A great deal has been written about the Massachusetts health care reform law passed when Mitt Romney was Governor, and it will be referred to often during the upcoming Presidential election. But who to believe? Both sides are capable of misrepresenting issues, so I went looking for data. I found an excellent source in the book The Great Experiment: The States, The Feds, and Your Healthcare. Chapter 7 is titled “Evaluating the Massachusetts Experiment: The Data”
The authors make the point that it takes a while before we can see results an draw conclusions:
The fact is that only now, in 2012, are we starting to get a clearer and fuller picture of the impact of a reform that reshaped significant aspects of the Massachusetts health care system. Many questions remain unanswered, and in some areas of interest, the data remain sparse.
Kindle edition is $5. Chapter 7 alone is worth that.
The Skeptical Scalpel as posted on the recent JAMA article titled “Utilization of Anesthesia Services During Outpatient Endoscopies and Colonoscopies and Associated Spending in 2003-2009“. I would love to read Lee Fleisher’s editorial, but can’t because it’s behind a paywall and, well, I am no longer a member of the AMA.
Let me just add that what follows is my personal opinion, not that of my group or of my professional Society.
1. Ask an experienced endoscopy nurse who has been present during conscious sedation colonoscopies AND endoscopies done with propofol which she would prefer. That answer tells me more than any “proven safety or patient experience benefit”.
2. When my wife needs another colonoscopy, one of my anesthesiology colleagues will be there to take care of her. If I have to pay more for that, I’d be happy to. She and I will be going home thirty minutes after her procedure while the ‘endoscopists administered sedation’ patient spends the morning there.
3. Anyone who implies that anesthesiologists are behind this trend toward toward increased utilization is without a clue. The endoscopy units are demanding our services. We are not forcing ourselves on them. I do much better financially if I spend a day in the operating room rather than doing 20-45′ procedures with long breaks in between.
4. It does come down to money–money for the endoscopy centers and the endoscopists who own them. A center staffed with anesthetists can pump through many more procedures in a day than one using conscious sedation.
5. I am growing tired of trying to instill my fields’ approach to patient safety into efforts outside my own operating room only to be accused of trying to protect my turf or maximize my income. That’s not how my (our) brains works. If you want to know how to do things safely I am happy to help you figure that out. If not, fine. Go knock yourself out.
