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Anesthesia services in GI procedures increasing, often in low-risk patients
Between 2010 and 2013, use of anesthesia services in outpatient gastroenterology procedures continued to increase, and a large proportion of these services were used on low-risk patients, according to recent study data.
“Anesthesia service use rendered by anesthesia professionals in outpatient gastroenterology (GI) procedures has increased rapidly in the past decade,” having tripled between 2003 and 2009, Hangsheng Liu, PhD, a policy researcher at the RAND Corporation, and colleagues wrote. “To inform policy debate about anesthesia service use in low-risk patients as well as predict the potential impacts of CMS’s rule change,” — which defines anesthesia services as part of routine screening colonoscopy and thus removes cost sharing — “we aim to update our previous study of the trend in anesthesia service use during outpatient GI procedures using data from 2010 to 2013.”
Hangsheng Liu
Using the Medicare Limited Data Set and Truven MarketScan data from this period, they identified GI procedures and anesthesia services performed only by anesthesia providers based on CPT codes, which were linked together by patient identifiers and dates of upper GI procedures and colonoscopies. They defined low-risk patients as those with an American Society of Anesthesiologists physical status class I or II and used a prediction algorithm to determine low-risk status for those without an ASA class listed on the claim. Anesthesia services are considered “potentially discretionary” in such patients, they wrote.
More than 6.6 million unique patients in the sample had an endoscopic procedure during the study period, and those who received anesthesia services were more likely to be women and have more comorbid conditions on average (both P < .01).
Among the Medicare population, 33.7% had anesthesia services in 2010 vs. 47.6% in 2013, and in the commercially insured population, 38.3% had anesthesia services in 2010 vs. 53% in 2013.
Most procedures with anesthesia services were performed in low-risk patients. This proportion decreased slightly in the Medicare population over the study period, from 63.5% to 58.3%, but remained similar in the commercially insured population, changing from 81% to 81.3% over the study period.
The volume of anesthesia services in low-risk patients increased 14% among Medicare patients, from 27,191 to 33,181 per million enrollees, and by almost 15% among commercially insured patients, from 15,871 to 22,247 per million enrollees. Spending for these services in low-risk Medicare patients also increased from $3.14 million to $3.45 million per million enrollees, and in low-risk commercially insured patients spending for these services increased from $7.69 million to $10.66 million per million enrollees. The annual growth rate in the volume of anesthesia services in low-risk patients increased by 6.9% in Medicare patients and by 11.9% in commercially insured patients, and spending on these services increased annually by 3.2% and 11.5%, respectively.
“In summary, anesthesia service use in GI procedures continued to rise, as well as the spending associated with anesthesia services in low-risk patients,” the researchers concluded. “Our study provides more evidence for the policy debate and informs policymakers and payers about the financial impacts of covering potentially low-value care.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.