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Invited Commentary
March 2017

What Can the Use of Anesthesia Services for Endoscopy in the Veterans Health Administration Teach Us About Appropriate Care?

Author Affiliations
  • 1Leonard Davis Institute of Healthcare Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Intern Med. 2017;177(3):438. doi:10.1001/jamainternmed.2016.8571

Given the current interest in moving from volume to value, there is increasing attention paid to the area of appropriateness of medical care. This has led to the development of campaigns such as Choosing Wisely, which reminds consumers and clinicians to determine whether care has minimal or no value. Third-party payers, including insurers and the Centers for Medicare and Medicaid Services, have developed alternative payment mechanisms such as bundled payments and accountable care organizations to try to decrease the use of low- or no-value services. The provision of anesthesia services routinely for low-risk patients has been one of the areas in which the value of the service has been questioned.1 In this issue of JAMA Internal Medicine, Adams and colleagues2 report on trends in the use of monitored anesthesia care (MAC) for endoscopy in the Veterans Health Administration (VHA) as a means of further informing this debate. They report an increase in the use of MAC over time in the VHA but find that the overall rate remains low.

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