Certificate-of-Need State Laws and Total Hip Arthroplasty

Casp, Aaron; Durig, Nicole E.; Cancienne, Jourdan M.; Werner, Brian C.; Browne, James A.

doi:10.1016/j.arth.2018.11.038

Cited by 8 publications

(7 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, the true effect of certificate of need regulation, or its repeal, may vary based on each states’ specific politics and administration of the law. Although the current data are unable to account for these particular differences between states, the method of designating states by certificate of need status used in this work mirrors that of previous research, and the sensitivity analysis seeking to adjust for variation in state administration of certificate of need laws was unrevealing . Fifth, certificate of need laws may regulate multiple aspects of care not limited to the 10 procedures included in this study.…”

Section: Discussionmentioning

confidence: 93%

“…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%

See 3 more Smart Citations

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

Yuce

Chung

Barnard

et al. 2020

JAMA

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

confidence: 93%

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%

See 2 more Smart Citations

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

Yuce

Chung

Barnard

et al. 2020

JAMA

View full text Add to dashboard Cite

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Certificate‐of‐Need laws in healthcare: A comprehensive review of the literature

Mitchell

2024

Southern Economic Journal

View full text Add to dashboard Cite

Certificate‐of‐Need (CON) laws limit the supply of healthcare services in about two‐thirds of U.S. states. The regulations require those who wish to open or expand their facilities to first prove that their services are needed. Once encouraged by the federal government, Congress eliminated the inducement in the 1980s and since then several states have either pared their CON programs back or eliminated them altogether. To date, there have been 128 academic assessments of CON laws and together these papers contain over 450 tests. In this paper, I review this literature, organizing the results around the most common rationales for CON laws. The accumulated evidence is overwhelming that CON laws do not achieve their purpose. Instead, the balance of evidence suggests that these regulations increase spending, reduce access to care, undermine quality, and fail to ensure care for underserved populations.

show abstract

Certificate-of-Need State Laws and Total Hip Arthroplasty

Cited by 8 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

Certificate‐of‐Need laws in healthcare: A comprehensive review of the literature

Contact Info

Product

Resources

About