Thursday, July 14, 2011

Paying For Other People's Anesthesia

I recently had an enlightening, and infuriating, conversation with one of our gastroenterologists. The guy was grumbling about how our hospital was so inefficient and bureaucratic. His ire came down particularly hard on anesthesiologists. At our hospital, any inpatient that is having an endoscopy automatically gets an anesthesiologist to provide sedation. He proudly proclaimed that at his surgery center, he sedates patients all day long without an anesthesiologist present and he has never had a single anesthetic complication. In fact he says he has had more patient complications with anesthesiologists than without them.

I countered that most of the cases we do on inpatients are much sicker than the prescreened patients he sees at his ambulatory center. I questioned him about who was watching the patient while he's watching his procedure monitor and the nurses were running around taking care of his needs. He claimed he has never had a patient complain about recall or difficulty with the procedure and that for a healthy ASA 1 patient, an anesthesiologist is not cost effective and is more of a nuisance than a benefit to the health care industry. He said he wouldn't want to have his insurance premiums raised just to cover the cost of anesthesia for a healthy patient. Anesthesiologists are part of the problem of exorbitant medical costs in this country. Grrr. Just when you thought you knew a guy after working together for so many years.

That got me thinking. Why don't we use some legislative persuasion to convince insurance companies to cover anesthesia services for more procedures? After all, I'm paying health insurance premiums that covers benefits that I don't use. Things like insulin syringes and glucose strips. I don't use them but my premiums are helping cover the cost for people who do. How about screening mammograms. Covered but I'm never going to need one. The high cost of brand name prescription drugs are spread over the entire population of health insurance beneficiaries, even though only a small proportion of people actually use it. Social services? Mental health benefits? It's all in my insurance benefits though I have yet to take advantage of them.

I remember about a decade ago that there was an uproar when a woman in labor was denied an epidural because her insurance didn't cover it and the anesthesiologist refused to take the woman's cash. This became a national sensation and insurance companies were then mandated to cover labor epidurals in their policies. Insurance companies could argue that nobody NEEDS a labor epidural to have a baby. Babies have been born without them since the dawn of time. But by sobbingly recounting the horrible pain of delivery on TV, the government and the insurance companies were shamed into providing the service. Of course this doesn't come free. The cost of the epidurals are spread to everybody who buys health insurance.

So why don't we, and the ASA, lobby the state insurance commissioners to mandate insurance companies reimburse anesthesiologists for endoscopies and other procedures that they routinely deny payment? While it's true that many people don't require an anesthesiologist present to provide sedation during an endoscopy, the procedure is so much safer and more pleasant for the patient when we are in the room monitoring them. Instead of writing pleading reimbursement letters to the faceless multibillion dollar insurance corporations, we can easily identify patients who can tell heart-wrenching horror stories of having to endure endoscopies while being barely sedated by their GI doctors. Such tales told in front of legislative committees while being broadcast to the evening news will surely persuade our elected officials how terrifying an endoscopic procedure can be for some people. We can give our version of the great satisfaction patients derive from being sedated by an anesthesiologist and how they afterwards would recommend it to all their friends. We can argue that this will increase the compliance with screening procedures that are currently recommended to detect early GI cancers and thereby save costs in the long run. And isn't this anesthesia mandate worth it for an extra, I don't know, $10 a month on somebody's health insurance premiums? We only have to ask one question to the legislators: would they want their mothers scoped with or without an anesthesiologist present. Sounds like a plan to me.

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