Aetna has announced that it will delay its plans to institute a new policy under which the insurer would cover monitored anesthesia care only for high-risk patients, according to the company’s web site.
Aetna came under scrutiny from GI groups when it announced this policy in December; critics said the insurer was prioritizing profits over patient safety and that the policy would negatively impact colorectal screening rates. Further, they said the new policy would take patient-care decision-making out of the hands of physicians. Finally, critics said that Aetna’s policy, which would have restricted when the insurer covered the use of the anesthesia drug propofol, would have forced organizations performing colonoscopies to limit when patients could receive the drug.
“Not all patients can be sedated with moderate sedation,” noted Nicholas LaRusso, MD, the president of the American Gastroenterological Association Institute, in a letter to Aetna dated Jan. 25. “Anesthesiologists are necessary for patients who need deep sedation with propofol, but whose gastroenterologists aren’t trained to administer deep sedation.”
The inability of providers to offer the powerful sedation drug, would discourage patients from undergoing colonoscopy, he posited. As a result of the AGA letter and outcry from providers, the policy — which had an implementation date of April 1 — will now be delayed until patient-friendly alternatives that do not require the added expense of an anesthesiologist become available.
“We have determined that in those few markets where monitored anesthesia care 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,” says Troyen A. Brennan, MD, Aetna’s chief medical officer, in a statement.
Aetna stressed in its announcement that it has always covered moderate sedation for routine colonoscopies and endoscopies, and that the new policy would not have eliminated coverage for sedation, but rather monitored anesthesia care in “routine” cases. The company says that its member data “confirms there is no relationship between improved screening rates and the use of monitored anesthesia care.”
The policy delay was lauded by GI professional groups.
“We believe that physicians and patients should determine the best place, method or procedure to be used in a particular situation,” says the American College of Gastroenterology in a statement. “Aetna’s decision not to interfere with physician/patient decision-making regarding appropriate sedation practices for colonoscopy is important for our members and their patients because it preserves the ability of physicians and their patients to make an assessment of the proper method of delivering patient care on a case-by-case basis without interference by the insurance company. We applaud all parties who voiced their concerns about Aetna’s decision and applaud Aetna’s recognition of the need to withdraw this misguided policy.”
The AGA echoed those sentiments.
“Aetna has engaged in an exchange of information and viewpoints with our society regarding the possible public health impact of this policy,” says Joel V. Brill, MD, AGAF, chair of the AGA Institute practice management and economic committee. “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.”
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