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By Vivian Ho, Joseph S. Ross, Brahmajee K. Nallamothu and Harlan M. Krumholz

Abstract

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 ages 65 and older 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 1989-2002.

Results: Each year, the per capita number of hospitals performing CABG and PCI was higher in states without CON (3.7 per 100,000 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 percent fewer PCIs per 1,000 elderly (p=.01), equivalent to 322,526 fewer PCIs for 1989-2002. 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: CON restricts the number of cardiac facilities, but its effect on utilization rates may vary by procedure.

This is the author's version of a work that was accepted for publication in American Heart Journal.