A Bundled Payment Framework for Colonoscopy Performed for Colorectal Cancer Screening or Surveillance

Brill, Joel V.; Jain, Rajeev; Margolis, Peter; Kosinski, Lawrence R.; Holt, Worthe; Ketover, Scott R.; Kim, Lawrence S.; Clote, Laura E.; Allen, John I.

doi:10.1053/j.gastro.2014.01.043

Cited by 39 publications

(16 citation statements)

References 28 publications

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“…Currently, there are significant financial incentives for endoscopy practices to continue using anesthesia-administered propofol[13,14], thereby limiting the number of providers willing to invest in a CAPS system. However, with the anticipated advent of bundled payment for screening and surveillance colonoscopy[15-17], we believe that non-anesthesiologist-administered propofol sedation has considerable potential once the United States health care financial landscape changes. In our unit, the universal enthusiasm for non-anesthesiologist-administered propofol sedation on the part of nurses, doctors and patients motivated us to develop so-called nurse-administered propofol continuous infusion sedation (NAPCIS), which is a method of propofol delivery that replicates the capabilities of CAPS by using programmable intravenous fluid infusion pumps commonly available in the hospital (Alaris ® pump module, Becton Dickinson, Franklin Lakes, NJ, United States).…”

Section: Discussionmentioning

confidence: 99%

One year experience with computer-assisted propofol sedation for colonoscopy

Lin

Selva

Kozarek

et al. 2017

WJG

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AIMTo report our one-year experience with computer assisted propofol sedation (CAPS) for colonoscopy as the first United States Medical Center to adopt CAPS technology for routine clinical use.METHODSBetween September 2014 and August 2015, 2677 patients underwent elective outpatient colonoscopy with CAPS at our center. All colonoscopies were performed by 1 of 17 gastroenterologists certified in the use of the CAPS system, with the assistance of a specially trained nurse. Procedural success rates, polyp detection rates, procedure times and recovery times were recorded and compared against corresponding historical measures from 2286 colonoscopies done with midazolam and fentanyl from September 2013 to August 2014. Adverse events in the CAPS group were recorded.RESULTSThe mean age of the CAPS cohort was 59.9 years (48.7% male); 31.3% were ASA I, 67.3% ASA II and 1.4% ASA III. 45.1% of the colonoscopies were for screening, 31.5% for surveillance, and 23.4% for symptoms. The mean propofol dose administered was 250.7 mg (range 16-1470 mg), with a mean fentanyl dose of 34.1 mcg (0-100 mcg). The colonoscopy completion and polyp detection rates were similar to that of historical measures. Recovery times were markedly shorter (31 min vs 45.6 min, P < 0.001). In CAPS patients, there were 20 (0.7%) cases of mild desaturation (< 90%) treated with a chin lift and reduction or temporary discontinuation of the propofol infusion, 21 (0.8%) cases of asymptomatic hypotension (< 90 systolic blood pressure) treated with a reduction in the propofol rate, 4 (0.1%) cases of marked agitation or discomfort due to undersedation, and 2 cases of pronounced transient desaturation requiring brief (< 1 min) mask ventilation. There were no sedation-related serious adverse events such as emergent intubation, unanticipated hospitalization or permanent injury.CONCLUSIONCAPS appears to be a safe, effective and efficient means of providing moderate sedation for colonoscopy in relatively healthy patients. Recovery times were much shorter than historical measures. There were few adverse events, and no serious adverse events, related to CAPS.

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Section: Discussionmentioning

confidence: 99%

One year experience with computer-assisted propofol sedation for colonoscopy

Lin

Selva

Kozarek

et al. 2017

WJG

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“…In the West, substantial increases in health‐care expenditure are a challenge for the sustainability of health‐care delivery . Specifically in the USA , where health‐care expenditure has nearly doubled the rate of annual inflation over the last two decades, significant health‐care reforms have been implemented.…”

Section: Clinical Strategies For Optical Diagnosis In Western Practicementioning

confidence: 99%

“…In the West, substantial increases in health-care expenditure are a challenge for the sustainability of health-care delivery. 38 Specifically in the USA, where health-care expenditure has nearly doubled the rate of annual inflation over the last two decades, significant health-care reforms have been implemented. The Patient Protection and Affordable Care Act (ACA) was signed into US law in 2010, and aims to expand 39 Payment reform and 'bundling' of payments have seen a shift from a fee-for-service model to a value-based model, and significant reductions in reimbursement for some endoscopic procedures.…”

Section: Clinical Strategies For Optical Diagno-sis In Western Practicementioning

confidence: 99%

Optical diagnosis of colorectal neoplasia: A Western perspective

Sakata

Kheir

Hewett

2016

Digestive Endoscopy

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Optical diagnosis is an emerging paradigm in Western endoscopic practice for the colonoscopic management of diminutive polyps, and includes two complementary clinical strategies: 'resect and discard', in which diminutive high-confidence adenomas are identified, and then removed and discarded without pathological assessment; and 'diagnose and leave', where diminutive highconfidence hyperplastic polyps are identified in the rectosigmoid and then left without resection or biopsy. Like other aspects of colonoscopy performance, adoption of optical diagnosis in Western practice is limited by operator dependency and variation in clinical effectiveness. There is substantial potential for optical diagnosis of colorectal neoplasia during colonoscopy to alleviate the rising costs of health care in the West. However, operator dependence in diagnostic performance together with critical system factors such as informed consent, credentialing, medical legal support and reimbursement incentives must be overcome before optical diagnosis of diminutive lesions is considered for widespread adoption in Western clinical practice.

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“…The American Gastroenterological Association has proposed a bundled payment framework for colorectal cancer screening and surveillance, which includes the costs of pathology. [15] Both paradigms of optical diagnosis may be attractive options for providing value-based care within this framework. [16][17][18] This study demonstrated that older males were more likely to support "resect and discard," but no patient factors were associated with acceptance of "diagnose and leave."…”

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confidence: 99%