Certificate-of-Need State Laws and Total Knee Arthroplasty

Browne, James A.; Cancienne, Jourdan M.; Casp, Aaron; Novicoff, Wendy M.; Werner, Brian C.

doi:10.1016/j.arth.2018.01.063

Cited by 13 publications

(10 citation statements)

References 23 publications

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“…Most prior studies were based on data that are 2 decades old, have focused on cardiac procedures, and examined limited outcomes such as mortality and hospital procedural volume. [2][3][4]10,11,[36][37][38] Less is known regarding the effect of certificate of need on clinical outcomes (eg, surgical site infection, readmission) or the concentration of cases within states. One study, evaluating No differences remained significant at the P < .005 level or after adjusting for 11 tests using the Bonferroni method (lower P < .05 to P < .005).…”

Section: Discussionmentioning

confidence: 99%

“…The current literature regarding the clinical implications of certificate of need remains limited. Most prior studies were based on data that are 2 decades old, have focused on cardiac procedures, and examined limited outcomes such as mortality and hospital procedural volume . Less is known regarding the effect of certificate of need on clinical outcomes (eg, surgical site infection, readmission) or the concentration of cases within states.…”

Section: Discussionmentioning

confidence: 99%

“…Most prior studies were based on data that are 2 decades old, have focused on cardiac procedures, and examined limited outcomes such as mortality and hospital procedural volume. [2][3][4]10,11,[36][37][38] Less is known regarding the effect of certificate of need on clinical outcomes (eg, surgical site infection, readmission) or the concentration of cases within states. One study, evaluating all-cause mortality within the general US population from 1992 through 2011, found no significant difference by state status, with point estimates suggesting that states with certificate of need regulation had higher all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

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Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries

Yuce

Chung

Barnard

et al. 2020

JAMA

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IMPORTANCE Certificate of need laws provide state-level regulation of health system expenditure. These laws are intended to limit spending and control hospital expansion in order to prevent excess capacity and improve quality of care. Several states have recently introduced legislation to modify or repeal these regulations, as encouraged by executive order 13813, issued in October 2017 by the Trump administration.OBJECTIVE To evaluate the difference in markers of hospital activity and quality by state certificate of need status. These markers include hospital procedural volume, hospital market share, county-level procedures per 10 000 persons, and patient-level postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study involving Medicare beneficiaries aged 65 years or older who underwent 1 of the following 10 procedures from January 1, 2016, through November 30, 2018: total knee or hip arthroplasty, coronary artery bypass grafting, colectomy, ventral hernia repair, lower extremity vascular bypass, lung resection, pancreatic resection, cystectomy, or esophagectomy.EXPOSURES State certificate of need regulation status as determined by data from the National Conference of State Legislatures. MAIN OUTCOMES AND MEASURESOutcomes of interest included hospital procedural volume; hospital market share (range, 0-1; reflecting 0%-100% of market share); county-level procedures per 10 000 persons; and patient-level postoperative 30-day mortality, surgical site infection, and readmission.RESULTS A total of 1 545 952 patients (58.0% women; median age 72 years; interquartile range, 68-77 years) at 3631 hospitals underwent 1 of the 10 operations. Of these patients, 468 236 (30.3%) underwent procedures in the 15 states without certificate of need regulations and 1 077 716 (69.7%) in the 35 states with certificate of need regulations. The total number of procedures ranged between 729 855 total knee arthroplasties (47.21%) and 4558 esophagectomies (0.29%). When comparing states without vs with certificate of need regulations, there were no significant differences in overall hospital procedural volume (median hospital procedure volume, 241 vs 272 operations per hospital for 3 years; absolute difference, 31; 95% CI, −27.64 to 89.64; P = .30). There were no statistically significant differences between states without vs with certificate of need regulations for median hospital market share (median, 28% vs 52%; absolute difference, 24%; 95% CI, −5% to 55%; P = .11); procedure rates per 10 000 Medicare-eligible population (median, 239.23 vs 205.41 operations per Medicare-eligible population in 3 years; absolute difference, 33.82; 95% CI, −84.08 to 16.43; P = .19); or 30-day mortality (1.17% vs 1.33%, odds ratio [OR], 1.04; 95% CI, 0.93 to 1.16; P = .52), surgical site infection (1.24% vs 1.25%; OR, 0.93; 95% CI, 0.83 to 1.04; P = .21), or readmission rate (9.69% vs 8.40%; OR, 0.80; 95% CI, 0.57 to 1.12; P = .19).CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries who underwent a range of surgical procedures from 2...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Most prior studies were based on data that are 2 decades old, have focused on cardiac procedures, and examined limited outcomes such as mortality and hospital procedural volume. [2][3][4]10,11,[36][37][38] Less is known regarding the effect of certificate of need on clinical outcomes (eg, surgical site infection, readmission) or the concentration of cases within states. One study, evaluating all-cause mortality within the general US population from 1992 through 2011, found no significant difference by state status, with point estimates suggesting that states with certificate of need regulation had higher all-cause mortality.…”

Section: Discussionmentioning

confidence: 99%

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Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries

Yuce

Chung

Barnard

et al. 2020

JAMA

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“…Two studies of 1990s data have reported that higher CABG mortality rates in non-CON states (Vaughan-Sarrazin et al 2002;Rosenthal and Sarrazin 2001). Related studies include (Browne et al 2018;Casp et al 2019;Ettner et al 2020;Herb et al 2021;Ohsfeldt and Li 2018;Rahman et al 2016;Schultz et al 2021;Stratmann and Wille 2016;Wu et al 2019;Yuce et al 2020;Ziino et al 2021).…”

Section: Introductionmentioning

confidence: 99%

The Effects of Certificate-of-Need Laws on the Quality of Hospital Medical Services

Stratmann

2022

JRFM

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Certificate-of-need (CON) laws restrict entry into health services by requiring healthcare providers to seek approval from state healthcare regulators before making any major capital expenditures. An important question is whether CON laws influence the quality of medical services in CON law states. For instance, if CON laws actually lower the quality of medical services, they fail to achieve their intended effect. This paper tests the hypothesis that hospitals in states with CON laws provide lower-quality services than hospitals in states without CON laws. Our overall results suggest that CON regulations lead to lower-quality care for some quality measures and have little or no effect on other quality standards. The results remain consistent across several robustness tests.

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“…Use of CON legislation varies by state; in CON states, a state agency is required to authorize healthcare network or hospital expansions. 3…”

mentioning

confidence: 99%

Utilization and Reimbursement Trends Based on Certificate of Need in Single-level Cervical Discectomy

Ziino

Bala

Cheng

2020

J Am Acad Orthop Surg

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Objective: To compare utilization and reimbursement for cervical discectomy in certificate of need (CON) and non-CON states. Summary of Background Data: Cervical discectomy is a commonly performed procedure, but little is known about utilization and reimbursement patterns in the CON setting. Introduction: Cervical discectomy is increasingly used and remains effective. Increasing healthcare costs have led to decreased reimbursement and a push toward outpatient procedures. CON programs were established to ensure that expansion of medical facilities were within acceptable use; however, the literature on their impact in spine surgery is limited. The purpose of this study was to examine the impact of CON status on both reimbursement and utilization in cervical decompression in both inpatient and outpatient settings. Methods: We analyzed a private payer and Medicare database from 2007 to 2015. All single-level cervical discectomies were selected then split into CON and non-CON states. Each group was then further split into inpatient and outpatient. Utilization and reimbursement were analyzed using the compound annual growth rate (CAGR), with reimbursement adjusted by the US Bureau of Labor Statistics Consumer Price Index. Results: We identified 1,580 single level cervical decompressions in our study period: 888 were done in the inpatient setting, whereas 692 were done in the outpatient setting. Adjusted reimbursement only increased in the non-CON outpatient setting, with a CAGR of 2.0%. All other settings had decreased reimbursement. Utilization increased across all four settings, with the highest growth seen in the CON outpatient setting, with a CAGR of 12.7%. The highest average reimbursement was in the non-CON outpatient setting at $4,237. Discussion: Cervical discectomy is seeing increased utilization most rapidly in the outpatient setting, although reimbursement is declining with the exception of procedures done in the non-CON outpatient setting. Surgeons should be aware of these trends in the changing healthcare economic climate. Study Design: A retrospective database review

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Certificate-of-Need State Laws and Total Knee Arthroplasty

Cited by 13 publications

References 23 publications

Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries

Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries

The Effects of Certificate-of-Need Laws on the Quality of Hospital Medical Services

Utilization and Reimbursement Trends Based on Certificate of Need in Single-level Cervical Discectomy

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