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Thursday, February 28, 2008

Coming soon to your Aetna health policy: The "Only wusses need sedation" doctrine
Posted by Jill | 1:01 PM
Last year, after much anxiety and trauma, I finally had the colonoscopy you're supposed to have when you turn 50. It was done at an outpatient surgical center, with sedation (propofol) administered by a board-certified anesthesiologist. I felt woozy, and the next thing I knew I was awake. Piece of cake.

Given that propofol has no reversal agent, and I am terrified of anesthesia, the fact that an anesthesiologist was on the case helped alleviate any fear of never waking up.

Some people have reported waking up during the procedure, others tell horror stories about memories of the procedure occurring later on, despite the amnesia effect of the other, more commonly used drug, Versed.

Colonoscopy is one of the procedures people dread most. That dread is the reason most people put off having one, when any polyps that are found can be removed before they become cancerous. That mine was so trauma-free is the main reason why I don't have any qualms about having another one when it's time. In theory, this should reduce my risk of incurring large bills for cancer treatment later on.

The other reason I have no qualms about another colonoscopy is that my insurance provider is not Aetna. Because it took a serious outcry to get Aetna to back off its plans to stop covering the use of anesthesiologist-administered propfol for colonoscopy:

owing to critics who contended it was putting profits before patients, Aetna said Wednesday that it had suspended — at least temporarily — a plan to stop paying for routine use of a powerful anesthetic in a procedure to screen for colon cancer.

The drug, propofol, provides quick and reliable sedation for patients who are undergoing a colonoscopy, an examination of the lower intestine with a flexible probe that provides the most thorough form of screening for colon cancer.

Because of federal regulatory recommendations and, in some cases, specific state regulations, propofol is often administered by an anesthesiologist instead of the doctor performing the colonoscopy.

Aetna said in December that it would stop paying for the use of propofol in routine cases as of April 1 because research showed the participation of an anesthesiologist added $300 to $1,000 to the screening costs without improving outcomes.

Aetna cited the practice as an example of unnecessary spending. It said doctors in many parts of the country who used propofol in just 10 percent of their cases were achieving the same results as those in areas like the New York City region, where close to 80 percent of patients received the drug.

Critics had said that restricting use of propofol would discourage patients from undergoing a colonoscopy. Cancers of the colon and rectum trail only lung and prostate cancer in cancer deaths among Americans, according to the Centers for Disease Control and Prevention, but survival rates are high when they are caught early.

Insurers have been split on whether to cover propofol for colonoscopies. Humana and WellPoint are among the large players that, like Aetna, have sought to curtail coverage while UnitedHealthcare, which has 26 million members, has advertised its intent to support propofol in all screenings. Medicare leaves the decision up to its local carriers, most of which have restrictive policies.

Some doctors maintain that propofol helps them by keeping patients calmer during screenings than the traditional cocktails they administered of sedatives like Versed and tranquilizers like Valium. And, because it wears off sooner, patients can go home more quickly.


Propofol has no reversal agent, so it must be administered by someone who knows what s/he is doing. On the plus side, it has a short half-life so overdosing is unlikely. But it must be titrated continually through the procedure.

This is a perfect example of insurance companies trying to cut corners at the expense of patient care. Colonoscopy is so effective in improving outcomes for patients where cancer is found because it can be detected early, and also effective in finding polyps before they can become cancerous or precancerous, you'd think that methods that make the procedure less frightening would be a no-brainer.

But then you'd have to believe that health insurance companies are in the business of health. And by now we all know that it's more profitable to cover patients who die younger than to cover procedures that might keep them around longer.

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4 Comments:
Blogger Citizen Carrie said...
The person at Aetna who came up with that idea probably has some weird fetish we're better off not knowing about. Either that or the person underwent an examination from space aliens at some time in his or her life.
2/28/08, 1:43 PM  
Anonymous Anonymous said...
I like Jill's "only wussies.." idea better.
But they used Fentenynl and a nurse anesthetist when I had mine. Does that mean I got shortchanged?
2/28/08, 2:55 PM  
Anonymous Anonymous said...
Some years ago I had to have a colonoscopy and my insurer didn't cover an anesthesiologist so the doctor administering the test had to go with the best drug he was authorized to administer (don't recall what it was.) He assured me I wouldn't feel a thing and wouldn't remember anything and I can assure you he was wrong on both counts. I came to during the procedure in excruciating pain trying to crawl off the table. The nurses had to break out restraints to keep me down. DO NOT let these bastards get away with this - that invasive a procedure requires anesthesia.
2/28/08, 6:56 PM  
Blogger Jayhawk said...
My colonoscopy was at the Mayo and they used Versed. I was awake throughout and remember every minute of it. Not only that, but there was bleeding so it had to be repeated two days later, and again the next week. I did not sleep through any one of the three. I also did not enjoy the two-week hospitalization and iv's required by the resulting intestinal infection.

I will never, ever have another colonoscopy.
2/29/08, 12:39 PM  
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