To the Members of the Massachusetts Gastroenterology Association,
On behalf of the MGA board of directors, along with strong support from gastroenterologists throughout the state, along with support from the Massachusetts Society of Anesthesiologists (MSA), I am reaching out with an update regarding our efforts in opposition of the Blue Cross Blue Shield (BCBS) policy number 154 regarding the coverage of monitored anesthesia care (MAC) in GI procedures. This policy is set to be enforced as of July 1, 2023. As you are aware, one of the MGA’s primary missions is to promote high quality and cost-effective GI care for the patients in our state. Whether you are a part of a private practice, hospital-based group, multi-specialty group or other setting, we can all benefit from working together.
The MGA has been working with members of the MSA, MHA (Massachusetts Health & Hospital Association), MMS (Massachusetts Medical Society), and MAASC (Massachusetts Association of Ambulatory Surgery Centers). We are also in discussions with ASGE regarding updates to the 2018 guidelines that BCBS is utilizing to argue that conscious sedation is sufficient for patients undergoing GI procedures, as well as ACG, AGA, DHPA and MNA (Massachusetts Nursing Association).
Our arguments against this BCBS policy include:
- The current backlog in procedure availability as a result of the COVID-19 pandemic, as well as recent recommendations to lower the screening age to 45 years old
- Patients have received propofol for at least 10 years (one CRC screening cycle for average risk patients), and now expect this type of anesthesia for their procedures
- Sedation choices should be determined by patient & their physician, not dictated by insurance
- -Concerns regarding increased risk for possible failed procedures, inadequate sedation, pain and post-procedure nausea
- Legalization and increased usage of marijuana products, leading to increased needs for sedation
- Conscious sedation will require training of nurses and GI physicians (recent graduates) who lack sufficient training, in the setting of a significant labor shortage in the healthcare industry
As a result, this suggested policy will limit access to high-quality care for BCBS members.
We will continue to update you in our efforts to oppose this consequential policy. Please continue to support the MGA by asking your GI colleagues and fellows to join the MGA (Massachusetts Gastroenterology Association - Join (massgi.org). Together we will continue to work to provide the best care for our patients.
Lauren Bleich, MD- MGA President