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Comment & Response
October 2016

American Society of Anesthesiologist Classification—Higher Incentives for Higher Scores

Author Affiliations
  • 1Department of Medicine, University of Texas Southwestern Medical Center, Dallas
JAMA Intern Med. 2016;176(10):1577-1578. doi:10.1001/jamainternmed.2016.5442

To the Editor I read with interest the research letter by Nie et al in a recent issue of JAMA Internal Medicine on upcoding of American Society of Anesthesiologists (ASA) classification during endoscopy.1 This has long been a closed-door talk not described before. Liu et al reported that between 2003 and 2009, the proportion of endoscopic procedures using anesthesia services more than doubled.2 They estimated that more than two-thirds of the patients were low risk. The gastroenterology professional societies do not recommend routine assistance of anesthesiologist during endoscopic procedures for low-risk patients. A few third-party payors responded by limiting reimbursements to only high-risk patients, with one of the criteria of high-risk patients being an ASA score of III or higher. Nie et al show that following this guideline more patients were assigned a higher ASA score and speculate that this is driven by financial incentives.1

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