Blue Cross restricting anesthesia for colonoscopies

The money has to come from somewhere. We’ve got a higher target for excessive Executive Compensation in 2024.

Blue Cross colonoscopy policy prompts outrage among Mass. doctors | WBUR News

intercst

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“The dispute is over the level of sedation required for people getting colonoscopies and other similar procedures, known as endoscopies. Doctors often prefer to use anesthesia, also known as deep sedation, which puts patients to sleep. But Blue Cross officials say many patients at low risk of medical complications don’t need anesthesia and can be examined while they’re sedated, but awake, which is known as moderate or conscious sedation.”

Hmm. The colonoscopies I’ve had have all been with the “you’re aware, but you don’t care” category. No problems, and preferable to me to complete anesthesia.

DB2

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I’ve had the light sedation with no anesthesiologist in the room for my colonoscopy, too. But the doctor and patient should be making that decision, not an MBA at the insurance company.

intercst

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Sure, but as indicated in the article, Massachusetts is an outlier here.

DB2

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Will be an outlier … for now. Just like it’s only Blue Cross indicated in the article … for now.

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There is a fine and invisible line between sedated and general anesthesia. I’ve had little frail grandmothers take enough to put down a horse while your prototypical NFL lineman is asleep by showing them the bottle. Worst case scenario, sure we will try sedation, patient panics or reacts badly, you have a WWE match going on while trying to finish putting the patient asleep, not safe for anyone. I had that argument numerous times with surgeons that just didn’t get that concept until the * matter hit the spinning blades of the air circulator. (Really? can’t use a medical term for manure?)

Currently, these procedures are almost exclusively performed with propofol. A wonderful drug that is as close to flipping a light switch in producing unconsciousness/awake with little to no side effects.

Just love it when non-medical people say what is necessary.

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Oh yes. It certainly is.

One minute you’re thinking to yourself…

“It doesn’t seem to be wor…”

… and, lo, barely 5 minutes later, you wake up in recovery and a whole 2 hour procedure has gone down!!

I think part of the problem is that anaesthesia (and, by extension, anaesthesiologists) are victims of their own success. Something that’s potentially a really risky endevour (rendering an individual more or less unconscious) and then waking them up with all their marbles is now so safe that it’s seen as almost a non event. Except by folk who know better, that is.

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And i have had the out of network anesthesiologist problem. Not covered by insurance. Much more costly.

Everyone involved needs to get their act together. Is anesthesologist needed? Is it covered by insurance?

Only when you need them.

I guess the real question is, how can you be sure, in advance, that the odds are still in your favour this time.

Folk tend to far more risk tolerant before the “spit” has hit the blades than when they (or a family member representative) is being interviewed by a personal injury lawyer afterwards.

Agree, the deep sedation carries a much higher risk of something going wrong with the anaesthesia and I’ve known about that risk for decades.

You say that as if there’s a safety concern behind this insurance company decision…

I’ve had three colonoscopies now. The first two, at my request, were without any sedation. It went just fine. Didn’t hurt, just felt a bit weird. And it was very entertaining watching the scope go along the tunnel, vacuuming up debris as it went.

The third was done as an adjunct “might as well do it at the same time” procedure. I was under full sedation for something else they were doing. It also went just fine.

It seems to me to clearly be something that should be decided by the patient after consultation with the doctor.

The two procedures done without anesthesia were far, far cheaper. Although I’m fairly sure the cost to me would have been similar, as insurance would have paid for sedation as it’s the usual way to do things.

This contrasts with childbirth. My kids were all born at home. It cost us way more because insurance wouldn’t pay for the midwife or pretty much anything. Not the usual process. So even though it cost about 10% of what a simple hospital birth would have cost, our out of pocket was far more.

-IGU-

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True story. Was putting an elderly gentleman asleep, very chatty to cover up his nervousness. No problem. We are in the OR, hooked up to monitors, he starts to tell a joke, propofol hits right before the punch line. And we are all thinking, well, we won’t hear the end of that joke. An hour later, waking him up, opens his eyes, takes a deep breath, and delivers the punch line like nothing had happened.

As far as anesthesia being a victim of success, yes. From when I was in training (early 90s), many drugs have massively improved and more monitoring capabilities are now standard of care. Mainly things like pulse oximetry and end tidal CO2 monitoring have greatly reduced operative morbidity and mortality. So surgeons are constantly pushing the envelope about what is appropriate* because things are safer now. Had some old anesthesiologists tell stories of they only had a BP cuff, stethoscope, and their fingers on a pulse when they trained. And I have been in 3rd world countries on mission trips where that was the case so it makes you very appreciative of what you have.

  • before I retired, total joint replacements were starting to become out patient procedures. Obviously had to be highly selective in the patients but the whole slippery slope thing. usually ends badly.
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Saying it because it is my opinion that there should be.

Full anaesthesia is one step away from death and never as safe as not having gone quite that close to the edge.

It may be a lot safer today than it was back in the 1980s when I learned that, but it’s not a nothingburger.

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Well, considering that the procedure…and the only procedure…under discussion in the article is colonoscopy, I think it’s a pretty safe bet that the degree of anaesthesia produced using propofol is a really long way away from “one step away from death” (and you can thank an anaesthesiologist for keeping it like that).

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My pain threshold is stupidly high and I get my teeth done without novocaine. It probably colors my perceptions. :wink:

Full anesthesia is one SYRINGE away from death. While another topic entirely, the only difference between anesthesia and capital punishment via IV is the one syringe to stop the heart.

You might be one of those people that have an abnormal pain receptor complex. Highly unusual and they are being studied for any insights into pain treatments.

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Extremely, highly unusual. Although I’ve had a few folk who insisted they had a high pain threshold, it never manifest itself in sitting stock still during a procedure, and showing zero response to a pain stimulus. In fact, the involuntary muscle twitches and movements that’re reflex responses to pain always seemed to happen at a point when any movement was least desirable and neither me, my chairside assistant nor the patient were expecting it.

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“Stupidly high” = high enough that I can damage myself before I notice that I am doing it.

I can’t control the twitches - and we aren’t talking about root canal work either. The novocaine is useful. The problem is that I don’t notice little pains before they turn into large ones.

Which IS stupid :slight_smile:

Once I notice it, I can ignore quite a lot as well, but before I do that, I ask myself, “Why?” It isn’t that I like the hurt, - but I do regard it as a friend of sorts.

Pain tells me to stop doing a painful thing, and It is nature’s most efficient teacher.

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I don’t like the way they do capital punishment with all the drugs.

It’s just dumb and invasive.

Fill a chamber with Nitrogen and you’d not ever notice the transition. We have special warnings around the liquid N₂ in the labs because it is so damned easy to make a mistake with it.

Better not to do it at all, anyway. The Jury is wrong enough often enough.