Aetna to delay implementation of policy for monitored anesthesia during colonoscopy

Aetna announced on February 27 that they would delay a proposed change in insurance coverage for the services of a anesthesiologist for monitored anesthesia care (MAC) during routine upper and lower endoscopic procedures including colonoscopy.

The policy was to go into effect on April 1.

The new policy, announced in late December, would have continued to cover moderate sedation administered by the physician doing the procedure but would only pay for deeper sedation via monitored anesthesia care for high-risk patients. 

According to a Aetna press release,

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 expects that new devices and sedatives, now being reviewed by the FDA, will be available in late summer and will provide patient experiences similar to those delivered with MAC.  However, they will be able to be administered by the treating doctor and won’t require an additional anesthesiologist.

Troyen A. Brennan, M.D., Aetna’s chief medical officer, said,

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 health care, top priorities. 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 health care 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.

He also said,

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.

Media coverage of the proposed policy has been confusing and frightening for patients potentially leading to reduced screening rates for colorectal cancer.  It was not always clear that moderate sedation — drugs to relax patients and relieve pain — would still be available for all colonoscopies.  Patients with a medical condition that required deeper sedation administered by an anesthesiologist would also have that covered under the new policy.  However, anesthesiologist care would not be routine.

One sedative drug Diprivan® (propofol) has been part of this controversy.  The drug induces sedation rapidly and patients recover from it quickly and are able to leave the recovery area sooner.  However, its FDA approved label says,

For general anesthesia or monitored anesthesia care (MAC) sedation, DIPRIVAN^® Injectable Emulsion should be administered only by persons trained in the administration of general anesthesia and not involved in the conduct of the surgical/diagnostic procedure.

Thus the need for an anesthesiologist if Diprivan is used during colonoscopy.

The American Gastroenterological Society announced that they commend Aetna on the decision to delay implementation of the policy,

The AGA Institute commends Aetna for listening to our concerns. Aetna will now delay implementation until patient-friendly alternatives for sedation — which will not require an anesthesiologist — are approved by the FDA.

What this means for patients

People insured by Aetna having screening colonoscopies will continue to be able to have monitored anesthesia care using drugs that require an anesthesiologist after April 1 whether or not they are high-risk.

Not all upper endoscopies and colonoscopies use MAC for sedation.  Moderate sedation using drugs that make you sleepy and relaxed and manage pain will continue to be available for you as it was before.

You should discuss what sedation is going to be used for your colonoscopy and whether an anesthesiologist will be present with your gastroenterologist before your test.

If you believe that you have an need for deep sedation because of your age, prior colonoscopy experience, past surgeries, or other medical reason talk to the gastroenterologist about using an anesthesiologist to monitor your care.

In any event, sedation to make patients comfortable during colonoscopy is available and is routinely used. No one need fear colonoscopy because of unnecessary pain.

People who have had a colonoscopy can help reduce deaths from colorectal cancer by assuring their friends and family who have not been screened that colonoscopy is not painful.