Anesthesiologist-directed sedation for ambulatory endoscopic procedures has enjoyed an unparalleled and unbridle growth in recent years. Between 2003 and 2009, payments for anesthesiologist-directed sedation tripled from just under $400 million to 1.3 billion. This dramatic upsurge was driven not by increased cost but by increased utilization, which occurred almost exclusively in the commercial payor sector. […]