Aetna Announces Delay in Implementation of New Clinical Policy.Decision on Monitored Anesthesia Care monitored anesthesia care Anesthesiology A philosophy for administering local anesthesia, which ↑ Pt comfort and safety, through use of formal anesthesiology services–eg, an anesthesiologist or a certified nurse/ registered nurse anesthetist Seeks to Avoid Impact on Colon Cancer colon cancer, cancer of any part of the colon (often called the large intestine). Colon cancer is the second most common cancer diagnosed in the United States. Screening Rates, Provides Transition to Patient-Friendly Alternatives in Emerging New Sedation Sedation Definition Sedation is the act of calming by administration of a sedative. A sedative is a medication that commonly induces the nervous system to calm. Purpose The process of sedation has two primary intentions. Approaches HARTFORD, Conn. -- Aetna (NYSE NYSE See: New York Stock Exchange : AET AET Aetna, Inc. AET After Extra Time AET Actual Evapotranspiration AET Alliance for Environmental Technology AET Alpha-Ethyltryptamine AET Applied Extrusion Technologies, Inc. ) today announced that it will delay the effective date of a new clinical policy addressing the medical necessity of an anesthesiologist's services during routine upper and lower endoscopic en·do·scope n. An instrument for examining visually the interior of a bodily canal or a hollow organ such as the colon, bladder, or stomach. en procedures, such as a colonoscopy Colonoscopy Definition Colonoscopy is a medical procedure where a long, flexible, tubular instrument called the colonoscope is used to view the entire inner lining of the colon (large intestine) and the rectum. . Aetna has always covered moderate sedation, which is delivered by the treating physician, and is the type of sedation used for the majority of colonoscopies across the country. In the new policy, which was announced in late December, Aetna continues to cover moderate sedation, but only covers monitored anesthesia care for high-risk patients. The policy was scheduled to be effective on April 1, 2008. Aetna will now delay implementation until patient-friendly alternatives - which will not require the added expense of an anesthesiologist Anesthesiologist A medical specialist who administers an anesthetic to a patient before he is treated. Mentioned in: Anesthesia, General, Appendectomy, Parathyroidectomy anesthesiologist - are approved by the Food and Drug Administration (FDA FDA abbr. Food and Drug Administration FDA, n.pr See Food and Drug Administration. FDA, n.pr the abbreviation for the Food and Drug Administration. ) and available in the marketplace. "Aetna believes that we have a responsibility to encourage physicians to follow clinical practices based on the best medical evidence," said Troyen A. Brennan, M.D., Aetna's chief medical officer. "It's not only important to the health of our nearly 37 million unique members, but it promotes affordable quality health care and access to important procedures, such as cancer screening, which we consider top priorities. "We have determined that in those few markets where monitored anesthesia care (MAC) has become the routine approach to sedation, implementation of our policy on April 1 would inconvenience our members in those markets and potentially depress cancer screening rates in the short term." In addition, Aetna said that some groups and individuals unfortunately have chosen to misinterpret mis·in·ter·pret tr.v. mis·in·ter·pret·ed, mis·in·ter·pret·ing, mis·in·ter·prets 1. To interpret inaccurately. 2. To explain inaccurately. the new policy as no longer covering sedation, and have suggested that the policy would negatively impact screening rates. Neither is true. Aetna has always covered moderate sedation for routine colonoscopies and endoscopies, and that the company's member data confirms there is no relationship between improved screening rates and the use of monitored anesthesia care. Aetna believes such misinformation mis·in·form tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms To provide with incorrect information. mis can cause confusion among its members and could negatively impact colon cancer screening rates. Such an outcome is unacceptable to Aetna. Aetna hopes that the delay in implementing this policy will allow adequate time for the arrival on the market of attractive, patient-friendly alternatives to anesthesiologist-monitored sedation services. New medical devices, as well as new sedatives, are expected on the market during the late summer, and are in review with the FDA now. They are designed to provide a patient experience that is very similar, or perhaps better, than MAC, but can be managed exclusively by the GI performing the screening procedure. Both would eliminate the significant expense of having a second physician attending during a routine screening service for a healthy patient. "Once these new options are available in the marketplace, we will move forward with our policy. Aetna considers the health of our members, and their access to preventive screenings and affordable quality health care, top priorities," Dr. Brennan said. "Our goal is to improve the consistency of care delivered to our members nationally, align that care with the best evidence available and remove unnecessary costs from the health care system. These are worthwhile goals that should be shared by the medical community, and we will continue to work with care providers to achieve them." About Aetna Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 36.7 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health Behavioral health was first used in the 1980's to name the combination of the fields mental health and substance abuse. As an example, an organization serving both mental health and substance abuse clients might refer to its practice as behavioral health or , group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, and government-sponsored plans in the U.S. and internationally. Aetna's international businesses include Aetna Global Benefits, Aetna's expatriate benefits division that focuses on providing comprehensive solutions to employees working, traveling and living in over 100 countries. www.aetna.com |
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