Aetna postpones policy changes to sedation coverage

Aetna Inc. said Wednesday it will delay a proposed policy that would stop covering the cost of using anesthesiologists during colonoscopies.

The policy had been opposed by a group of New Jersey doctors and others who said denying coverage of anesthesiologists to anxious patients would lead to fewer cancer screenings.

Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.

The Hartford-based insurer's policy was to take effect Apri1 1. Aetna said it will now be implemented after the U.S. Food and Drug Administration approves other forms of sedation.

"Implementation of our policy on April 1 would inconvenience our members ... and potentially depress cancer screening rates in the short term," said Dr. Troyen Brennan, Aetna's chief medical officer.

Aetna initially announced its policy in December in an attempt to address questions about the medical necessity of an anesthesiologist's services during routine upper and lower endoscopic procedures, such as colonoscopies. Aetna would still cover anesthesiologists for high-risk patients.

The change was opposed by medical groups in New Jersey and Pennsylvania, as well as other medical groups that said patients should be assured that their insurance coverage includes the cost of anesthesiologists who administer propofol, an anesthesia the doctors say is effective and comfortable.

"We laud them for taking that move, not only for our physicians but also for their patients," said Michael Kornett, chief executive of the Medical Society of New Jersey.

Aetna has said moderate sedation works just as well and does not require an anesthesiologist, which can drive up the cost of the procedure by between $200 and $1,000. Gastroenterologists generally decide whether to use propofol or moderate sedation.

Aetna said it hopes delaying the policy will allow adequate time for new "attractive, patient-friendly alternatives to anesthesiologist-monitored sedation services" to be approved by the FDA.

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, Aetna said.

Once that occurs, Aetna will implement its policy, Brennan said.

Kornett said he doubts the effectiveness of new devices that he said will take a few years to come on the market.

"I can't imagine how a device will take the place of human judgment," he said.

Joel Brill, a Phoenix gastroenterologist who participated in discussions with Aetna and praised the insurer for changing its policy, said he would be comfortable using a computer-assisted sedation system that would administer propofol. The machine would allow the endoscopist to administer propofol without an anesthesiologist or nurse anesthesist, he said.

"We continue to evolve. We continue to benefit from advances in medical devices and technologies," Brill said.

Colorectal cancer is the second leading cause of cancer death in the United States and regular screening could eliminate as many as 60 percent of deaths each year, according to the U.S. Centers for Disease Control and Prevention.

Aetna stock rose 4 cents, to $52.30, in afternoon trading.