Cardiac Certificate of Need regulations and the availability and use of revascularization services - 15/08/11
, Joseph S. Ross, MD, MHS c, d, Brahmajee K. Nallamothu, MD, MPH e, Harlan M. Krumholz, MD, SM f, g, hThe Robert Wood Johnson Foundation had no role in the design or conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review, or approval of the manuscript.
Résumé |
Background |
Many states enforce Certificate of Need (CON) regulations for cardiac procedures, but little is known about how CON affects utilization. We assessed the association between cardiac CON regulations, availability of revascularization facilities, and revascularization rates.
Methods |
We determined when state cardiac CON regulations were active and obtained data for Medicare beneficiaries ≥65 years old who received coronary artery bypass graft surgery (CABG) or a percutaneous coronary intervention (PCI) between 1989 and 2002. We compared the number of hospitals performing revascularization and patient utilization in states with and without CON regulations, and in states which discontinued CON regulations during 1989 to 2002.
Results |
Each year, the per capita number of hospitals performing CABG and PCI was higher in states without CON (3.7 per 100000 elderly for CABG, 4.5 for PCI in 2002), compared with CON states (2.5 for CABG, 3.0 for PCI in 2002). Multivariate regressions that adjusted for market and population characteristics found no difference in CABG utilization rates between states with and without CON (P = .7). However, CON was associated with 19.2% fewer PCIs per 1000 elderly (P = .01), equivalent to 322526 fewer PCIs for 1989 to 2002. Among most states that discontinued CON, the number of hospitals performing PCI rose in the mid 1990s, but there were no consistent trends in the number of hospitals performing CABG or in PCIs or CABGs per capita.
Conclusions |
Certificate of Need restricts the number of cardiac facilities, but its effect on utilization rates may vary by procedure.
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| Dr Ross was a scholar in the Robert Wood Johnson Clinical Scholars Program at Yale University sponsored by the Robert Wood Johnson Foundation at times during his involvement in the project. |
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| Support was given from a grant awarded to Dr Ho by the National Heart, Lung, and Blood Institute (R01 HL073825-01A1). |
Vol 154 - N° 4
P. 767-775 - octobre 2007 Retour au numéro
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