Aetna has announced that, based on input from the AGA Institute and discussions with a number of gastroenterologists, it will not implement Clinical Policy Bulletin 0740 on April 1, 2008, as planned. This policy would have restricted the use of an anesthesia professional in standard upper or lower endoscopic procedures, including colonoscopy, for average-risk patients.

Last month, we contacted Aetna on behalf of AGA members to express concern that this policy could negatively impact colorectal cancer screening rates, which are already discouragingly low. The AGA Institute commends Aetna for listening to our concerns. Aetna will now delay implementation until patient-friendly alternatives for sedation -- which will not require an anesthesiologist -- are approved by the FDA.

Along with our sister GI societies, we look forward to addressing concerns about payer sedation policies. Our goal is to ensure that payment policies do not pose a barrier to patients receiving medically necessary colorectal cancer screening and other endoscopic services.

"Aetna has engaged in an exchange of information and viewpoints with our society regarding the possible public health impact of this policy," said Joel V. Brill, MD, AGAF, chair of the American Gastroenterological Association (AGA) Institute practice management and economic committee. "The AGA Institute commends Aetna for listening to our concerns. We are dedicated to working with all stakeholders involved to provide clear recommendations to physicians, patients, purchasers and payers regarding the appropriate use of sedation for endoscopic procedures."

As noted in the August 2007 AGA Institute Review of Endoscopic Sedation. the AGA encourages practitioners to develop a structured sedation protocol suited to the needs of their patients and practice. We are committed to ensuring patients have access to medically necessary technologies, pharmaceuticals and services delivered by appropriately trained health-care professionals. Patients should feel confident that they are undergoing colorectal cancer screening and other endoscopic procedures in an environment that promotes safety, patient comfort and quality of care. Ultimately a qualified health-care practitioner should be the decision maker regarding the use and administration of sedation agents in conjunction with the patient.