Previous studies have identified an increasing number of gastroenterology (GI) procedures using anesthesia services to provide sedation, with a majority of these services delivered to low-risk ...patients. The aim of this study was to update these trends with the most recent years of data.
We used Medicare and commercial claims data from 2010 to 2013 to identify GI procedures and anesthesia services based on CPT codes, which were linked together using patient identifiers and dates of service. We defined low-risk patients as those who were classified as ASA (American Society of Anesthesiologists) physical status class I or II. For those patients without an ASA class listed on the claim, we used a prediction algorithm to impute an ASA physical status.
Over 6.6 million patients in our sample had a GI procedure between 2010 and 2013. GI procedures involving anesthesia service accounted for 33.7% in 2010 and 47.6% in 2013 in Medicare patients, and 38.3% in 2010 and 53.0% in 2013 in commercially insured patients. Overall, as more patients used anesthesia services, total anesthesia service use in low-risk patients increased 14%, from 27,191 to 33,181 per million Medicare enrollees. Similarly, we observed a nearly identical uptick in commercially insured patients from 15,871 to 22,247 per million, an increase of almost 15%. During 2010-2013, spending associated with anesthesia services in low-risk patients increased from US$3.14 million to US$3.45 million per million Medicare enrollees and from US$7.69 million to US$10.66 million per million commercially insured patients.
During 2010 to 2013, anesthesia service use in GI procedures continued to increase and the proportion of these services rendered for low-risk patients remained high.
The frequency with which anesthesiologists or nurse anesthetists provide sedation for gastrointestinal endoscopies, especially for low-risk patients, is poorly understood and controversial.
To ...quantify temporal comparisons and regional variation in the use of and payment for gastroenterology anesthesia services.
A retrospective analysis of claims data for a 5% representative sample of Medicare fee-for-service patients (1.1 million adults) and a sample of 5.5 million commercially insured patients between 2003 and 2009.
Total number of upper gastrointestinal endoscopies and colonoscopies, proportion of gastroenterology procedures with associated anesthesia claims, payments for gastroenterology anesthesia services, and proportion of services and spending for gastroenterology anesthesia delivered to low-risk patients (American Society of Anesthesiologists physical status class 1 or 2).
The number of gastroenterology procedures per million enrollees remained largely unchanged in Medicare patients (mean, 136,718 procedures), but increased more than 50% in commercially insured patients (from 33,599 in 2003 to 50,816 in 2009). In both populations, the proportion of procedures using anesthesia services increased from approximately 14% in 2003 to more than 30% in 2009, and more than two-thirds of anesthesia services were delivered to low-risk patients. There was substantial regional variation in the proportion of procedures using anesthesia services in both populations (ranging from 13% in the West to 59% in the Northeast). Payments for gastroenterology anesthesia services doubled in Medicare patients and quadrupled in commercially insured patients.
Between 2003 and 2009, utilization of anesthesia services during gastroenterology procedures increased substantially. Anesthesia services are predominantly used in low-risk patients and show considerable regional variation.
The Injury and Illness Prevention Program (IIPP) requirement has been the most frequently cited standard in California workplace health and safety inspections almost every year since it became ...effective in July 1991. This evaluation of the IIPP measures program effectiveness using information on citations for violations of the program and data on worker safety in California.
The Injury and Illness Prevention Program (IIPP) requirement has been the most frequently cited standard in California workplace health and safety inspections almost every year since it became ...effective in July 1991. Every workplace safety inspection must assess compliance with the IIPP. This article presents the results of an evaluation of the IIPP's effects on worker injuries in California and should inform policy both in California and in the federal Occupational Safety and Health Administration (OSHA) program, which has made the adoption of a similar national requirement a top priority. Using data from the Workers' Compensation Information System, OSHA Data Initiative statistics, and Workers' Compensation Insurance Rating Bureau of California reports on medical and indemnity claims from single-establishment firms, the evaluation team analyzed the impact of citations for violations of the IIPP on safety performance by (1) using the number of citations as a measure of effectiveness and (2) assessing the number of establishments that were cited for noncompliance and then came into compliance. They found that enforcement of the IIPP appears to prevent injuries only when inspectors cite firms for violations of specific subsections of that standard. Eighty percent of the citations of the IIPP by the California Division of Occupational Safety and Health program are for only a different section, the one that requires employers to have a written IIPP. The specific subsections refer to the provisions that mandate surveying and fixing hazards, investigating the causes of injuries, and training employees to work safely. Because about 25 percent of all inspections cite the IIPP, citations of the specific subsections occur in about 5 percent of all inspections. In those inspections, the total recordable injury rate falls by more than 20 percent in the two years following the inspection.
In principle, efforts to improve patient safety, if they are successful, should lead to reductions in claims of medical malpractice. In practice, however, this has not yet been systematically ...demonstrated to be so. The authors examined the relationship between safety outcomes in hospitals and malpractice claiming against providers, using administrative data and measures for California from 2001 to 2005. They found that decreases in the county-level frequency of adverse safety outcomes were positively and significantly associated with decreases in the volume of malpractice claims, as captured by records from four of the largest malpractice insurers in the state. This result suggests that policy options that improve patient safety may offer a new avenue for reducing malpractice pressure on physicians, at the same time that they improve clinical outcomes.
LIMITATIONS OF PREVIOUS RESEARCH John Mendeloff; Wayne B. Gray; Amelia M. Haviland ...
An Evaluation of the California Injury and Illness Prevention Program,
01/2012
Book Chapter
Odprti dostop
Overall, the research base on the effects of safety programs is thin, especially for mandatory programs. Safety magazines are replete with articles with titles like “How We Reduced Our Injuries by 80 ...Percent,” but the representativeness of these reports is suspect because successes are much more likely to be written up and published than failures.
A “regression to the mean” bias also often plagues these studies. This bias refers to the fact that new safety initiatives are often adopted as a response to an unusually bad year for injuries. Because the number of injuries at a workplace has a substantial
ACKNOWLEDGMENTS John Mendeloff; Wayne B. Gray; Amelia M. Haviland ...
An Evaluation of the California Injury and Illness Prevention Program,
01/2012
Book Chapter
INTRODUCTION John Mendeloff; Wayne B. Gray; Amelia M. Haviland ...
An Evaluation of the California Injury and Illness Prevention Program,
01/2012
Book Chapter
Odprti dostop
The modern era in U.S. occupational safety and health regulation began more than 40 years ago, when the Occupational Safety and Health Act of 1970 became law and created the Occupational Safety and ...Health Administration (OSHA). Although OSHA sponsors consultation and education programs, it has relied primarily on enforcing a set of safety and health standards governing specific hazards through inspections and penalties. The act transferred most authority for workplace safety and health regulation from the states to the federal government; however, it allowed states to enforce the law as long as their programs were “as effective as” the federal
In this chapter, we look at whether firms that had high injury rates within their industry were more likely to be noncompliant with the IIPP standard. Ideally, we would like to know whether ...noncompliance with the IIPP contributes to higher injury rates. Necessary, but not sufficient, conditions for that causal role are (1) that noncompliance and the injury rate are positively related and (2) that the noncompliance status precedes or occurs simultaneously with the injury rate. In the model we test here, we examine the relation between measures of injury performance and the status of IIPP compliance.
In all cases,
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