title: Anesthesia Service Use During Outpatient Gastroenterology Procedures Continued to Increase From 2010 to 2013 and Potentially Discretionary Spending Remained High.
abstract: Previous studies have identified an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk patients. The aim of this study was to update these trends with the most recent years of data.
  
  
  
  We used Medicare and commercial claims data from 2010 to 2013 to identify GI procedures and anesthesia services based on CPT codes, which were linked together using patient identifiers and dates of service. We defined low-risk patients as those who were classified as ASA (American Society of Anesthesiologists) physical status class I or II. For those patients without an ASA class listed on the claim, we used a prediction algorithm to impute an ASA physical status.
  
  
  
  Over 6.6 million patients in our sample had a GI procedure between 2010 and 2013. GI procedures involving anesthesia service accounted for 33.7% in 2010 and 47.6% in 2013 in Medicare patients, and 38.3% in 2010 and 53.0% in 2013 in commercially insured patients. Overall, as more patients used anesthesia services, total anesthesia service use in low-risk patients increased 14%, from 27,191 to 33,181 per million Medicare enrollees. Similarly, we observed a nearly identical uptick in commercially insured patients from 15,871 to 22,247 per million, an increase of almost 15%. During 2010-2013, spending associated with anesthesia services in low-risk patients increased from US$3.14 million to US$3.45 million per million Medicare enrollees and from US$7.69 million to US$10.66 million per million commercially insured patients.
  
  
  
  During 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.
authors.affiliation: RAND Corporation, Boston, Massachusetts, USA.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Predmore
authors.affiliation: RAND Corporation, Santa Monica, California, USA.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Nie
authors.affiliation: RAND Corporation, Santa Monica, California, USA.
authors.forename: Regan
authors.initials: R
authors.lastname: Main
authors.affiliation: RAND Corporation, Boston, Massachusetts, USA.
authors.forename: Soeren
authors.initials: S
authors.lastname: Mattke
authors.affiliation: RAND Corporation, Boston, Massachusetts, USA.
authors.forename: Hangsheng
authors.initials: H
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000191:economics / Q000379:methods* / Q000639:trends; D000072077:Anesthetists / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D016292:Procedural Sedation / Q000191:economics / Q000379:methods / Q000639:trends; D054810:Deep Sedation / Q000191:economics / Q000379:methods / Q000639:trends; D016145:Endoscopy, Digestive System / Q000191:economics / Q000379:methods* / Q000639:trends; D005260:Female; D005762:Gastroenterology / Q000191:economics / Q000379:methods* / Q000639:trends; D005102:Health Expenditures; D006801:Humans; D016247:Information Storage and Retrieval; D016015:Logistic Models; D008297:Male; D006278:Medicare; D008875:Middle Aged; D015999:Multivariate Analysis; D014481:United States; D055815:Young Adult