 through 2009 to 1.1 million people in Medicare fee-for-service and 5.5 million adults with commercial insurance.
Researchers found that the use of anesthesia providers during outpatient GI procedures among those studied increased from about 14 percent of cases in 2003 to more than 30 percent of cases in 2009. About two-thirds of the anesthesia services were delivered to low-risk patients where use of the services is generally considered to be unnecessary.
The study estimates that payments nationally for anesthesia providers during outpatient GI procedures rose from $400 million in 2003 to $1.3 billion in 2009, including $1.1 billion for services provided to low-risk patients. Payments made to anesthesia providers for GI outpatient procedures doubled among Medicare patients and quadrupled in commercial insured patients. Involvement of anesthesia providers was four times more common in the Northeast than in the Western region of the U.S.
"The nation's health system is under pressure to reduce low-value health care in order to curb the rapid overall rise in health care costs," Mattke said. "If we cannot eliminate health care spending that provides little or no value, we risk facing spending cuts that could deprive patients of needed care."
Support for the study was provided by Ethicon Endo-Surgery, Inc. Other authors of the study are Hangsheng Liu, Dr. Daniel Waxman and Regan Main.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis.
Journal
JAMA