Aetna Announces Delay in Implementing Anesthesia Policy

Decision on monitored anesthesia care seeks to avoid impact on colon cancer screening rates, provides transition to patient-friendly alternatives in emerging new sedation approaches

HARTFORD, Conn. — Aetna announced that it will delay the effective date of a new clinical policy addressing the medical necessity of an anesthesiologist’s services during routine upper and lower endoscopic procedures, such as a colonoscopy. Aetna has always covered moderate sedation, which is delivered by the treating physician, and is the type of sedation used for the majority of colonoscopies across the country. In the new policy, which was announced in late December, Aetna continues to cover moderate sedation, but only covers monitored anesthesia care for high-risk patients. The policy was scheduled to be effective on April 1, 2008. Aetna will now delay implementation until patient-friendly alternatives – which will not require the added expense of an anesthesiologist – are approved by the Food and Drug Administration (FDA) and available in the marketplace.

"Aetna believes that we have a responsibility to encourage physicians to follow clinical practices based on the best medical evidence," said Troyen A. Brennan, MD, Aetna’s chief medical officer. "It’s not only important to the health of our nearly 37 million unique members, but it promotes affordable quality healthcare and access to important procedures, such as cancer screening, which we consider top priorities.

"We have determined that in those few markets where monitored anesthesia care (MAC) has become the routine approach to sedation, implementation of our policy on April 1 would inconvenience our members in those markets and potentially depress cancer screening rates in the short term."

In addition, Aetna said that some groups and individuals unfortunately have chosen to misinterpret the new policy as no longer covering sedation, and have suggested that the policy would negatively impact screening rates. Neither is true. Aetna has always covered moderate sedation for routine colonoscopies and endoscopies, and the company’s member data confirms there is no relationship between improved screening rates and the use of monitored anesthesia care. Aetna believes such misinformation can cause confusion among its members and could negatively impact colon cancer screening rates. Such an outcome is unacceptable to Aetna.

Aetna hopes that the delay in implementing this policy will allow adequate time for the arrival on the market of attractive, patient-friendly alternatives to anesthesiologist-monitored sedation services. New medical devices, as well as new sedatives, are expected on the market during the late summer, and are in review with the FDA now. They are designed to provide a patient experience that is very similar, or perhaps better, than MAC, but can be managed exclusively by the GI performing the screening procedure. Both would eliminate the significant expense of having a second physician attending during a routine screening service for a healthy patient.

"Once these new options are available in the marketplace, we will move forward with our policy. Aetna considers the health of our members, and their access to preventive screenings and affordable quality healthcare, top priorities," Brennan said. "Our goal is to improve the consistency of care delivered to our members nationally, align that care with the best evidence available and remove unnecessary costs from the healthcare system. These are worthwhile goals that should be shared by the medical community, and we will continue to work with care providers to achieve them."

The American Gastroenterological Association Institute commented on Aetna’s decision. "Aetna has engaged in an exchange of information and viewpoints with our society regarding the possible public health impact of this policy," said Joel V. Brill, MD, AGAF, chair of the American Gastroenterological Association (AGA) Institute practice management and economic committee. "The AGA Institute commends Aetna for listening to our concerns. We are dedicated to working with all stakeholders involved to provide clear recommendations to physicians, patients, purchasers and payers regarding the appropriate use of sedation for endoscopic procedures."

Source: Aetna

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