On anesthesia services.

Payment & Practice Management| February 2023 2023 Payment Changes for Anesthesia and Pain Services Helen Olkaba, MS Helen Olkaba, MS Search for other works by this author on: This Site PubMed Google Scholar ASA Monitor February 2023, Vol. 87, e4. https://doi.org/10.1097/01.ASM.0000919612.36588.ef Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation Helen Olkaba; 2023 Payment Changes for Anesthesia and Pain Services. ASA Monitor 2023; 87:e4 doi: https://doi.org/10.1097/01.ASM.0000919612.36588.ef Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: pain While there will be no changes in how you report your anesthesia services; there are some changes to the pain codes in 2023. Somatic Nerve Injection CPT codes 64415, 64416, 64417, 64445, 64446, 64447, and 64448 describe only injection of an anesthetic agent in the area of the peripheral nerve and/or catheter placement for postoperative pain management. Starting January 1, 2023, somatic nerve injection codes will be bundled with imaging services. In recent years, these codes have been frequently reported with imaging (CPT code 76942 (Ultrasound image guidance)). Due to the frequent reporting of imaging, these codes were identified by the CPT Editorial Panel and the RVS Update Committee (RUC) to be revised and imaging was bundled into the procedure codes. Table 1 lists the new code descriptions for Somatic Nerve Injection codes. This change also affects the reimbursement rates of the Somatic Nerve Injection codes. After the... You do not currently have access to this content.

Objective: Healthcare providers need to establish close relationships with patients planning to undergo major elective surgery as this helps produce positive patient outcomes. This study aimed at investigating surgery and anesthesia services and patients’ attitude toward informed consent at Ayder comprehensive specialized university hospital, in Northern Ethiopia. Material and Methods: A facility-based cross-sectional study was conducted in the biggest health facility in Northern Ethiopia. Four hundred ten patients with major elective surgery were recruited. A structured questionnaire was used to collect socio-demographics, anesthesia and surgery services and the attitude of patients toward informed consent. Descriptive results were presented using frequencies and tables. Regression analysis was accompanied by an odds ratio and a 95% confidence interval was run to identify factors associated with the outcome variable. Results: Study participants’ mean age was 36.1+11.7. Around two-thirds (71.7%) and one-fourth (26.6%) of the study participants were informed about their proposed surgical procedure and its possible complications, respectively. Two hundred ninety four (66.8%) and 88 (21.5%) were made aware of the type of anesthesia that was going to be administered and possible complications. About half (50.7%) had expressed a positive attitude towards informed consent. Rural residents have about twice (AOR=1.9; 95% CI: 1.06-2.73) higher odds of expressing a positive attitude towards the informed consent than their counterparts. Conclusion: The study revealed that the proportion of patients who were informed about their anesthesia-surgery services was moderate. Besides, patients’ attitude toward informed consent was poor. The residence was a good predictor of positive patients’ attitudes toward informed consent. Thus, healthcare professionals in the surgery department should establish clear and transparent communication with patients about surgery and anesthesia-related services.

Following the implementation of Bhutan’s first Five-Year Plan in 1961, the national healthcare system underwent a remarkable transformation. From its humble beginnings in primary healthcare, the country now offers anesthesia and surgical services nationwide. Despite this progress, the healthcare system continues to face persistent shortages in human resources and infrastructure, particularly in the field of anesthesia. This perspective offers a comprehensive historical overview of anesthesia services in Bhutan, while highlighting challenges and presenting recommendations for future improvement.

The Safe Surgery Saves Life campaign of the World Health Organization advocates patient safety best practices during surgical procedures. Anesthesia service is indivisible from the patient safety best practices. Although anesthesia services are safer than ever before, safe delivery of anesthesia service and patient safety depends significantly on the availability of qualified anesthesiologists, the knowledge and competency of anesthesiologists, the work environment, and the availability of essential equipment and monitoring facilities. Despite anesthesiologists being the midstream of perioperative care, their role and service are often underacknowledged, especially in low- and middle-income countries (LMICs). Anesthesia services in LMICs face myriad challenges such as a shortage of skilled personnel, inadequate resources, limited training opportunities, and minimal administrative say, which act as the fragile point in the chain of safe surgery delivery. Specific solutions should focus on strengthening the anesthesia workforce, providing fair remuneration and incentives, advocating for anesthesia autonomy, and facilitating access to educational resources. Nevertheless, managing these problems requires a collaborative effort involving governments, healthcare organizations, and international stakeholders to develop sustainable solutions and prioritize the well-being of both anesthesia providers and patients. This editorial focuses on it briefly, emphasizing the anesthesia of rural healthcare service and patient safety.

History of the establishment of the School of Anaesthetic Assistants (SAA ) in Sudan was mentioned in details where it was clear that in the late fifties and early sixties surgical services were expanding without similar expansion in anaesthetic services due to lack of interest from doctors in anaesthesia. This is taken as a prototype to what is happening in most African Countries (Akinyemi & Soyannwo 1980). The effort of the pioneers to overcome this problem was tremendous; they managed to solve the problem, though on a lower profile, by the establishment of the SAA, while their effort to gain more doctors to the specialty continued. The lack of job description for the anaesthetic assistants was clear. The curriculum of the school was updated. But the shortage of trainers was obvious. The study done in Soba University Hospital (SUH), Khartoum Teaching Hospital (KTH) & and some States hospitals showed clearly that the best anaesthetic outcome was obtained where both physician anaesthetist and anaesthetic assistant work together. The mortality rates were higher with the assistants working unsupervised, while morbidity was higher with the physician anaesthetists and this is due to their ability to recognize and manage complications more than the assistants. The study recommends that a clear job description for the assistants should be put forward. More effort should be spent to attract more doctors to the specialty. More care should be paid to the proper documentation for anaesthetic events in the patient record sheets. ABBREVIATIONS SAA (school of anaesthesia assistant) KTH (Khartoum Teaching Hospital) SUH (Sopa University Hospital) AA (anaesthesia assistant) INTRODUCTION History of the establishment of the School of Anaesthetic Assistants (SAA ) in Sudan was mentioned in details where it was clear that in the late fifties and early sixties surgical services were expanding without similar expansion in anaesthetic services due to lack of interest from doctors in anaesthesia. This may be due to the lack of doctors in the country as a whole. Amina (1995) stated that from 1898 till independence in 1955 the number of Sudanese doctors was only 150. At that time the intake of students to the medical school was every two years and the number did not exceed twelve student at most. The first registrars of anaesthesia were taken in April 1958. There was no proper training locally and they depended on self-learning till they left to United Kingdom to get their degrees. Those were Professor Eltahir Fadl Mahmoud and Dr. Abdel Ghani Farah (prof Eltahir F. 2001, pers. Comm., 3 April). METHODOLOGY A) Study site: This study was conducted at I) School of Anaesthetic assistants, Khartoum Teaching Hospital. II) Soba University Hospital (SUH) III) Khartoum Teaching Hospital (KTH) IV) Five hospitals from the States, namely Port Sudan, Kassala, Gadarif, El Rahad and Medani. B) The history of the SAA was taken by different means i) From records of the School. ii) Senior graduates of the School. iii) Pioneers who started the School. iv) the current Dean of the School. The Impact of Anaesthetic Assistants on Anaesthesia Service in Sudan 2 of 7 v) Individual Anaesthetists. C) The Selected hospitals were studied by the following means: i) Visits and appropriate data collection. ii) For KTH and SUH the study included a retrospective and prospective periods. SUH: Retrospective period: from Jan 98 to March 99 and from June 2000 to Dec 2000. Prospective period: from April 99 to Dec 99 and from January 2001 to June 2001. KTH: Retrospective period: From Jan 99 – April 2000. Prospective period: from May 2000 to Dec 2000 and from July 2001 to Oct 2001. Data collected included number of anaesthetics done, who conducted the anaesthesia, Hospitals in the States: data collected was mainly retrospective; from records when available or from assistants and surgeons working in these hospitals (Mohamed A 2000, Babiker A 2000, Abdalla A 2000, Mohamed E 2001, Eshag 2001, Yousif E 2001, Enour H 2001 pers. Cumm). Obtain recorded information from SUH, KTH and provinces as regards:Number of patients and type of anaesthesia 1. administered. Outcome and complication recorded. 2. Number and type of anaesthetic personnel in Sudan 3. general and in selected hospitals specially. Satisfaction and evaluation of surgeons and 4. obstetricians throw designed questioner from anaesthesia service. Designed questioner to the directors of hospitals 5. (5) hospitals were selected to know size of service provided by (AA) in these hospitals.

BackgroundPatient satisfaction is a subjective and challenging perception, linking physical, expressive, psychological, societal, and cultural factors. Dissatisfaction arises if the patient feels an inconsistency between expected and delivered care. Usually health care satisfactions are very high and according to many studies levels of satisfaction are above 85% and patient’s satisfaction in terms of anesthesia is not very different. The aim of this study was to assess patient’s satisfaction with perioperative anesthesia service and associated factors.MethodsInstitution-based cross-sectional study was conducted from December to January, 2017/8 at the Ayder Comprehensive Specialize Hospital. The data were collected using structured interviewer-administered questionnaire prepared to collect data on demographic character of the patients, determinant factors which could affect the patient satisfaction level on anesthesia service. Epi Info version 6 was used to record the data and SPSS version 20 was used for the analysis. Descriptive statistics were used to explore the socio-demographic characteristics of patients; factors possibly related to satisfaction level and overall satisfaction were summarized as frequencies and percentages.ResultsOne hundred twenty consecutive patients were originally enrolled in the study that took over 1 Month. The overall proportion of patients who satisfied with anaesthesia services was 88.33%. Nausea and vomiting, pain, shortness of breath and cold were factors which affected patient satisfaction negatively.Conclusion and recommendationCompared with the other studies done at home and abroad; the overall proportion of patients, in Ayder comprehensive specialized hospital, who responded for satisfaction with perioperative anesthesia service is low. Patient satisfaction level should be determined regularly and all bodies should work to decrease the factors which decrease the satisfaction level.

The first Minimum Guidelines for the Standards of Practice of Anaesthesia (the Guidelines) was approved by the Council of the Canadian Anaesthetists’ Society (the Society) on January 17, 1975 and published in booklet form in 1977. Several concurrent events drove the formulation of the Guidelines. The development of standards on ‘‘Anesthesia Services’’ by the Canadian Council on Hospital Accreditation (now Accreditation Canada) was an initial cause of concern in anesthesia circles, since it was perceived as an encroachment on ‘‘areas of responsibility’’. At about the same time, there were two unfortunate deaths under anesthesia that prompted the Canadian Medical Protective Association to consult with the Society and to advise them to propose minimum standards of anesthesia practice. The Committee on Standards of Practice was directed to prepare such guidelines, and a final draft, much like the form we see today, was accepted by 1974 and published in 1975 as a policy of the Canadian Anaesthetists’ Society. Dr. J. Earl Wynands, the President of the Society at that time, stated that the committee had produced ‘‘a major and definitive report that will have an impact on the practice and delivery of anaesthetic care in this country’’. All this, incidentally, occurred several years before the Harvard Standards were proposed in 1986, so the Society can be regarded as an international leader in the field of standards development and patient safety. The Guidelines were received with enthusiasm, although not universal support at that time, since some expressed concern that the Society had ‘‘set a standard that now had to be followed.’’ However, a consensus evolved recognizing that the Guidelines were intended to represent the generally accepted standard of care and that they served as a ‘‘stimulus for improving the quality of anesthesia practice’’. The Guidelines were written in such a manner as to provide flexibility for modification as anesthesia practice evolves, as monitoring techniques become more sophisticated, and as new technologies become available. The Guidelines were modified periodically at irregular intervals until 1989 and annually since then. In an early revision of the Guidelines, the term ‘‘standards’’ was removed from the title of the document, emphasizing instead the term ‘‘guideline’’ to indicate that the document was intended to represent a ‘‘statement of principle rather than a standard or required level of conduct’’. A contentious issue for some time was the role of general practitioners in providing anesthesia care in addition to Royal College trained specialists. This concern came about in the context of the general recognition that a significant proportion of health care in Canada took place in communities too small to support a specialist anesthesia practice. The eventual compromise was to define the practice of anesthesia as a ‘‘specialized field of medicine’’ while explicitly recognizing that ‘‘appropriately trained family physicians may be required to provide anesthesia services’’ in some communities. The role of anesthesia assistants (AA) was a similarly contentious issue. The role of paramedical personnel was first raised by Dr. Graves in a report to Council in 1968. The discussion of their role continued for many years and culminated in 2006 in a ‘‘Position Paper on Anesthesia Assistants’’ published by the Canadian Anesthesiologists’ Society as Appendix 5 to the Guidelines. The Society remains involved in defining the curriculum for AA training in a joint working group R. N. Merchant, MD (&) Department of Anesthesia and Perioperative Medicine, Royal Columbian Hospital, 330 Columbia St. E., New Westminster, BC V3L 3W7, Canada e-mail: richard.merchant@ubc.ca

Objectives:The objectives of this study are to 1) understand the differences in costs between rotator cuff repair (RCR) performed in ambulatory surgery center (ASC) versus outpatient hospital (OH) settings; 2) determine the patient’s out-of-pocket expenditure and surgeon reimbursement; and 3) characterize trends in expenditure for RCR over time.Methods:We identified patients who had undergone outpatient arthroscopic RCR in the United States (U.S.) using the IBM MarketScan Commercial Claims and Encounters Database. The database was chosen for its large, national sample of privately insured patients. Patients who had Current Procedural Terminology (CPT) code 29827 between April 1, 2013 and June 30, 2018 were included. Revision RCR procedures and procedures with a concomitant arthroscopic or open biceps tenodesis, Bankart repair, superior labrum anterior and posterior (SLAP) repair, lysis of adhesions (CPT: 29828, 23430, 29806, 29807, 29825) were excluded. Day-of-surgery expenditure was identified by summing all claims billed with an “immediate-procedure-related code” in a 3-day window surrounding the date of the procedure (Procedure Date ± 1 Day). The day-of-surgery expenditure was broken down into anesthesia services, nerve block, operating room facility, surgical team, patient out-of-pocket expenditure, and other expenditures. Median and interquartile range were calculated for each variable. The breakdown of day- of-surgery expenditure and patient out-of-pocket expenditure between the OH and ASC settings were compared using two-tailed Mann Whitney U Tests. Spearman Rank Order Correlation was done for all variables to test for association between expenditure and year to determine trends over time. All values were inflation adjusted to 2018 dollars using the consumer price index for medical care.Results:A total of 43,020 patients were identified; 24,850 in the OH setting and 18,170 in the ASC setting. This converts to an ASC utilization of 42 percent over the study period. In 2018, ASC utilization was at 45%. We found that RCR performed in the OH setting resulted in 55% greater day-of-surgery expenditure (p<0.001) than in the ASC setting. In the OH setting, operating room facility cost was 35% greater (p <0.001), anesthesia services was 7.4% greater (p<0.001), but nerve block was 2.4% lower (p<0.001) (Figure 1). Additionally, for RCRs performed in the OH setting, Spearman coefficients demonstrated that immediate procedure cost (rho = 0.209, p < 0.001) increased along with expenditure for anesthesia services (rho = 0.085, p < 0.001), nerve block (rho = 0.135, p < 0.001), and operating room facility cost (rho = 0.108, p < 0.001) over our study period. For RCRs performed in the ASC setting, immediate procedure cost (rho = 0.309, p < 0.001) increased along with expenditure for anesthesia services (rho = 0.116, p < 0.001), nerve block (rho = 0.086, p < 0.001), and operating room facility cost (rho = 0.148, p < 0.001). Surgical team reimbursement was 6.3% greater in the ASC setting (p < 0.001), but decreased over time in both the ASC (rho = -0.069, p < 0.001) and OH (rho = -0.046, p < 0.001) settings. Lastly, there was no difference in patient out-of-pocket expenditure for RCRs performed in the OH setting vs. ASC setting (Table 1). However, patient out-of-pocket expenditure for RCRs is increasing in both settings (OH: rho = 0.147, p < 0.001; ASC: rho = 0.203, p < 0.001).Conclusions:RCR performed in an ASC setting results in significant cost savings for payers with a slight change in surgeon reimbursement and no change in patient-out-of-pocket expenditure. Most of the cost savings came from operating room facility expenditure. For the surgeon, surgical team reimbursements are higher in the ASC setting. However, the overall trend in surgical team reimbursement is downwards in both the ASC and OH settings whereas the cost per RCR to the healthcare system is increasing. Thus, surgeon reimbursement is becoming a smaller percentage of the immediate procedure cost and should not be further cut when policy makers evaluate strategies to decrease the economic burden of RCRs on the healthcare system, especially when the cost savings from performing a RCR far outweigh both the amount the surgeon is reimbursed as well as the difference in surgeon reimbursement between an ASC and OH. For a healthcare system, especially under a population health perspective, the incentive to perform RCRs at an ASC is significant. The cost savings come from almost every breakdown category.The cost savings achieved per RCR in an ASC vs. an OH equals about $4,000. With nearly 400,000 RCRs performed per year, the U.S. healthcare system could save a projected $1.6 billion per year on RCRs alone when the surgery is performed in an ASC. Thus, our study shows that there is a clear financial advantage to the healthcare system for RCRs being done at ASCs, although the patient does not realize these cost savings.

"Go to the People. Live Among Them." Reflections on Anesthetic and Surgical Care in Rural and Remote Regions.

A robust anesthesia workforce is essential to the provision of safe surgical, obstetrical, and critical care but information describing the physician anesthesia workforce and volume of clinical services delivered in Canada is limited. This study examines the Canadian physician anesthesia workforce, exploring trends in physician characteristics and activity levels over time. Practice patterns of specialist anesthesiologists and family physician anesthetists (FPAs) working in urban and rural communities were of particular interest. Physicians who provided anesthesia care between 1996 and 2018 were identified using health administrative data from the Canadian Institute of Health Information (CIHI). In addition, data from the Canadian Post-MD Education Registry (CAPER) were used to characterize physicians pursuing postgraduate anesthesia training (1996-2019). Descriptive analyses of physician demographics, training, location, specialty designations, and volume of clinical services were undertaken. Between 1996 and 2018, the anesthesia workforce grew 1.8-fold to 3681 physicians, including 536 FPAs. Over the same time, nerve block services increased 7-fold, and payments for other anesthesia services increased 5-fold. The average age of the anesthesiology workforce increased by 2.3 years and the annual retirement rate was 3%. The workforce has become more gender balanced but remains predominantly male (73% in 2018). The proportion of physicians who were trained internationally (about 30%; 38% in rural areas) remained stable (and higher than that in the overall physician workforce). FPAs provided most anesthesia care in rural Canada and their attrition rate was generally 2- to 3-fold higher than specialists. Physicians in the rural anesthesia workforce provided anesthesia services more intensively over time. Relatively few FPAs who left the anesthesia workforce entered full retirement and they instead contributed other medical services to their communities. This study provides foundational information regarding anesthesia workforce capacity over a 22-year period, including insights into demographics, locations of practice, and clinical volumes. The results do not quantify the gap between service capacity and need; however, they support the need for a national workforce strategy to achieve equitable access to sustainable anesthesia services in Canada, particularly for rural communities.

Background The world health report 2008 emphasizes putting people at the centre of service is not only about service delivery models from a short-term perspective, but rather about long-term commitment to health care. (1) Given the critical shortage of the health workforce, investments in training, retaining and sustaining them are necessary. Sub-Saharan Africa is a prime example of uneven distribution of health-care personnel. The subcontinent carries 24% of the global burden of disease in 11% of the world's population, but has as little as 3% of the world's health workers. (2) The concern for countries in sub-Saharan Africa and other nations was recognized by the World Health Assembly resolution WHA59.23 that urged for rapid scaling up of health workforce production. (3) Addressing the situation should take into account the four reforms (universal coverage, people-centred service delivery, leadership and public policies) towards refocusing health systems through primary health care. Importance of anaesthesia workforce The contribution of surgical conditions to the global burden of disease and the potential impact of the provision of basic surgical services at the first referral level facility is widely under appreciated. It is estimated that 11% of the world's disability-adjusted life years (or years lost from healthy lives) are from conditions that are very likely to require surgery. (2) Adequate surgical care as a primary care strategy can address and greatly alleviate this burden. (4) Increasing evidence is beginning to emerge that maternal and infant survival is proportionately correlated to the number of health workers providing obstetric care that includes anaesthesia. (5,6) The delivery of surgical (including obstetrics and trauma) care is highly dependent on the availability and retention of a trained anaesthesia healh workforce. The United Kingdom Confidential Enquiry for Perioperative Death in 1987 reported one death per 185 000 anaesthetic procedures; whereas in Zambia (University teaching hospital), it was one death per 1925. The avoidable anaesthesia-mortality rate in Malawi (central hospital) was one death per 504; in Nigeria (teaching hospital) for Caesarean sections, one death per 387 anaesthetic procedures; in Togo (teaching hospital), one death per 133; and in Zimbabwe (district hospital), one death per 482. (7) Many of these unnecessary deaths were a result of airway problems and hypovolaemia in healthy young patients. (7) Though the common perception is that anaesthesia services are only required at the level of secondary and tertiary health-care facilities, the availability of basic services at the first referral level facility can contribute significantly to a reduction in death and disability. At the district and sub-district level, health personnel are expected to provide a range of anaesthesia services (local, intravenous ketamine, spinal and general anaesthesia) for the management of pregnancy-related complications, unsafe abortion, injuries (road traffic accidents, domestic violence, burns, falls, rape), complications of female genital mutilation, congenital anomalies as well as other surgical conditions. To safely deliver anaesthesia in emergency and surgical procedures, investments for appropriate training are required. The role of anaesthesia extends beyond the operating room, and is necessary in postoperative monitoring, intensive care units, for co-existing medical conditions, as well as providing pain relief (particularly in children and women in labour). A workforce trained in basic anaesthetic techniques at the primary health care level can also resuscitate critically ill patients or those with severe trauma and stabilize their condition, before transfer to a more specialized facility. The anaesthesia services required at the first referral level facilities can mostly be delivered by trained nonphysician anaesthetists. Current situation Physician anaesthetists are scarce in many developing countries and not available at first referral level health facilities. …

Incidence of accidental intraoperative awareness and quality of perioperative anesthesia service: cross-sectional study

Tertiary pediatric medical centers disproportionately care for low-income, underserved children with significant dental needs. Long wait times for hospital operating room treatment increase tooth loss rather than restoration. Oral sedation has commonly been provided to avoid the long waits for operating room treatment. However, this can be challenging with young, anxious patients. High failure rates and repeat visits for oral sedation have resulted in continued waiting for definitive dental services in the operating room. The Division of Dentistry requested the Department of Anesthesiology to create a general anesthesia program in the dental clinic to increase the use of anesthesia services but align the cost of the anesthetic with the revenue stream. Our aim was to objectively measure the performance of a dental clinic anesthesia service by comparing the percentage of case completions, percentage of complete radiographs, and number of serious adverse events to clinic-based oral sedations. We were also interested in total number of cases completed. We retrospectively studied data regarding an in-office general anesthesia (IOGA) program for dentistry and compared it to oral sedations before and after instituting the IOGA program. Patients received either a general endotracheal anesthetic or nonintubated total intravenous general anesthesia. Successful case completion increased from 88.6% (oral sedation) to 99.5% (IOGA). One hundred percent of IOGA cases had complete radiographs, as opposed to 63.4% for oral sedation. This was an increase from 53.5% from the previous 2 years with oral sedation. Serious adverse event rate was 0% (0/508) for oral sedation and 0.2% (1/418) for IOGA. Comparing 2 years before and after IOGA revealed a decrease in oral sedations from 930 to 508, whereas IOGA increased from 0 to 418 cases. Anesthesia services in dental clinic increased complete dental care and complete radiographs, reduced failed sedations, and were performed safely.

Screening decreases colorectal cancer (CRC) mortality. The national press has scrutinized colonoscopy charges. Little systematic evidence exists on colorectal testing and payments among commercially insured persons. Our aim was to characterize outpatient colorectal testing utilization and payments among commercially insured US adults. We conducted an observational cohort study of outpatient colorectal test utilization rates, indications, and payments among 21 million 18-64-year-old employees and dependants with noncapitated group health insurance provided by 160 self-insured employers in the 2009 Truven MarketScan Databases. Colonoscopy was the predominant colorectal test. Among 50-64-year olds, 12% underwent colonoscopy in 1 year. Most fecal tests and colonoscopies were associated with screening/surveillance indications. Testing rates were higher in women, and increased with age. Mean payments for fecal occult blood and immunochemical tests were $5 and $21, respectively. Colonoscopy payments varied between and within sites of service. Mean payments for diagnostic colonoscopy in an office, outpatient hospital facility, and ambulatory surgical center were $586 (s.d. $259), $1,400 (s.d. $681), and $1,074 (s.d. $549), respectively. Anesthesia and pathology services accompanied 35 and 52% of colonoscopies, with mean payments of $494 (s.d. $354) and $272 (s.d. $284), respectively. Mean payments for the most prevalent colonoscopy codes were 1.4- to 1.9-fold the average Medicare payments. Most outpatient colorectal testing among commercially insured adults was associated with screening or surveillance. Payments varied widely across sites of service, and payments for anesthesia and pathology services contributed substantially to total payments. Cost-effectiveness analyses of CRC screening have relied on Medicare payments as proxies for costs, but cost-effectiveness may differ when analyzed from the perspectives of Medicare or commercial insurers.

Phytochemistry of the essential oil of Melissa officinalis L. growing wild in Morocco: Preventive approach against nosocomial infections