Letter to Aetna Regarding Sedation Policy
January 25, 2008
Troyen A. Brennan, MD, MPH
Senior Vice President, Chief Medical Officer
Aetna
151 Farmington Avenue, RC 5A
Hartford, CT 06156
Dear Dr. Brennan:
The American Gastroenterological Association (AGA) and the AGA Institute comprise the nation’s oldest not-for-profit medical specialty society and the largest society of gastroenterologists, representing more than 16,000 physicians and scientists who are involved in research, clinical practice and education on disorders of the digestive system.
On behalf of our members and their patients, I am writing in reference to Aetna’s revised Clinical Policy Bulletin 0740 for Anesthesia Services for Gastrointestinal Endoscopy, which is scheduled to become effective on April 1, 2008. The policy notes that Aetna considers it medically unnecessary for an anesthesia professional to be present when average-risk patients undergo standard upper or lower endoscopic procedures, including colonoscopy.
When the New York Times covered this impending policy on December 28, 2007, the AGA heard from a number of concerned members. In the intervening weeks, a groundswell of members from across the country have expressed concern that the policy could adversely affect colorectal cancer screening rates. As an organization, the AGA shares this concern. Therefore, we formally ask Aetna to defer implementation of this policy until consulting with a task group of gastroenterologists with the goal of addressing the possible effect of the policy on public health and the potential impact on colorectal cancer screening rates.
As you may be aware, colorectal cancer is the second leading cause of death among all Americans. Despite recommendations that everyone age 50+ get screened for colorectal cancer, only a fraction of this group has been checked. This is a major public health concern. AGA members worry that our efforts to increase colorectal cancer screening will be undercut by payers that decrease physicians’ control of screening methods, sedation agents and the presence of medical team members – in this case, anesthesiologists. Not all patients can be sedated with moderate sedation. Anesthesiologists are necessary for patients who need deep sedation with propofol, but whose gastroenterologists aren’t trained to administer deep sedation.
Thank you for considering our request to convene a task group of gastroenterologists to consider the unintended public health consequences of Clinical Policy Bulletin, Anesthesia Services for Gastrointestinal Endoscopy. We are prepared to provide Aetna with the names of gastroenterologists for this task group. Please let me know what other assistance we can provide you in this process.
Sincerely,
Nicholas LaRusso, MD
President, AGA Institute
