Why a new colonoscopy policy upset docs

Also: Respiratory illnesses are on the rise; Healey's budget cuts to MassHealth [Donate ❤️]( [View in Browser](  January 9, 2024 Hi CommonHealth reader, If you've ever had a colonoscopy, you know it can be unpleasant. Prepping for the procedure requires fasting, drinking a laxative and giving yourself diarrhea to empty the colon. In the procedure room, doctors insert a long tube with a camera into the anus, inflate the colon and search for growths known as polyps. But there's a reason for the unpleasantness: Colonoscopies are widely considered a critical tool for detecting cancer and preventing illness and death. Doctors often prefer to put patients to sleep for the procedure, using anesthesia. This is done about 60% of the time across Massachusetts, [according to my reporting]( and at some clinics, virtually every procedure involves anesthesia. But a new insurance policy from Blue Cross Blue Shield of Massachusetts could change the way colonoscopies are done. Blue Cross officials say many patients don't need anesthesia, which is also known as deep sedation. Instead, they say, patients at low risk of complications can be screened while sedated — but still awake. As of Jan. 1, Blue Cross officials said they will pay only for anesthesia they consider medically necessary. [This policy change has triggered a backlash among gastroenterologists.]( (They are so concerned that several quickly returned my calls during their holiday breaks.) These doctors told me that when patients are awake for an endoscopy procedure — which is known as conscious or moderate sedation — they can feel uncomfortable and crampy. Sometimes, if the patient is in pain, doctors have to stop the exam and try again another day. Dr. Braden Kuo, a gastroenterologist at Massachusetts General Hospital, said limiting the use of anesthesia could discourage people from getting a procedure that already makes them squeamish. "It is very short-sighted," Kuo said of the [Blue Cross policy](. "That short-term theoretical cost savings is going to traumatize patients. It's going to affect their willingness to have future colonoscopies that can prevent downstream colon cancer and complications — which will cost the health care system more money and ultimately, even more importantly, affect patients' lives." Why are doctors so worked up about this? They say colonoscopies are the gold standard for identifying colon cancer and preventing deaths from cancer. And they're still catching up on a backlog of screenings from when these procedures stalled during the early part of the COVID pandemic. Blue Cross executives, meanwhile, say their policy is aligned with national guidelines and will allow anyone who truly needs anesthesia to receive it. This includes people with various medical conditions and people who have a fear of medical care. "Our goal is to make sure that the care that we cover is clinically appropriate and consistent with the clinical guidelines," said Dr. Sandhya Rao, chief medical officer at Blue Cross. Blue Cross officials and gastroenterologists have been going back and forth on this change for a while. The company updated its policy and delayed the implementation for six months after listening to doctors, Rao said. But Dr. Lauren Bleich, president of the Massachusetts Gastroenterology Association, said the situation has been chaotic. She described it this way: "[We have] patients calling up and screaming at staff, canceling appointments out of fear or confusion, and staff not knowing if they’re proceeding correctly." Does this insurance policy change how you're thinking about your next colonoscopy? Let me know at [pdmcc@bu.edu](mailto:pdmcc@bu.ed), and [read my full story here](. P.S.— This newsletter will be off next week because of the Martin Luther King Jr. Day holiday. We'll be back on Jan. 23. 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