CMS Reduction in RVU Payment for Endoscopy With Anesthesia Slowed but Did Not Stop Growth in Anesthesia Use
Douglas K. Rex, MD, MASGE, reviewing Adams MA, et al. Gastroenterology 2022 Mar 15.
In 2017, the Centers for Medicare and Medicaid Services (CMS) instituted a small relative value unit (RVU) reduction in the professional fee payment for endoscopy performed with anesthesia assistance (AA) for the patient. The current study examined trends in AA growth in 4 U.S. regions for the 3 years before and after the payment change.
In the 3 years before the change, the rate of AA use increased by 1.11% per quarter for routine outpatient colonoscopies and endoscopies. In the post-period, the rate of increase slowed to 0.66% per quarter. The association between AA use and factors such as increased morbidity (relative risk [RR], 1.055) and obstructive sleep apnea (RR, 1.021) was very weak. AA use increased from 58.3% in the first quarter of 2014 to 77.7% in the fourth quarter of 2019. The slowing of the rate of increase was highest in the Midwest, with essentially no change in the rate of rise in the Southern or Western U.S. regions. Overall rates of AA utilization remained highest in the South, followed by the Northeast, then the Midwest, and lowest in the West.
COMMENTThese data indicate that the financial disincentive instituted in 2017 by CMS was insufficient to have a major impact nationally on the use of anesthesia for upper endoscopy and colonoscopy.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
CITATION(S)
Adams MA, Gao Y, Kumbier K, Rubenstein JH. Impact of a policy to address low-value use of anesthesia assistance for routine gastrointestinal endoscopy. Gastroenterology 2022 Mar 15. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2022.03.013)
