Why Has Monitored Anesthesia Care Use During Endoscopy Increased in the VA System?

The use of propofol for endoscopy, commonly delivered by anesthesia specialists (i.e., monitored anesthesia care, or MAC) has been increasing dramatically across the United States for more than a decade. The increase seen in the private system is widely attributed to financial incentives and increased patient and physician satisfaction associated with propofol, which also increases risk for aspiration pneumonia, as documented in multiple population-based studies.

In a retrospective study, researchers examined trends in MAC within the U.S. Veterans Affairs (VA) medical system, where financial incentives for MAC are absent. Results were as follows:

• Among over 2 million upper endoscopies and colonoscopies performed between 2000 and 2013, MAC was…