I am well aware of the colonoscopy rules. I struggle with them when patients who would not meet the standard are scheduled with us because they are employees of

I am well aware of the colonoscopy rules. I struggle with them when patients who would not meet the standard are scheduled with us because they are employees of the hospital and it will not pay for care outside the system. It is one of the many factors that goes into the hospital’s subsidy to my group. Most of these are too ill to be done in a non-hospital facility - though most do fine and go home, there are some we have to admit overnight for observation. It is almost universal that hospitals pay from their fees for part of the anesthesia services because the direct reimbursement we get is so low. You can get one at 45, no questions asked, or you can claim you had a bloody stool. As far as pain, that’s hard to measure. Procedures that are done under sedation or anesthesia in the US are done in other countries with little or nothing. I had all of my wisdom teeth extracted and all of my dental fillings done under local anesthesia only. It was fine. I don’t need gas, I don’t need sedatives.