EXTRA EXPERTISE Dr. Woody (right) administers anesthesia while the gastroenterologist focuses on the endoscopy.

Who's administering anesthesia in your endo room? Are RNs pushing sedatives and anesthetics? Are your GI docs sedating with Versed and fentanyl? Or are dedicated anesthesia providers administering propofol? I've heard the arguments that it's safe and effective for a nurse or gastroenterologist to sedate GI patients. And yes, there is an anesthetic fee in an era when insurers are unwilling to reimburse monitored anesthesia care for procedures such as diagnostic endoscopy. But having provided more than 20,000 one-on-one physician GI anesthetics and supervised nurse anesthetists doing many more, I feel there's no more safer and efficient way to sedate GI patients than having a qualified anesthesia provider in the room. Let me count the reasons why.

GI doctors can perform a better exam. When the patient is comfortable and not bouncing all over the table, the GI doc can concentrate on the procedure instead of monitoring and administering medications to patients. The anesthetist monitors and hooks up the patients to monitors in the procedure room, holding room and recovery room, thus facilitating the quality and speed of the procedure. And because the anesthesia pro is 100% responsible for the anesthetics, the GI is not liable for anesthetic complications.

It's better for the patient. Before I joined my GI facility 7 years ago as medical director, GI docs routinely administered Versed and fentanyl to their patients. With these agents, patients would sometimes remain sedated for hours after the procedure, which not only stacked up the recovery room with groggy patients, but also got in the way of doctor-patient communication. Many patients wouldn't remember seeing the doctor the day of the procedure and didn't remember a thing they were told before or after surgery. Now that I administer ultra-short-acting propofol, patients recover much quicker and recall what the GI doc told them just before and just after the procedure. What's more, my patients have less nausea and vomiting.

Improved safety. Having an anesthesia provider at the facility before and after the GI doctor comes and goes adds a level of safety for the patient and facility. The anesthetist may handle medical problems throughout the day, take on medical director activities and handle day-to-day physician duties as well. The anesthetist can train and educate nurses and staff, provide extra expertise in starting IV lines — both peripherally and centrally if needed — and perform extra pre-operative patient evaluations. The anesthetist stays until the last patient leaves the facility.

Economic benefits. With an anesthetist on staff, both the center and the GI doctor can do more cases per hour. It lets the center that does the procedures at a huge discount to Medicare, Medicaid and insurance providers remain profitable, and means a bigger profit for the GI doctor doing more cases per hour while having his fees discounted. Having anesthesia service contracts with independent anesthetists will promote competition and bring the cost of anesthesia down as well. Those that provide good service and reasonable charges will replace those that charge too much. And with the recent OIG advisory opinion that looks to take referring doctors out of the kickback game (see "OIG to Surgeons: 'Hands Off Anesthesia Fees!'"), the free market will dictate price, making the anesthetic fee worth the service provided.