BCBS of Massachusetts faces backlash from docs over anesthesia coverage policy change (Fierce Healthcare)

Blue Cross Blue Shield Massachusetts (BCBSMA) is facing significant backlash from gastrointestinal groups over its new policy, effective January 1, which will restrict coverage of monitored anesthesia care (MAC) for patients undergoing endoscopic procedures like colonoscopies. The policy change affects patients classified as American Society of Anesthesiologist class I or II, typically without accompanying comorbidities.

Key Points from the Article:

1. Policy Details: The new BCBSMA policy will no longer cover MAC for certain patients undergoing endoscopic procedures, including colonoscopies, bronchoscopies, and some pain procedures. Instead, these patients will only be covered for moderate sedation.
2. Backlash from Medical Groups: National groups such as the American College of Gastroenterology, the American Society for Gastrointestinal Endoscopy, and the American Gastroenterology Association have criticized the decision. They argue that it will lead to less safe clinical conditions, lower quality of care, and worsen Massachusetts’ backlog of screenings.
3. Concerns Raised by Physicians: Physicians like Dr. Max Tilson, Vice President of the Massachusetts Gastroenterology Association, express concerns that this policy change will exacerbate public health problems, especially with rising disease rates and the importance of colonoscopies in identifying and preventing colorectal cancer.
4. BCBSMA’s Stance: BCBSMA defends its decision, stating that the policy spares certain groups, including those with conditions requiring regular colonoscopies, patients with a failed procedure, those with a fear of medical procedures, and patients with chronic conditions needing deep sedation. The insurer argues that moderate sedation is comparably safe and more cost-effective for certain patients.
5. Impact on Patients and Providers: Critics of the policy note that patients expecting to be put under for a colonoscopy may be uncomfortable with the idea of remaining awake. The policy could lead to increased wait times and stress for both providers and patients. Additionally, there are concerns about the training of nurses in administering moderate sedation and the potential impact on workforce and safety standards.
6. Potential National Implications: There is a fear that if the policy is successfully implemented in Massachusetts, it might be adopted nationally, significantly impacting the screening and treatment landscape for gastrointestinal diseases.