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Anesthesia Service Use and the Uptake of Screening Colonoscopies

Hirshman, Samuel AB; Mattke, Soeren MD, DSc; Liu, Hangsheng PhD

doi: 10.1097/MLR.0000000000000690
Original Articles

Background: The Center for Medicare & Medicaid Services recently defined “screening colonoscopy” to include separately furnished anesthesia services.

Objective: To examine the relationship between anesthesia service use and the uptake of screening colonoscopies.

Study Design: We correlated metropolitan statistical area (MSA) level anesthesia service use rates, derived from the 2008, 2010, and 2012 Medicare and MarketScan claims data, with the presence of individual level guideline concordant screening colonoscopy using the Behavioral Risk Factor Surveillance System data for the same years.

Measures: Proportion of colonoscopies with anesthesia service was calculated at the MSA level. A guideline concordant screening colonoscopy was defined as a colonoscopy received within the past 10 years.

Results: The average MSA level anesthesia service use rate in colonoscopy significantly increased from 25.34% in 2008 to 44.25% in 2012; but only a moderate increase in the rate of guideline concordant colonoscopies was observed, from 57.36% in 2008 to 65.32% in 2012. After adjusting for patient characteristics, we found a nonsignificant negative association between anesthesia service use rate and colonoscopy screening rate, with an odds ratio of 0.90 for receiving a guideline concordant colonoscopy for each percentage point increase in anesthesia service use rate (P=0.27). The relationship between anesthesia service use and the overall colorectal cancer screening rate followed the same pattern and was also not statistically significant.

Conclusions: No significant association between anesthesia service use and colonoscopy screening or colorectal cancer screening rates was found, suggesting that more evidence is needed to support the Center for Medicare & Medicaid Services rule change.

Supplemental Digital Content is available in the text.

RAND Corporation, Boston, MA

Supported by Ethicon Endo-Surgery Inc.

The study was approved by RAND’s Institutional Review Board.

The authors declare no conflict of interest.

Reprints: Hangsheng Liu, PhD, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116. E-mail:

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