Author Affiliations: RAND Corporation, Boston, Massachusetts (email@example.com).
In Reply: Dr Scemama and colleagues, Dr Rex, and Dr Perel point out that the increased use of anesthesia services during gastrointestinal endoscopies is partly driven by a preference to use propofol for sedation, which can only be administered by persons trained in general anesthesia in the United States. We agree and are aware of the ongoing debate about the merits of this restriction, but cannot contribute to it based on our data. The choice of the sedation approach is currently driven by a complex set of factors, including patient and clinician preferences, clinical need, regulatory requirements, and financial considerations.1 More evidence is needed to inform rational clinical decisions and a payment system that rewards evidence-based practice. However, our analysis shows that current practice is not aligned with current standards of care and that the overall cost of potentially discretionary spending warrants further investigation into this issue.
Liu H, Mattke S. Anesthesia Care for Low-Risk Patients Undergoing Gastrointestinal Endoscopies—Reply. JAMA. 2012;307(24):2585–2587. doi:10.1001/jama.2012.6541